A novel fluorescence in situ hybridization test for rapid pathogen identification in positive blood cultures

AbstractA novel molecular beacon-based fluorescence in situ hybridization (FISH) test allowing for the identification of a wide range of bacterial pathogens directly in positive blood cultures (BCs) was evaluated with positive BCs of 152 patients. Depending on the Gram stain, either a Gram-negative or a Gram-positive panel was used. The time to result was 30 min, and the hands-on time was only 10 min. Seven per cent of the cultured microorganisms were not included in the FISH panels; the identification rate of those included was 95.2%. Overall, the FISH test enabled accurate pathogen identification in 88.2% of all cases analysed

Homeownership Across the American Life Course: Estimating the Racial Divide

Homeownership has historically been viewed as a fundamental piece of the American Dream, with up to 70 percent of households owning their home as of 2006. Yet it has also been demonstrated that nonwhites are less likely to own a home and that the value of their homes is much less than that for whites, even when social class is taken into account. This paper explores the overall life course patterns of homeownership and the importance of racial differences in understanding those dynamics. Based upon a life table methodology, we examine the homeownership patterns for individuals between the ages of 25 to 55 using 36 waves of the Panel Study of Income Dynamics. Our findings indicate that although the vast majority of nonwhites will eventually become homeowners, there is nevertheless a significant racial divide in the patterns of homeownership. Nonwhites are less likely than whites to become homeowners, are more likely to purchase their first home at a later age, are less likely to have acquired as much equity in their home, and are less likely to own their home outright. The implications of these findings are discussed within the overall context of racial stratification in America

Estimating the Life Course Dynamics of Asset Poverty

Poverty can be conceptualized and measured in several different ways. The most common approach has been to rely on a scarcity of income as the basis for poverty. This paper analyzes poverty using a relatively new and alternative measuring stick—that of asset poverty. Using data from the Panel Study of Income Dynamics, we examine the extent to which individuals have enough assets to allow them to live for three months above the official poverty line. Households that fail to have the necessary amount of assets are considered asset poor. Three different measures of counting assets are used in this paper—net worth; financial wealth; and liquid wealth. We construct a series of life tables that allow us to examine the period, cohort, and age patterns of asset poverty from 1984 to 2004. Our results indicate that asset poverty is widespread across the life course. The vast majority of those in early adulthood will experience asset poverty in terms of their net worth, financial wealth, and liquid wealth. For those in the middle and later stages of the life course, there remains a substantial risk of encountering financial wealth and liquid wealth asset poverty. In addition, individuals who have less education, are not married, are black, and who do not own a home, are all significantly more likely to experience asset poverty. The policy implications of these findings are discussed

Robotic Repair of Congenital Paraesophageal Hiatal Hernia

Abstract Congenital paraesophageal hiatal hernias are rare and can be associated with gastric incarceration, volvulus, mucosal ulceration, and anemia. Primary repair of the hernia and fundoplication are recommended. In this paper, we report a case of a 3-year-old child with abdominal pain who was noted to have a paraesophageal hiatal hernia with partial gastric volvulus. A 5 mm robot platform was utilized to facilitate hernia sac dissection, hiatal repair, and fundoplication.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63210/1/lap.2008.0185.pd

American Poverty as a Structural Failing: Evidence and Arguments

Empirical research on American poverty has largely focused on individual characteristicst o explain the occurrence and patternso f poverty. The argument in this article is that such an emphasis is misplaced. By focusing upon individual attributes as the cause of poverty, social scientists have largely missed the underlying dynamic of American impoverishment. Poverty researchers have in effect focused on who loses out at the economic game, rather than addressing the fact that the game produces losers in the first place. We provide three lines of evidence to suggest that U.S. poverty is ultimately the result of structural failings at the economic, political, and social levels. These include an analysis into the lack of sufficient jobs in the economy to raise families out of poverty or near poverty; a comparative examination into the high rates of U.S. poverty as a result of the ineffectiveness of the social safety net; and the systemic nature of poverty as indicated by the life course risk of impoverishment experienced by a majority of Americans. We then briefly outline a framework for reinterpreting American poverty. This perspective incorporates the prior research findings that have focused on individual characteristics as important factors in who loses out at the economic game, with the structural nature of American poverty that ensures the existence of economic losers in the first place

