Optimal management of urinary tract infections in older people

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials

Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study

<b>Background</b>: Taller people and those with better lung function are at reduced risk of coronary heart disease (CHD). Biological mechanisms for these associations are not well understood, but both measures may be markers for early life exposures. Some studies have shown that leg length, an indicator of pre-pubertal nutritional status, is the component of height most strongly associated with CHD risk. Other studies show that height-CHD associations are greatly attenuated when lung function is controlled for. This study examines (1) the association of height and the components of height (leg length and trunk length) with CHD risk factors and (2) the relative strength of the association of height and forced expiratory volume in one second (FEV1) with risk factors for CHD. <b>Subjects and methods</b>: Cross sectional analysis of data collected at detailed cardiovascular screening examinations of 1040 men and 1298 women aged 30–59 whose parents were screened in 1972–76. Subjects come from 1477 families and are members of the Midspan Family Study. <b>Setting</b>: The towns of Renfrew and Paisley in the West of Scotland. <b>Results</b>: Taller subjects and those with better lung function had more favourable cardiovascular risk factor profiles, associations were strongest in relation to FEV1. Higher FEV1 was associated with lower blood pressure, cholesterol, glucose, fibrinogen, white blood cell count, and body mass index. Similar, but generally weaker, associations were seen with height. These associations were not attenuated in models controlling for parental height. Longer leg length, but not trunk length, was associated with lower systolic and diastolic blood pressure. Longer leg length was also associated with more favourable levels of cholesterol and body mass index than trunk length. <b>Conclusions</b>:These findings provide indirect evidence that measures of lung development and pre-pubertal growth act as biomarkers for childhood exposures that may modify an individual's risk of developing CHD. Genetic influences do not seem to underlie height-CHD associations

Specific DNA structural attributes modulate platinum anticancer drug site selection and cross-link generation

Heavy metal compounds have toxic and medicinal potential through capacity to form strong specific bonds with macromolecules, and the interaction of platinum drugs at the major groove nitrogen atom of guanine bases primarily underlies their therapeutic activity. By crystallographic analysis of transition metal-and in particular platinum compound-DNA site selectivity in the nucleosome core, we establish that steric accessibility, which is controlled by specific structural parameters of the double helix, modulates initial guanine-metal bond formation. Moreover, DNA conformational features can be linked to both similarities and distinctions in platinum drug adduct formation between the naked and nucleosomal DNA states. Notably, structures that facilitate initial platinum-guanine bond formation can oppose cross-link generation, rationalizing the occurrence of long-lived therapeutically ineffective monofunctional adducts. These findings illuminate DNA structure-dependent reactivity and provide a novel framework for understanding metal-double helix interactions, which should facilitate the development of improved chromatin-targeting medicinal agent

Method for Using Rubric Ratings on Fishbone Diagrams to Compare Case Studies

Background: In multi-case study program evaluations, the large amount of qualitative data that are generated from interviews can be difficult to utilize. This is particularly so when inference must be made as to why some cases succeed and some fail. Purpose: This paper shows a method for comparing multiple evaluation sites by using a rubric to define ratings for relevant factors, and an Ishikawa fishbone diagram as a model to show relationships among those factors. We show how this technique identified reasons for differences in outcomes among the sites. Setting: The evaluation setting was a large-scale safety innovation in the U.S. railroad industry. Four cases were considered—two passenger railroads and two freight railroads. Intervention: The Confidential Close Call Reporting System (C3RS) program allowed railroad workers to confidentially submit “close calls” which were reviewed by a team made up of labor, management, and the Federal Railroad administration to determine ways to improve safety. Research design: Multiple comparative case study, Ishikawa root and contributing cause modeling, evaluative rubric scoring, and data visualization techniques. Data collection & analysis: Interview data were collected from four pilot railroad sites, each of which participated in a five-year test of C3RS. Testing periods overlapped, with the entire evaluation lasting about 12 years. Findings: The method of using Ishikawa fishbone diagrams with ratings from an evaluative rubric was an effective method to summarize, analyze, and present large quantities of qualitative data. The approach succeeded in explaining degrees of success and failure across the sites. The sponsor and industry stakeholders were able to understand the analysis and the findings, and to develop deep insight into how to promote successful implementation. Keywords: Multiple comparative case studies; qualitative methodology; qualitative coding; data visualization; fishbone diagrams; Ishikawa diagrams; evaluative rubrics; close calls; near miss; data visualization

