Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients.

PURPOSE: To estimate the economic impact of a Tegaderm(TM) chlorhexidine gluconate (CHG) gel dressing compared with a standard intravenous (i.v.) dressing (defined as non-antimicrobial transparent film dressing), used for insertion site care of short-term central venous and arterial catheters (intravascular catheters) in adult critical care patients using a cost-consequence model populated with data from published sources. MATERIAL AND METHODS: A decision analytical cost-consequence model was developed which assigned each patient with an indwelling intravascular catheter and a standard dressing, a baseline risk of associated dermatitis, local infection at the catheter insertion site and catheter-related bloodstream infections (CRBSI), estimated from published secondary sources. The risks of these events for patients with a Tegaderm CHG were estimated by applying the effectiveness parameters from the clinical review to the baseline risks. Costs were accrued through costs of intervention (i.e. Tegaderm CHG or standard intravenous dressing) and hospital treatment costs depended on whether the patients had local dermatitis, local infection or CRBSI. Total costs were estimated as mean values of 10,000 probabilistic sensitivity analysis (PSA) runs. RESULTS: Tegaderm CHG resulted in an average cost-saving of £77 per patient in an intensive care unit. Tegaderm CHG also has a 98.5% probability of being cost-saving compared to standard i.v. dressings. CONCLUSIONS: The analyses suggest that Tegaderm CHG is a cost-saving strategy to reduce CRBSI and the results were robust to sensitivity analyses

Mismatch Repair Genes Mlh1 and Mlh3 Modify CAG Instability in Huntington's Disease Mice: Genome-Wide and Candidate Approaches

The Huntington's disease gene (HTT) CAG repeat mutation undergoes somatic expansion that correlates with pathogenesis. Modifiers of somatic expansion may therefore provide routes for therapies targeting the underlying mutation, an approach that is likely applicable to other trinucleotide repeat diseases. Huntington's disease HdhQ111 mice exhibit higher levels of somatic HTT CAG expansion on a C57BL/6 genetic background (B6.HdhQ111) than on a 129 background (129.HdhQ111). Linkage mapping in (B6x129).HdhQ111 F2 intercross animals identified a single quantitative trait locus underlying the strain-specific difference in expansion in the striatum, implicating mismatch repair (MMR) gene Mlh1 as the most likely candidate modifier. Crossing B6.HdhQ111 mice onto an Mlh1 null background demonstrated that Mlh1 is essential for somatic CAG expansions and that it is an enhancer of nuclear huntingtin accumulation in striatal neurons. HdhQ111 somatic expansion was also abolished in mice deficient in the Mlh3 gene, implicating MutLγ (MLH1–MLH3) complex as a key driver of somatic expansion. Strikingly, Mlh1 and Mlh3 genes encoding MMR effector proteins were as critical to somatic expansion as Msh2 and Msh3 genes encoding DNA mismatch recognition complex MutSβ (MSH2–MSH3). The Mlh1 locus is highly polymorphic between B6 and 129 strains. While we were unable to detect any difference in base-base mismatch or short slipped-repeat repair activity between B6 and 129 MLH1 variants, repair efficiency was MLH1 dose-dependent. MLH1 mRNA and protein levels were significantly decreased in 129 mice compared to B6 mice, consistent with a dose-sensitive MLH1-dependent DNA repair mechanism underlying the somatic expansion difference between these strains. Together, these data identify Mlh1 and Mlh3 as novel critical genetic modifiers of HTT CAG instability, point to Mlh1 genetic variation as the likely source of the instability difference in B6 and 129 strains and suggest that MLH1 protein levels play an important role in driving of the efficiency of somatic expansions

The Lability and Relative Reactivities of Organic Radicals

Studies have been made of the rates of many reactions involving organometallic compounds, by means of the color test of Gilman and Schulze. These rate studies comprise: (1) the relative reactivities of a variety of compounds towards a typical organometallic compound; (2) the relative reactivities of a series of related compounds like nitriles or azo compounds with an organometallic compound; (3) and, the differences in rate of reaction of a series of organometallic compounds towards other compounds.. The same method has been used in a study of the effect of concentration, temperature and catalysts on reaction rates. Also, it has been shown to be of service in a study of the mechanism of reactions, like the two-stage conversion of esters to ketones to tertiary alcohols; and the lability and relative electronegativities of radicals

