Test–Retest Reliability of the Preroad DriveABLE Competence Screen

ABSTRACT

Objective: To determine the test–retest reliability of a computerized preroad screen of prerequisite skills required for safe driving. Subjects & Methods: Driveable Screen administered to 39 individuals referred for driving evaluation due to cognitive decline or stroke. The Screen provides three recommendations—driving cessation, indeterminate, no evidence of reduced competence. Predicted probability of failing the road test is also generated. Results: Reliability according to the recommendation was substantial for the entire group (K = 0.654; CI = 0.459–0.848) and subgroup with stroke (K = 0.742; CI = 0.540–0.944). The numbers of participants with cognitive decline was too small to allow subgroup analyses. Of the nine participants with test–retest disagreement in recommendation, Test 2 was always better (McNemar's X² = 9.00, p = 0.01). Excellent reliability was found on probability of failing the Road Test (Intraclass Correlation Coefficient = 0.908; CI = 0.832–0.950). The test–retest reliability of the subtests ranged from fair to substantial. Conclusions: The Screen demonstrates sufficient test–retest reliability to encourage its use. However, the finding of significantly better scores on Test 2 for a portion of participants raises concern regarding its validity with repeat testing.     

Quantification of Lipopolysaccharides in Human Bile with or without Gram-Negative Bacteria

Lipopolysaccharide (LPS) was assayed in 78 samples of human common-duct bile, obtained at endoscopic retrograde cholangiography. The LPS was assayed by a chromogenic limulus amebocyte lysate (LAL) test, after dilution of bile samples in heparinized plasma and inactivation of inhibitors. The assay was not influenced by other biliary constituents, as demonstrated by the recovery of standards. Bile pigments did not influence the results. The LAL test was positive in 60 of the samples, 59 of which had a positive culture for gram-negative bacteria or Candidasp. The levels of LPS were significantly correlated to the total number of bacteria (n = 16, R = 0.55, p < 0.05). The median LPS level was 35,250 ng/l and showed a very large variation (140 ng/l to 27.8 mg/l). In four of the samples gram-negative bacteria were present, but no LPS could be detected. The study demonstrates the presence of LPS in great quantities in human bile and supports the feasibility of using the LAL test on bile samples. The presence of LPS (within the detection limit) appears to be associated with local microbial colonization.     

Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin–meropenem combination

Abstract

In this prospective study, consecutive isolates of Klebsiella pneumoniae were tested for different mechanisms of carbapenem resistance using the modified Hodge test (MHT), Rosco Neo-Sensitabs (ROSCO). Phenylalanine arginine beta-naphthylamide assay (PABN) inhibitor-based test was done on isolates in which the mechanism of resistance was not identifiable by the ROSCO. Among 105 selected isolates, carbapenemase production was noted in 100 (95%) by MHT and ROSCO showed 97 (92·4%) inhibition with dipicolinic acid signifying the production of MBL. PCR amplification was positive in 90 (86%) isolates for bla_NDM-1 and 46 (44%) isolates for bla_OXA-48. 54 (51%) isolates were positive for bla_CTX-M and all belonged to bla_CTX-M group 1. Isolates co produced bla_OXA-48 (31/105, 30%) and bla_CTX-M (40/105, 38%) in combination with the carbapenemase (bla_NDM-1) gene. Five colistin-resistant isolates were positive for bla_OXA-48. Eight isolates did not show inhibition with any of the inhibitor containing disks and found to be positive for bla_OXA-48. Isolates were tested for colistin-meropenem synergy and detection rate was higher by the checkerboard (48%) than E-test method (35%). Our study necessitates continuous surveillance to recognize the predominant machinery of resistance in a particular geographical region to formulate effective control measures.     

凝血检验标本采集与处理过程中的质量控制分析

目的观察分析凝血检验标本采集与处理过程中的质量控制。方法选择凝血检验标本采集与处理强化质控措施实施后(2018年3月至2019年2月)和实施前(2017年3月至2018年2月)在本院行凝血检验的健康体检者各41例,分别作为观察组和对照组。收集两组待检查者的标本采集、处理过程记录,比较两组标本不合格发生率。结果观察组凝血检验标本不合格发生率(2.44%,1/41)显著低于对照组(19.51%,8/41),差异有统计学意义(P<0.05)。结论强化质控措施可有效提升凝血检验标本采集与处理过程规范性,降低不合格标本风险,有助于保障凝血检验准确性和有效性,临床应用价值较高。     

Rapid Detection of ESBL-Producing Enterobacteriaceae in Blood Cultures

We rapidly identified extended-spectrum β-lactamase (ESBL) producers prospectively among 245 gram-negative bacilli–positive cultured blood specimens using the Rapid ESBL Nordmann/Dortet/Poirel test and direct bacterial identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. This combination identified ESBL-producing Enterobacteriaceae within 30 min and had high predictive values.     

