Sunlight inactivation of Campylobacter jejuni and Salmonella enterica, compared with Escherichia coli, in seawater and river water

The inactivation of Campylobacter jejuni and Salmonella enterica, compared with Escherichia coli, was determined in 100 l chambers of seawater and river water located at an outdoor site. The chambers (paired with dark controls) were seeded with waste stabilization pond effluent and laboratory-cultured pathogens, and exposed to sunlight in summer and winter experiments. All sunlight inactivation (k(S)) rates, as a function of cumulative global solar radiation (insolation), were far higher than the corresponding dark (k(D)) rates, with a ranking (and average k(S) rates for seawater and river water, respectively) of: C. jejuni (3.23; 2.34)>S. enterica (0.51; 0.37)>E. coli (0.34; 0.26). All the T(90) (time to 90% inactivation) values were higher in winter than in summer, but there was far greater similarity between the summer and winter S(90) (insolation needed for 90% inactivation) values. The rapid inactivation of C. jejuni was attributed to a high susceptibility to photooxidative damage. The results suggest that, in sunlight-exposed waters, E. coli will be a more conservative indicator for C. jejuni than for S. enterica, and C. jejuni transmission as a pathogenic agent is less likely than for S. enterica.     

Practical aspects of intensive insulinization in the intensive care unit

PURPOSE OF REVIEW: Strategies used for intensive insulin therapy of critically ill patients and differences of approach according to medical condition are reviewed. RECENT FINDINGS: Acceptance of proposed glycemic targets for critically ill patients has been tempered by uncertainties about benefit of strict glycemic control for specific target subpopulations, differences between treatment centers, optimal timing and duration of intervention, and safety. Present-day intravenous insulin infusion protocols may perform well only for restricted populations. Assessment of protocol performance requires knowledge of algorithm behavior on or near the narrow target range and, using the patient as unit of observation, examination of glycemic variability. Systems of the future will permit adjustment of algorithm parameters to meet individual- or population-specific targets and match carbohydrate exposure. SUMMARY: Attainment and preservation of glycemic control among critically ill patients are best attempted with intravenous insulin infusion. Advances in the design of decision support and insulin delivery systems, and progress in the technology of continuous blood glucose monitoring, are likely to reduce the risk of hypoglycemia, without compromise of target range control, such that the patient outcomes enjoyed by experienced centers in the future will prove generalizable to others through the extension of new technologies.     

Correlates of inmates' self-reported HIV/AIDS risk behaviors, prior incarceration, and marijuana use

The primary purpose of this study was to determine associations between measures of prior incarceration and marijuana use with self-reported HIV/AIDS risk behaviors among a sample of soon-to-be-released adult male inmates. Analyses presented exclusively involve calculating two multiple logistic regression models to test the study hypothesis. The general model specified self-reported marijuana use as an outcome with selected demographic variables including ethnicity, age, education, and income prior to incarceration as predictor variables. Significant bivariate associations were recorded for age, education, and sexual self-expectation with respect to reincarceration. Specifically, the least amount of education reported, the more likely study participants were to have been incarcerated more than once.     

History of prior TB infection and HIV/AIDS risk behaviours among a sample of male inmates in the USA

This study looked at inmates' self-reported data on prior treatment for tuberculosis (TB) and HIV/AIDS risk among a sample of inmates in a medium security prison. Contingency tables were used and risk ratios were computed to provide an estimate of relative risk for inmates with a history of being treated for TB in opposition to inmates without a history of being treated for TB. Findings suggest that inmates who reported being treated for TB were more likely to have had sex with a man while in prison and to report that, while in prison, they had a main sex partner. They were also 1.15 times more likely to have had sex with a person from the transgender community while in prison and 2.53 times more likely to report having been forced to have sex while in prison than those without a past history of being treated for TB. Future studies should attempt to determine the extent to which having an infectious disease such as TB impacts behavioural change with respect to behaviours practised by inmates.     