Estrategia de conservación y calidad de vida en el corredor biológico lago arenal tenorio, Costa Rica: informe de investigación elaborado dentro del curso

Desde los años 1980 con la redefinición de los conceptos de desarrollo incluyendo consideraciones de sostenibilidad, pasando luego por la cumbre de Río 1992 y las subsiguientes iniciativas de la agenda ambiental internacional, los estados firmantes han llevado a cabo una serie de medidas para alcanzar los principios planteados en todos los documentos y acuerdos internacionales. En la región centroamericana, incluyendo a México, parte de las estrategias desarrolladas han promovido la integración y trabajo en común de diferentes países como es el caso del Corredor Biológico Mesoamericano (CBM). En Costa Rica, a dentro del CBM, el Corredor Biológico Lago Arenal Tenorio (CBLAT) comprende la cuenca del embalse Arenal y facilita la conectividad ecológica entre el Parque Nacional Volcán Tenorio y Volcán Arenal. El objetivo principal de este trabajo es comprender cómo una estrategia de conservación a escala de paisaje, en este caso el Corredor Biológico Lago Arenal Tenorio, contribuye a mejorar la calidad de vida de las personas que habitan en este espacio desde su propia percepción y opinión. El presente informe ofrece información preliminar que podría servir de base para tomar decisiones e implementar estrategias acordes con las necesidades reales de las poblaciones ubicadas en el espacio del CBLAT. (Résumé d'auteur

Le soutien social et l'anxiété : les prédicteurs de la santé mentale et validation d'un nouvel instrument de mesure

Les troubles anxieux font partie des troubles mentaux les plus prévalents depuis les dernières années. Il est démontré que ceux-ci altèrent de façon significative le fonctionnement quotidien des individus tout en exerçant un impact significatif sur les interactions sociales, surtout dans le cas du trouble d'anxiété sociale et du trouble panique avec ou sans agoraphobie. Le soutien social est un construit multidimensionnel reconnu comme étant une variable importante agissant sur la santé mentale. Malgré cela, peu d'études se sont penchées sur les liens entre les différentes fonctions du soutien social (émotionnelles, tangibles, affectives, informationnelles, positives, etc.) et les troubles anxieux. De plus, plusieurs études démontrent des relations significatives entre le soutien social et la détresse psychologique de même qu'entre le soutien social et le bien-être psychologique, par contre peu d'études ont tenté d'examiner simultanément les relations entre ces variables et aucune ne l'a fait chez une population d'hommes et de femmes avec un trouble anxieux. Pourtant, une meilleure compréhension de ces liens pourrait avoir des retombées majeures sur les services offerts aux individus qui présentent un trouble anxieux. Par ailleurs, l'évaluation précise du soutien social et des interactions sociales négatives chez les gens avec un problème d'anxiété s'avère une avenue idéale pour dépister les individus vivant des déficits au niveau du soutien social. Une telle analyse pourrait également permettre une intervention plus spécifique auprès des personnes anxieuses et de ses proches. Suite à l'exposé des différentes variables à l'étude et d'une brève recension des écrits sur les liens entre le soutien social et la santé mentale, deux études empiriques, qui tentent d'examiner les liens entre les différents types de soutien social et le fonctionnement des gens ayant un trouble anxieux ou vivant une situation d'anxiété, sont présentées. Les résultats de la première étude permettent de constater que le soutien social émotionnel/informationnel, affectif et les interactions sociales positives représentent des variables prédictives puissantes d'un niveau élevé de bien-être psychologique chez les femmes avec un trouble d'anxiété sociale, un trouble panique sans agoraphobie et une agoraphobie sans attaques de panique. Ensuite, les résultats de la deuxième étude présentent les propriétés psychométriques suite au développement et à la validation d'un nouveau questionnaire mesurant les différents comportements de soutien social en situation d'anxiété. Trois facteurs centraux sont retenus, dont un évalue les interactions sociales négatives et les deux autres, le soutien social. Finalement, le dernier chapitre est constitué d'une discussion générale des résultats obtenus, des contributions théoriques, des forces et des limites des études en plus d'examiner des pistes de recherches futures ainsi que certaines considérations cliniques. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Soutien social, Trouble anxieux, Anxiété, Bien-être psychologique, Détresse psychologique, Questionnaire, Mesure

Dietary factors impact on the association between CTSS variants and obesity related traits.