Superficial thrombophlebitis and risk for recurrent venous thromboembolism

AbstractObjective: Superficial thrombophlebitis (ST) is a frequent and potentially serious disease if complicated with venous thromboembolism (VTE). Data on risk factors and incidence rates for ST are scarce. It is also unknown whether ST is a risk factor for recurrence of VTE. Methods: After discontinuation of secondary thromboprophylaxis for a first spontaneous VTE, we prospectively observed 615 patients on average for 30 ± 26 months. Patients with natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer, who were pregnant, or were receiving long-term antithrombotic therapy were excluded. The study outcomes were occurrence of symptomatic ST or objectively documented recurrent symptomatic VTE. Results: ST developed in 45 patients (7.3%) with a first VTE. High factor VIII concentration emerged as an independent risk factor for ST (relative risk [RR], 2.0; 95% confidence interval [CI], 1.0-5.2), compared with lower levels after adjustment for age and sex; factor V Leiden and prothrombin G20210A concentration; hyperhomocysteinemia; high body mass index; and duration of oral anticoagulation therapy. VTE recurred in 12 (27%) of 45 patients with ST and in 67 (12%) of 570 patients without ST. In patients with VTE, subsequent ST emerged as an independent risk factor for recurrent VTE. Patients with ST had twofold higher RR (2.1; 95% CI, 1.0-4.2) for recurrence than did patients without ST after adjustment for putative confounding variables. Conclusion: Patients with a first spontaneous VTE and subsequent ST are at increased risk for recurrent VTE. High factor VIII concentration is an independent risk factor for ST. (J Vasc Surg 2003;37:834-8.

Inhibition of breathing after surfactant depletion is achieved at a higher arterial PCO(2 )during ventilation with liquid than with gas

BACKGROUND: Inhibition of phrenic nerve activity (PNA) can be achieved when alveolar ventilation is adequate and when stretching of lung tissue stimulates mechanoreceptors to inhibit inspiratory activity. During mechanical ventilation under different lung conditions, inhibition of PNA can provide a physiological setting at which ventilatory parameters can be compared and related to arterial blood gases and pH. OBJECTIVE: To study lung mechanics and gas exchange at inhibition of PNA during controlled gas ventilation (GV) and during partial liquid ventilation (PLV) before and after lung lavage. METHODS: Nine anaesthetised, mechanically ventilated young cats (age 3.8 ± 0.5 months, weight 2.3 ± 0.1 kg) (mean ± SD) were studied with stepwise increases in peak inspiratory pressure (PIP) until total inhibition of PNA was attained before lavage (with GV) and after lavage (GV and PLV). Tidal volume (V(t)), PIP, oesophageal pressure and arterial blood gases were measured at inhibition of PNA. One way repeated measures analysis of variance and Student Newman Keuls-tests were used for statistical analysis. RESULTS: During GV, inhibition of PNA occurred at lower PIP, transpulmonary pressure (Ptp) and Vt before than after lung lavage. After lavage, inhibition of inspiratory activity was achieved at the same PIP, Ptp and Vt during GV and PLV, but occurred at a higher PaCO(2 )during PLV. After lavage compliance at inhibition was almost the same during GV and PLV and resistance was lower during GV than during PLV. CONCLUSION: Inhibition of inspiratory activity occurs at a higher PaCO(2 )during PLV than during GV in cats with surfactant-depleted lungs. This could indicate that PLV induces better recruitment of mechanoreceptors than GV

Interval appendectomy in perforated appendicitis

The treatment of the perforated appendix remains controversial, with the optimal timing of surgical intervention unclear. Previous studies have documented an increase in both minor and major complication rates in patients undergoing appendectomy for perforated appendicitis. We sought to evaluate the nonoperative therapy of perforated appendicitis followed by interval appendectomy. The charts of all children undergoing admission for appendicitis during a 10-year period (n = 480) were reviewed. Data were abstracted regarding patient presentation, laboratory and radiologic findings, operative and pathology reports, and postoperative course in those patients with perforated appendicitis (n = 104). Comparisons were made between patients undergoing primary appendectomy for perforated appendicitis (n = 87) and those treated with IV antibiotics and hydration and then scheduled for interval appendectomy 4 to 6 weeks following the acute event (n = 17). Treatment assignment was determined by the attending pediatric surgeon in a non-randomized fashion. No significant differences were seen between these two groups in days of antibiotic treatment, nasogastric decompression, and IV hydration. Additionally, total hospital days and cost did not differ significantly between the two groups (primary = 10.3 days and $10,550; interval = 13.3 days and$13,221, P = 0.11 and 0.21, respectively). The overall complication rates, 12.6% in the primary group and 5.9% in the interval group, also did not differ significantly, while the major complication rate (wound dehiscence, abscess, and small-bowel obstruction), 10% versus 0%, was significantly higher in the primary group as compared with the interval group. Our data demonstrate no significant disadvantage, and possibly an improvement in the major complication rate, with nonoperative treatment of perforated appendicitis followed by interval appendectomy. We suggest that this treatment modality should be considered when evaluating the child with perforated appendicitis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47148/1/383_2004_Article_BF00171160.pd