Case-case-control study of risk factors for nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus in a medical-surgical intensive care unit

Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus (MRSA) often precedes the development of nosocomial infections. In order to identify risk factors for MRSA colonization, we conducted a case-case-control study, enrolling 122 patients admitted to a medical-surgical intensive care unit (ICU). All patients had been screened for nasopharyngeal colonization with S. aureus upon admission and weekly thereafter. Two case-control studies were performed, using as cases patients who acquired colonization with MRSA and methicillin-susceptible S. aureus (MSSA), respectively. For both studies, patients in whom colonization was not detected during ICU stay were selected as control subjects. Several potential risk factors were assessed in univariate and multivariable (logistic regression) analysis. MRSA and MSSA were recovered from nasopharyngeal samples from 27 and 10 patients, respectively. Independent risk factors for MRSA colonization were: length-of-stay in the ICU (Odds Ratio [OR]=1.12, 95%Confidence Interval[CI]=1.06-1.19, p<0.001) and use of ciprofloxacin (OR=5.05, 95%CI=1.38-21.90, p=0.015). The use of levofloxacin had a protective effect (OR=0.08, 95%CI=0.01-0.55, p=0.01). Colonization with MSSA was positively associated with central nervous system disease (OR=7.45, 95%CI=1.33-41.74, p=0.02) and negatively associated with age (OR=0.94, 95%CI=0.90-0.99, p=0.01). In conclusion, our study suggests a role for both cross-transmission and selective pressure of antimicrobials in the spread of MRSA.

Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Cross-sectional Study

OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.

Knowledge and practice of women regarding cervical cancer in a primary health care unit

Objectives: evaluating the level of information about the examination of uterine cervical cancer and its association with sociodemographic variables in women of a health care unit in the city of Bauru, São Paulo, Brazil. Methods: we conducted a cross-sectional descriptive study with 370 women aged 25 to 59, through structured interviews in their own homes; we used descriptive statistics and the χ2 test. Results: 40.5% of the women had not undergone the Papanicolaou test at the recommended frequency; 58.2% incorrectly defined the test, and 69.5% did not know about the risk factors for the development of cervical cancer; the knowledge about the test showed statistically significant association with schooling and family income of the studied population. Conclusions: women present deficiencies on the proper practice of the Papanicolaou test, on knowledge about the test, risk factors and prevention methods. Therefore, it is necessary to develop primary health actions for the most vulnerable population.

Reliable assessment of forearm photoageing by high-frequency ultrasound: a cross-sectional study

High-frequency ultrasound is a non-invasive tool used in skin ageing research to assess dermis thickness and echogenicity. This study evaluated the reliability of a range of high-frequency ultrasound parameters and tested their correlation with age and a validated clinical scale for the assessment of forearm skin photoageing; the difference between two body sites according to environmental exposition patterns was also investigated. Twenty-three volunteers aged 28-82 years were divided into three groups according to forearm photoageing degree. A 20 MHz ultrasound unit was used to obtain cross-sectional images of the skin by two trained investigators on two different sites: the dorsal forearm (chronically photoexposed skin) and the proximal medial arm (non-photoexposed skin). Several echogenicity parameters were studied for each skin compartment: total dermis, upper dermis and lower dermis, and the ratio between upper and lower dermis. The intraclass correlation coefficient (for complete agreement) between investigators was higher for upper and total dermis echogenicity measures compared with the lower dermis. At the non-photoexposed site, the upper and lower dermis parameter ratio was better correlated with age. At the photoexposed area, total dermis parameters demonstrated higher correlations with clinical score. The authors discuss the choice of parameters for forearm photoageing assessment using high-frequency ultrasound.

Experience of family members as a result of children's hospitalization at the Intensive Care Unit

Objective. To describe the experience of family members as a result of children’s hospitalization at the Intensive Care Unit (ICU). Methodology. Descriptive and cross-sectional study. A structured interview was held with 20 relatives of patients hospitalized at two clinics of the Botucatu Medical School at Universidade Estadual Paulista “Júlio de Mesquita Filho”. Information was collected between July and September 2010. Results. The main characteristics of the participating relatives were: 80% mothers of the children; 70% low education level and 70% married. Sixty percent of the children were hospitalized at the ICU for the first time. Eighty percent of the interviewees believe that the children’s behavior changes inside the unit and 85% consider that visiting hours are sufficient. The predominant negative feelings are fear (50%) and insecurity (20%), while the predominant positive feelings are hope (50%) and the expectation of discharge (25%). The professional who most supported the relatives was the nurse (35%). Conclusion. The family members’ experience as a result of the children’s hospitalization at the ICU involves positive and negative aspects, which also affect the child’s behavior at the unit.