Cathepsin S, a protein coded by the CTSS gene, is implicated in adipose tissue biology--this protein enhances adipose tissue development. Our hypothesis is that common variants in CTSS play a role in body weight regulation and in the development of obesity and that these effects are influenced by dietary factors--increased by high protein, glycemic index and energy diets

Patient Advisors: How to implement a process for involvement at all levels of governance in a healthcare organization

Patient involvement at the operational (clinical care and services), tactical (management), and strategic (board of directors and executive management) levels of establishments is increasingly sought after. To address this specific challenge, a Canadian healthcare organization, the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, has developed an integrated strategy based on three principles: (1) shared leadership between a patient and a manager to build the strategy; (2) a clear process for recruiting, training, and coaching patient advisors (PA) so that they can participate in decision-making at the various levels of governance of the establishment; and (3) a feedback process for improving the strategy over time. This initiative gave rise to a pool of 30 patient advisors who reviewed documentation (39.07%), presented testimonies to establishment practitioners (13.73%), participated in process improvement activities (12.97%) and committees (8.93%), and helped train students in health sciences (11.61%). It also led to the development of a request form for all persons wishing to involve PAs in their projects. This PA involvement, highly appreciated by both managers (94%) and PAs (81%), brought back the fundamental meaning of the patient–practitioner relationship and helped incorporate patients’ experiential knowledge into the care and service improvement process. This strategy can serve as a model for other organizations wishing to structure optimal patient engagement at the different levels of governance of their organization

Systematic Genetic Nomenclature for Type VII Secretion Systems

CITATION: Bitter, W., et al. 2009. Systematic genetic nomenclature for type VII secretion systems. PLoS Pathogens, 5(10): 1-6, doi: 10.1371/journal.ppat.1000507.The original publication is available at http://journals.plos.org/plospathogensMycobacteria, such as the etiological agent of human tuberculosis, Mycobacterium tuberculosis, are protected by an impermeable cell envelope composed of an inner cytoplasmic membrane, a peptidoglycan layer, an arabinogalactan layer, and an outer membrane. This second membrane consists of covalently linked, tightly packed long-chain mycolic acids [1,2] and noncovalently bound shorter lipids involved in pathogenicity [3–5]. To ensure protein transport across this complex cell envelope, mycobacteria use various secretion pathways, such as the SecA1-mediated general secretory pathway [6,7], an alternative SecA2-operated pathway [8], a twin-arginine translocation system [9,10], and a specialized secretion pathway variously named ESAT-6-, SNM-, ESX-, or type VII secretion [11–16]. The latter pathway, hereafter referred to as type VII secretion (T7S), has recently become a large and competitive research topic that is closely linked to studies of host–pathogen interactions of M. tuberculosis [17] and other pathogenic mycobacteria [16]. Molecular details are just beginning to be revealed [18–22] showing that T7S systems are complex machineries with multiple components and multiple substrates. Despite their biological importance, there has been a lack of a clear naming policy for the components and substrates of these systems. As there are multiple paralogous T7S systems within the Mycobacteria and orthologous systems in related bacteria, we are concerned that, without a unified nomenclature system, a multitude of redundant and obscure gene names will be used that will inevitably lead to confusion and hinder future progress. In this opinion piece we will therefore propose and introduce a systematic nomenclature with guidelines for name selection of new components that will greatly facilitate communication and understanding in this rapidly developing field of research.http://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1000507Publisher's versio

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton–proton collisions at the LHC

This paper presents the method and performance of primary vertex reconstruction in proton–proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of √s=8 TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of about 30μm is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than 20μm and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing

Incubation Period of Hantavirus Cardiopulmonary Syndrome

The potential incubation period from exposure to onset of symptoms was 7–39 days (median 18 days) in 20 patients with a defined period of exposure to Andes virus in a high-risk area. This period was 14–32 days (median 18 days) in 11 patients with exposure for <48 hours