National survey of physicians in Japan regarding their use of diagnostic tests for legionellosis

IntroductionBacterial culture remains the gold standard for the diagnosis of legionellosis. However, past reports indicate that most physicians use the urinary antigen test (UAT) alone. Combining it with other tests is important, especially in patients with negative UAT results. The aim of this study was to investigate the current situation of legionellosis diagnostics and clarify the issues that need to be addressed.MethodsBetween March 1, 2021 and April 30, 2021, a questionnaire survey was conducted in an anonymous manner among physicians working in Japan. Questionnaires were generated on a website and asked questions in a multiple-choice format.ResultsValid responses were received from 309 physicians during the study period. Most (92.9%) physicians reported using UAT as the initial test for patients suspected of having legionellosis, and <10% reported using other tests (e.g., culture, nucleic acid amplification test [NAAT], Gimenez staining, and serum antibody titer measurement [ATM]). When the initial test result was negative, 63% of physicians reported not conducting additional tests. Even when they chose to run additional tests, at most 27.8%, 23.6%, 12.3%, and 10.4% of all physicians used NAAT, culture, Gimenez staining, and serum ATM, respectively. The major reasons for not using tests other than UAT were “unavailability in the medical facility,” “long turn-around time,” and “difficult to collect sputum.”ConclusionsThe present survey revealed that most physicians in Japan used UAT alone for diagnosing legionellosis. Eliminating barriers to creating a reasonable environment and edification of physicians are needed to improve the current situation.     

Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients

The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent.     

应用沉淀法消除HLAP患者生化标本乳糜状态的探讨

目的探索磷钨酸镁沉淀法在高脂血症性急性胰腺炎(HLAP)患者标本进行生化检验前对重度乳糜状态的消除作用。方法取外观正常标本经磷钨酸镁处理后做各项生化检验,与处理前数据进行相关性分析;以脂肪乳液配制轻、中、重3组模拟乳糜血清做回收试验,计算各生化项目的回收率;收集HLAP患者标本做实证试验,观察乳糜消除效果和生化检验效果。结果除了二氧化碳结合力(CO2CP)、总胆红素(TBil)、直接胆红素(DBil)、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶同工酶1(LD-1)、半胱氨酸蛋白酶抑制剂C(Cys C)、高敏C反应蛋白(hs-CRP)外,钾离子(K+)、钠离子(Na+)、氯离子(Cl-)、钙离子(Ca2+)、血糖(Glu)、尿素(Urea)、尿酸(UA)、肌酐(Cr)、淀粉酶(AMY)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、胆碱酯酶(CHE)、总蛋白(TP)、白蛋白(Alb)、总胆汁酸(TBA)、肌酸激酶(CK)、乳酸脱氢酶(LD)、α-羟丁酸脱氢酶(α-HBDH)经磷钨酸镁处理后均可正确检测,且与处理前呈高度的直线相关,拟合曲线显著性检验显示P均0.01。回收试验中3组模拟乳糜血清各生化项目的回收率最低为98.03%,最高为103.44%,回收效果良好。HLAP患者标本经磷钨酸镁处理后可正确检测的生化项目与相关性分析实验中外观正常的标本一致,甘油三酯(TG)10 mmol/L或TG40 mmol/L的标本乳糜消除效果明显,TG为10~40 mmol/L的标本需先做稀释使TG10 mmol/L再做处理。结论磷钨酸镁沉淀法清除血脂效果显著,对绝大多数的生化检验不会产生干扰,适用于重度乳糜状态的HLAP患者标本生化检验前的处理。     

Visual working memory and perception speed of 3- to 6-year-old children tested with a Matrix Film Battery Test

In this study the visual working memory (VWM) and perception speed of 60 children between the ages of three and six years were tested with an age-based, easy-to-handle Matrix Film Battery Test (reliability R?=?.71). It was thereby affirmed that the VWM is age dependent (correlation coefficient r?=?.66***) as expected. Furthermore, a significant gender effect was found (partial correlation coefficient r_p?=?.42***) indicating that boys generally have a better VWM: they are able to memorise more items and they can process visual information faster. Given that the test was repeated during a period of eight months, strong learning effects could be detected which show that the VWM can be trained and that the test itself is also a good training tool.