Bacteria on the hands of school-age children at a Pediatric Hospitalization Unit

Objective. To estimate the prevalence of bacteria isolated in samples from the hands of school-age children at a hospitalization unit. Methodology. In 2009, strains were cultured from the hands of 90 school-age children at the pediatric hospitalization unit of Hospital Estadual Bauru (São Paulo, Brazil). After culture of the samples, the isolated bacteria were identified. Results. In 98% of the samples taken from the children, bacteria were isolated. Coagulase-negative Staphilococcus was isolated in 64% of the samples, followed by Staphilococcus aureus (5%) and Pseudomonas aeruginosa (1%). Conclusion. In most of the samples from the children’s hands, bacteria were isolated. Therefore, educative actions about hygiene habits in- and outside the hospital environment should be reinforced, aimed at children and their companions.

Effect of enzymatic treatment on the cross-flow microfiltration of acai pulp: Analysis of the fouling and recovery of phytochemicals

This study aimed to investigate the effects of pectinase enzyme treatment of acai pulp on cross-flow microfiltration (CFMF) performance and on phytochemical and functional characteristics of their compounds. Analyses of fouling mechanisms were carried out through resistance in series and blocking in law models. The enzymatic treatment was conducted using Ultrazym(R) AFPL (Novozymes A/S) at 500 mg kg(-1) of acai pulp for 30 min at 35 degrees C. Before microfiltrations, untreated and enzyme-treated acai pulps were previously diluted in distilled water (1:3; w/v). CFMFs were conducted using commercial alpha-alumina (alpha-Al2O3) ceramic membranes (Andritz AG, Austria) of 0.2 mu m and 0.8 mu m pore sizes, and 0.0047 m(2) of filtration area. The microfiltration unit was operated in batch mode for 120 min at 25 degrees C and the fluid-dynamic conditions were transmembrane pressure of Delta P = 100 kPa and cross-flow velocity of 3 m s(-1) in turbulent flow. The highest values of permeate flux and accumulated permeate volume were obtained using enzyme-treated pulp and 0.2 mu m pore size membranes with steady flux values exceeding 100 L h(-1) m(-2). For the 0.8 mu m pore size membrane, the estimated total resistance after the microfiltration of enzyme-treated acai pulp was 21% lower than the untreated pulp, and for the 0.2 mu m pore size membrane, it was 18%. Cake filtration was the dominant mechanism in the early stages of most of the CFMF processes. After approximately 20 min, however, intermediate pore blocking and complete pore blocking contributed to the overall fouling mechanisms. The reduction of the antioxidant capacity of the permeates obtained after microfiltration of the enzyme-treated pulp was higher (p < 0.01) than that obtained using untreated pulp. For total polyphenols, on the contrary, the permeates obtained after microfiltration of the enzyme-treated pulp showed a lower mean reduction (p < 0.01) than those from the untreated pulp. The results show that the enzymatic treatment had a positive effect on the CFMF process of acai pulp. (C) 2012 Elsevier Ltd. All rights reserved.

Loss of interest, depressed mood and impact on the quality of life: Cross-sectional survey

Abstract Background Depressive symptoms and chronic disease have adverse effects on patients' health-related quality of life (H-RQOL). However, little is known about this effect on H-RQOL when only the two core depressive symptoms - loss of interest and depressed mood - are considered. The objective of this study is to investigate H-RQOL in the presence of loss of interest and depressed mood at a general medical outpatient unit. Methods We evaluated 553 patients at their first attendance at a general medical outpatient unit of a teaching hospital. H-RQOL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Depressed mood and loss of interest were assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD)-Patient Questionnaire. A physician performed the diagnosis of chronic diseases by clinical judgment and classified them in 13 possible pre-defined categories. We used multiple linear regression to investigate associations between each domain of H-RQOL and our two core depression symptoms. The presence of chronic diseases and demographic variables were included in the models as covariates. Results Among the 553 patients, 70.5% were women with a mean age of 41.0 years (range 18-85, SD ± 15.4). Loss of interest was reported by 54.6%, and depressed mood by 59.7% of the patients. At least one chronic disease was diagnosed in 59.5% of patients; cardiovascular disease was the most prevalent, affecting 20.6% of our patients. Loss of interest and depressed mood was significantly associated with decreased scores in all domains of H-RQOL after adjustment for possible confounders. The presence of any chronic disease was associated with a decrease in the domain of vitality. The analysis of each individual chronic disease category revealed that no category was associated with a decrease in more than one domain of H-RQOL. Conclusion Loss of interest and depressed mood were associated with significant decreases in H-RQOL. We recommend these simple tests for screening in general practice.