The politics of action research: “If you don't like the way things are going,get off the bus”

Participatory action research is lauded for its emancipatory potential and practice relevance. Little research has focused on the ethical and political dimensions of power relations between management gatekeepers and staff in large organizations in the negotiation of action research. To illuminate the dynamics of this engagement, this paper is informed by Aristotle's practical ethics of phronesis, arguing that ethics emerge through human interaction. The paper reports on a multi-method study and intervention in inter-professional learning and collaboration, conducted between 2008 and 2010, across an Australian health system. It draws on results from researchers' progress notes, 139 semi-structured interviews and focus groups (492 participants), more than 200 h of organizational document analysis, and more than 200 h of ethnographic observation. From conventional thematic analysis, we note that the project had considerable support from senior managers who were gatekeepers for the research. Such support stemmed from managerialist tendencies, with senior managers explicitly aligning inter-professionalism with prospective health reforms and improvements to quality of care and patient safety. Senior managers were also enthusiastic about standardized processes. Many frontline staff were less supportive, and some were suspicious of or hostile towards management-led processes to improve and evaluate care. Some senior managers' self perceived alignment with and support for the research process changed to resistance once this finding was presented. This paradox in the interplay of research findings and research process evinces the inherent tension between organizational politics and conducting action research that reflexive researchers need to negotiate in knowledge translation, exchange or mobilization exercises.     

Insulinoma presenting with hyperandrogenism: a case report and a literature review

An 18-year-old woman presented with a 6-month history of amenorrhoea and hyperandrogenism. Three months later she developed several episodes of fasting hypoglycaemia and was subsequently diagnosed with an insulinoma. Hyperinsulinaemia was observed in association with an elevated serum testosterone level. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS). Polycystic ovarian syndrome is unusual in a patient having an insulinoma. The rarity of this association may be the result of the late age of onset of this type of tumour, intermittent secretion of excessive insulin by the tumour, the degree of hyperinsulinism or other factors extrinsic to the insulin receptor that may facilitate insulin activity. However, we could not discover how our patient differs in having had PCOS from the majority of women with insulinoma who do not. If other patients with insulinoma are subsequently found to have hyperandrogenism, then this tumour might be added to the differential diagnosis of causes of anovulatory cycles and hyperandrogenaemia, although rare the association would be uncommon.     

Hospitalisation,care plans and not for resuscitation orders in older people in the last year of life

BACKGROUND: over 60% of older people have at least one admission to hospital in their last year of life, with the majority of people having multiple admissions. In Bankstown, New South Wales, Australia, we have a diverse ethnic and cultural population. We were interested in bed utilisation, documentation, and follow through of "care plans" as well as "not for resuscitation" orders in the last year of life of the older people in our area. METHODS: we reviewed and collected data from the medical records of patients over 65 years of age who died in our hospital. Reviewers included a medical registrar, a research officer and two geriatricians. We collected a wide range of information pertaining to the 12 months before death. This included demographics, chronic illnesses, geriatric syndromes, number of admissions, bed days, care plans, and not for resuscitation orders as well as other relevant data. RESULTS: 110 patients' records were reviewed. The mean age was 80 years and 31% were from a non English-speaking background. The average number of admissions was 2.4 and the average number of bed days in the last year of life was 25. Sixty-one of the patients had a care plan and a not for resuscitation order, 91% of which were written shortly before death. Using bi-variate analysis of old age (over 80), number of chronic illnesses, or geriatric syndromes present, the number of bed days was positively correlated to care plan and not for resuscitation orders. Logistic multivariate analysis of chronic illnesses revealed that stroke (P=0.024) as well as stroke and fracture (P=0.008) were strongly correlated with care plan and not for resuscitation orders. Only 8 patients had an advanced care plan documented prior to last admission. When advanced care plans were documented, they were generally clearly written and followed through appropriately (7 out of 8). CONCLUSION: this study showed that in our diverse population there were multiple admissions and utilisation of hospital beds for older people in their last year of life. Care plans and not for resuscitation orders were rarely documented prior to last admission. However, when advanced care plans were done, they were usually well documented and followed through appropriately.