Effects of diamagnetic levitation on bacterial growth in liquid

Diamagnetic levitation is a technique that uses a strong, spatially-varying magnetic field to levitate diamagnetic materials, such as water and biological cells. This technique has the potential to simulate aspects of weightlessness, on the Earth. In common with all ground-based techniques to simulate weightlessness, however, there are effects introduced by diamagnetic levitation that are not present in space. Since there have been few studies that systematically investigate these differences, diamagnetic levitation is not yet being fully exploited. For the first time, we critically assess the effect of diamagnetic levitation on a bacterial culture in liquid. We used a superconducting magnet to levitate growing bacterial cultures for up to 18 hours, in a series of experiments to determine the effect of diamagnetic levitation on all phases of the bacterial growth cycle. We find that diamagnetic levitation increases the rate of population growth in a liquid culture. The speed of sedimentation of the bacterial cells to the bottom of the container is considerably reduced. Further experiments and microarray gene analysis show that the growth enhancement is due to greater oxygen availability in the magnetically levitated sample. We demonstrate that the magnetic field that levitates the cells also induces convective stirring in the liquid, an effect not present in microgravity. We present a simple theoretical model, showing how the paramagnetic force on dissolved oxygen can cause the liquid to become unstable to convection when the consumption of oxygen by the bacteria generates an oxygen concentration gradient. We propose that this convection enhances oxygen availability by transporting oxygen around the sample. Since convection is absent in space, these results are of significant importance and timeliness to researchers considering using diamagnetic levitation to explore weightless effects on living organisms and a broad range of other topics in the physical and life sciences

Systematic review of antimicrobial drug prescribing in hospitals.

Prudent antibiotic prescribing to hospital inpatients has the potential to reduce the incidences of antimicrobial resistance and healthcare-associated infection. We reviewed the literature from January 1980 to November 2003 to identify rigorous evaluations of interventions to improve hospital antibiotic prescribing. We identified 66 studies with interpretable data of which 16 reported 20 microbiological outcomes: Gram negative resistant bacteria (GNRB), 10 studies; Clostridium difficile associated diarrhoea (CDAD), 5 studies; vancomycin resistant enterococci (VRE), 3 studies and methicillin resistant Staphylococcus aureus (MRSA), 2 studies. Four studies provide good evidence that the intervention changed microbial outcomes with low risk of alternative explanations, eight studies provide less convincing evidence and four studies were negative. The strongest and most consistent evidence was for CDAD but we were able to analyse only the immediate impact of interventions because of nonstandardised durations of follow up. The ability to compare results of studies could be substantially improved by standardising methodology and reporting

Towards a generalisation of formal concept analysis for data mining purposes

In this paper we justify the need for a generalisation of Formal Concept Analysis for the purpose of data mining and begin the synthesis of such theory. For that purpose, we first review semirings and semimodules over semirings as the appropriate objects to use in abstracting the Boolean algebra and the notion of extents and intents, respectively. We later bring to bear powerful theorems developed in the field of linear algebra over idempotent semimodules to try to build a Fundamental Theorem for K-Formal Concept Analysis, where K is a type of idempotent semiring. Finally, we try to put Formal Concept Analysis in new perspective by considering it as a concrete instance of the theory developed

Bioaccumulation surveillance in Milford Haven Waterway

Biomonitoring of contaminants (metals, organotins, PAHs, PCBs) was carried out along the Milford Haven Waterway (MHW) and at a reference site in the Tywi Estuary during 2007-2008. The species used as bioindicators encompass a variety of uptake routes - Fucus vesiculosus (dissolved contaminants); Littorina littorea (grazer); Mytilus edulis and Cerastoderma edule (suspension feeders); and Nereis diversicolor (omnivore which often reflects contaminants in sediment). Differences in feeding strategy and habitat preference have subtle implications for bioaccumulation trends though, with few exceptions, contaminant body burdens in Milford Haven (MH) were higher than those at the Tywi reference site, reflecting inputs. Elevated concentrations of metals were occasionally observed at individual MH sites, whilst As and Se (molluscs and seaweed) were, for much of MHW, consistently at the higher end of the UK range. However, for the majority of metals, distributions in MH biota were not exceptional by UK standards. Several metal-species combinations indicated increases in bioavailability at upstream sites, which may reflect the influence of geogenic or other land-based sources – perhaps enhanced by lower salinity (greater proportions of more bioavailable forms). TBT levels in MH mussels were below OSPAR toxicity thresholds and in the Tywi were close to zero. Phenyltins were not accumulated appreciably in Mytilus, whereas some Nereis populations may have been subjected to localized (historical) sources. PAHs in Nereis tended to be evenly distributed across most sites, but with somewhat higher values at Dale for acenaphthene, fluoranthene, pyrene, benzo(a)anthracene and chrysene; naphthalenes tended to be enriched further upstream in the mid-upper Haven (a pattern seen in mussels for most PAHs). Whilst concentrations in MH mussels were mostly above reference site and OSPAR backgrounds, it is unlikely that ecotoxicological guidelines would be exceeded. PCBs in mussels were between upper and lower OSPAR guidelines and were unusual in their distribution in that highest levels occurred at the mouth of MH. Condition indices (CI) of bivalves (mussels and cockles) were highest at the Tywi reference site and at the seaward end of MH, decreasing upstream along the Waterway. There were a number of significant (negative) relationships between CI and body burdens and multivariate analysis indicated that a combination of contaminants could influence the pattern in condition (and sub-lethal responses such as MT and TOSC) across sites. Cause and effect needs to be tested more rigorously in future assessments