Assessment of cardiovascular risk of patients with arterial hypertension of a public health unit

OBJECTIVE: To assess the cardiovascular risk, using the Framingham risk score, in a sample of hypertensive individuals coming from a public primary care unit. METHODS: The caseload comprised hypertensive individuals according to criteria established by the JNC VII, 2003, of 2003, among 1601 patients followed up in 1999, at the Cardiology and Arterial Hypertension Outpatients Clinic of the Teaching Primary Care Unit, at the Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. The patients were selected by draw, aged over 20 years, both genders, excluding pregnant women. It was a descriptive, cross-sectional, observational study. The Framingham risk score was used to stratify cardiovascular risk of developing coronary artery disease (death or non-fatal acute myocardial infarction). RESULTS: Age range of 27-79 years ( = 63.2 ± 9.58). Out of 382 individuals studied, 270 (70.7%) were female and 139 (36.4%) were characterized as high cardiovascular risk for presenting diabetes mellitus, atherosclerosis documented by event or procedure. Out of 243 stratified patients, 127 (52.3%) had HDL-C < 50 mg/dL; 210 (86.4%) had systolic blood pressure > 120 mmHg; 46 (18.9%) were smokers; 33 (13.6%) had a high cardiovascular risk. Those added to 139 enrolled directly as high cardiovascular risk, totaled up 172 (45%); 77 (20.2%) of medium cardiovascular risk and 133 (34.8%) of low risk. The highest percentage of high cardiovascular risk individuals was aged over 70 years; those of medium risk were aged over 60 years; and the low risk patients were aged 50 to 69 years. CONCLUSION: The significant number of high and medium cardiovascular risk individuals indicates the need to closely follow them up.

Analisi di cross-correlazione di profili recettori di cellule semplici in V1

In questa tesi viene presentata un’analisi dettagliata sulla struttura di profili recettori di neuroni coinvolti nell’elaborazione visiva, con particolare attenzione per le cellule appartenenti alla corteccia visiva primaria (V1). Dopo aver illustrato brevemente il percorso effettuato dall’informazione visiva, costituito da retina, nucleo genicolato laterale e V1, vengono descritte la struttura e le principali caratteristiche di profili recettori dei neuroni appartenenti ad ognuno di questi livelli di elaborazione. Per modellare i profili recettori di cellule corticali in V1 si è deciso di utilizzare filtri bidimensionali realizzati mediante funzioni di Gabor nel dominio spaziale. Questo modello ha, infatti, il grande vantaggio di possedere alcune tra le maggiori proprietà dei profili recettori di neuroni appartenenti a V1: struttura del profilo recettore nello spazio (x,y), selettività in orientazione e in frequenza spaziale, indipendenza dalla fase dello stimolo. Viene successivamente presentato il concetto di campo di associazione visivo, mediante il quale sono determinate le caratteristiche principali (posizione spaziale ed orientazione) che diversi oggetti devono possedere per essere percepiti non come unità singole, ma come un unico elemento. I campi di associazione possono essere modellati mediante l’utilizzo del sistema di equazioni differenziali proposto da Citti-Sarti, le cui soluzioni sono curve integrali adatte a ricostruire la struttura dei campi di associazione, come proposti da Field, Hayes ed Hess. Diverse ipotesi sono state presentate su come cellule appartenenti a V1 siano in grado di realizzare simili campi di associazione, ed in particolare, da dove queste possano prendere le informazioni necessarie per farlo. Una di queste è quella sostenuta dai dati di Bosking et al., secondo i quali le connessioni intracorticali più fitte sono quelle tra neuroni non adiacenti tra loro, i cui profili recettori sono co-orientati (con la stessa orientazione preferenziale) e co-assiali (disposti lungo un asse del campo visivo che corrisponde all’orientazione preferenziale). L’analisi effettuata in questa tesi ha come obbiettivo proprio quello di ottenere informazioni utili su come cellule corticali siano legate alla fenomenologia dei campi di associazione. Come già detto, un filtro di Gabor bidimensionale può essere considerato un buon modello per profili recettori di questo tipo di cellule e quindi è possibile definirlo in maniera astratta come l’unità fondamentale nel processo di elaborazione visiva. Per questo motivo viene effettuata un’analisi di cross-correlazione tra un filtro di Gabor con una determinata orientazione e una famiglia di filtri di Gabor aventi n orientazioni. I risultati ottenuti sono stati trattati utilizzando la tecnica di soppressione dei non massimi, in modo da estrarre per ogni punto dell’immagine l’orientazione per la quale si ottiene la risposta massima. Successivamente, dai dati è stato possibile calcolare delle curve integrali simili a quelle ottenute dal modello differenziale proposto da Citti-Sarti. I risultati ottenuti da questa analisi si sono rivelati utili per comprendere più nel dettaglio i processi di elaborazione dei neuroni corticali, ed in particolare, per capire in che modo le informazioni necessarie per la realizzazione di strutture complesse ed articolate come quelle dei campi di associazione, siano già contenute intrinsecamente all’interno di ogni cellula corticale, unità fondamentale dell’elaborazione visiva.

Measurement of the inclusive jet cross section in proton-proton collisions at root out s = 7 TeV with the ATLAS detector

The dominant process in hard proton-proton collisions is the production of hadronic jets.rnThese sprays of particles are produced by colored partons, which are struck out of their confinement within the proton.rnPrevious measurements of inclusive jet cross sections have provided valuable information for the determination of parton density functions and allow for stringent tests of perturbative QCD at the highest accessible energies.rnrnThis thesis will present a measurement of inclusive jet cross sections in proton-proton collisions using the ATLAS detector at the LHC at a center-of-mass energy of 7 TeV.rnJets are identified using the anti-kt algorithm and jet radii of R=0.6 and R=0.4.rnThey are calibrated using a dedicated pT and eta dependent jet calibration scheme.rnThe cross sections are measured for 40 GeV < pT <= 1 TeV and |y| < 2.8 in four bins of absolute rapidity, using data recorded in 2010 corresponding to an integrated luminosity of 3 pb^-1.rnThe data is fully corrected for detector effects and compared to theoretical predictions calculated at next-to-leading order including non-perturbative effects.rnThe theoretical predictions are found to agree with data within the experimental and theoretic uncertainties.rnrnThe ratio of cross sections for R=0.4 and R=0.6 is measured, exploiting the significant correlations of the systematic uncertainties, and is compared to recently developed theoretical predictions.rnThe underlying event can be characterized by the amount of transverse momentum per unit rapidity and azimuth, called rhoue.rnUsing analytical approaches to the calculation of non-perturbative corrections to jets, rhoue at the LHC is estimated using the ratio measurement.rnA feasibility study of a combined measurement of rhoue and the average strong coupling in the non-perturbative regime alpha_0 is presented and proposals for future jet measurements at the LHC are made.

Probing quantum chromodynamics with the ATLAS detector : charged-particle event shape variables and the dijet cross-section

Die Quantenchromodynamik ist die zugrundeliegende Theorie der starken Wechselwirkung und kann in zwei Bereiche aufgeteilt werden. Harte Streuprozesse, wie zum Beispiel die Zwei-Jet-Produktion bei hohen invarianten Massen, können störungstheoretisch behandelt und berechnet werden. Bei Streuprozessen mit niedrigen Impulsüberträgen hingegen ist die Störungstheorie nicht mehr anwendbar und phänemenologische Modelle werden für Vorhersagen benutzt. Das ATLAS Experiment am Large Hadron Collider am CERN ermöglicht es, QCD Prozesse bei hohen sowie niedrigen Impulsüberträgen zu untersuchen. In dieser Arbeit werden zwei Analysen vorgestellt, die jeweils ihren Schwerpunkt auf einen der beiden Regime der QCD legen:rnDie Messung von Ereignisformvariablen bei inelastischen Proton--Proton Ereignissen bei einer Schwerpunktsenergie von $sqrt{s} = unit{7}{TeV}$ misst den transversalen Energiefluss in hadronischen Ereignissen. rnDie Messung des zweifachdifferentiellen Zwei-Jet-Wirkungsquerschnittes als Funktion der invarianten Masse sowie der Rapiditätsdifferenz der beiden Jets mit den höchsten Transversalimpulsen kann genutzt werden um Theorievorhersagen zu überprüfen. Proton--Proton Kollisionen bei $sqrt{s} = unit{8}{TeV}$, welche während der Datennahme im Jahr 2012 aufgezeichnet wurden, entsprechend einer integrierten Luminosität von $unit{20.3}{fb^{-1}}$, wurden analysiert.rn

Child Aggression in a Post-Communist Country: Race and Gender Aspects in a Cross-Cultural Comparison

Gypsies represent approximately 2.5% of the Czech population, but are considerably over-represented among the unemployed, prisoners, schooldropouts, neglected children, etc. Together with racist attitudes on the part of the majority, this causes strong inter-ethnic tension and obviouseconomic, moral and political problems. This research studied the way in which this situation is reflected in peer relations between Gypsy andmajority children in schools. Six samples of children (totalling 2974 children aged 7-15, of whom 15% were Gypsies) were studied through peernomination, teacher assessment and self-reporting. Gypsy/non-Gypsy and gender dichotomies were correlated with measures of aggression,victimisation and acceptance/rejection. The results showed that Gypsy children, both boys and girls, were more likely to nominate their Gypsy peers as aggressors than they nominatemajority children, implying that they tend to direct their rejection toward their own kind. The number of Gypsy children in a class was also animportant factor with Gypsies being more likely to be accepted and less likely to appear aggressive when they were only one or two in a class, thanin a class where there was a greater number of Gypsy pupils. When whole classes were taken as the unit of analysis, Gypsy children were seen asmore likely to behave aggressively in class by their Gypsy and non-Gypsy counterparts as well as by their teachers. At the same time they aremuch less likely to become victims of aggression than are non-Gypsy children, both boys and girls. Mr. Rican also found that the acceptance/rejection patterns of Gypsy children betray their unsatisfactory socialisation. Among their peers, Gypsyor non-Gypsy, they tend to prefer aggressors or children who teachers describe as showing little discipline or effort to succeed at school. Partialcorrelation to assess the influence of seniority on aggressiveness provided a warning that the recent lengthening of compulsory school attendance islikely to bring an increase in aggressiveness. He believes that Gypsy ethnic identity has lost many of its important positive aspects, making itsnegative aspects more prominent and more dangerous. He does however find some possible ways for teachers to reinforce the positive aspects ofGypsy children's identities in order to support their socialisation at schools.

Comparative dose measurements by spiral tomography for preimplant diagnosis: the Scanora machine versus the Cranex Tome radiography unit

Objective. The purpose of this study was to determine the dose profile of the Cranex Tome radiography unit and compare it with that of the Scanora machine.Study design. The radiation dose delivered by the Cranex Tome radiography unit during the cross-sectional mode was determined. Single tooth gaps in regions 3 (16) and 30 (46) were simulated. Dosimetry was carried out with 2 phantoms, a head and neck phantom and a full-body phantom loaded with 142 thermoluminescent dosimeters (TLD) and 280 TLD, respectively; all locations corresponded to radiosensitive organs or tissues. The recorded local mean organ doses were compared with those measured in another study evaluating the Scanora machine.Results. Generally, dose values from the Cranex Tome radiography unit reached only 50% to 60% of the values measured for the Scanora machine. The effective dose was calculated as 0.061 mSv and 0.04 mSv for tooth regions 3 (16) and 30 (46), respectively. Corresponding values for the Scanora machine were 0.117 mSv and 0.084 mSv.Conclusion. Cross-sectional imaging in the molar region of the upper and the lower jaw can be performed with the Cranex Tome unit, which delivers only approximately half of the dose that the Scanora machine delivers.

Development of a standard sign-out procedure for clinicians in a pediatric intensive care unit

Background: Poor communication among health care providers is cited as the most common cause of sentinel events involving patients. Sign-out of patient data at the change of clinician shifts is a component of communication that is especially vulnerable to errors. Sign-outs are particularly extensive and complex in intensive care units (ICUs). There is a paucity of validated tools to assess ICU sign-outs. ^ Objective: To design a valid and reliable survey tool to assess the perceptions of Pediatric ICU (PICU) clinicians about sign-out. ^ Design: Cross-sectional, web-based survey ^ Setting: Academic hospital, 31-bed PICU ^ Subjects: Attending faculty, fellows, nurse practitioners and physician assistants. ^ Interventions: A survey was designed with input from a focus group and administered to PICU clinicians. Test-retest reliability, internal consistency and validity of the survey tool were assessed. ^ Measurements and Main Results: Forty-eight PICU clinicians agreed to participate. We had 42(88%) and 40(83%) responses in the test and retest phases. The mean scores for the ten survey items ranged from 2.79 to 3.67 on a five point Likert scale with no significant test-retest difference and a Pearson correlation between pre and post answers of 0.65. The survey item scores showed internal consistency with a Cronbach's Alpha of 0.85. Exploratory factor analysis revealed three constructs: efficacy of sign-out process, recipient satisfaction and content applicability. Seventy eight % clinicians affirmed the need for improvement of the sign-out process and 83% confirmed the need for face- to-face verbal sign-out. A system-based sign-out format was favored by fellows and advanced level practitioners while attendings preferred a problem-based format (p=0.003). ^ Conclusions: We developed a valid and reliable survey to assess clinician perceptions about the ICU sign-out process. These results can be used to design a verbal template to improve and standardize the sign-out process.^