A new substrate for sampling deep river macroinvertebrates

We compared macroinvertebrate communities colonising multiplate samplers constructed from perspex or tempered hardboard (wood) with an alternative artificial substrate constructed from folded coconut fibre matting (coir) enclosed in nylon netting. Substrates were incubated for 62 days over January to March 2007 at six sites over 240 km along the Waikato River. The three substrates supported similar numbers of invertebrate taxa (27 - 29 taxa), but coir samples contained 71% of total invertebrate numbers from all substrates combined, compared with <17% for each type of multiplate sampler. Coir faunas were heavily dominated by the hydrobiid snail Potamopyrgus (84 % of numbers), and this taxon along with the amphipod Paracalliope comprised 58 - 66 % of invertebrates on both types of multiplate samplers. Analysis of a Bray-Curtis matrix suggested statistically significant differences in percent community composition between coir samplers and each type of multiplate sampler over the late summer study period. Densities per cm3 of Oligochaeta, Mollusca, and "other worms" (Platyhelminthes, Rhabdocoela, Nemertea and Hirudinea combined) were significantly higher in coir samples than one or both of the multiplate samplers. Results suggest coir samplers may provide a useful supplement to multiplate samplers for deep river invertebrate studies by collecting a different range of taxa, including those favouring cover and characteristic of depositional environments

Management of oropharyngeal cancer: a cross-sectional review of institutional practice at a large Canadian referral centre

BACKGROUND: Over the years, the treatment of oropharyngeal cancer has changed; in the past, first-line treatment consisted of surgery followed by adjuvant radiotherapy, today however, primary treatment typically involves concomitant chemoradiation, and reserves surgery for salvage. While chemoradiation is the modality of choice for primary management of oropharyngeal cancer, disease characteristics, institutional bias, and patient preferences influence treatment choice. This has lead to variation in the treatment of OPC, and has generated some uncertainly regarding the ideal therapeutic approach. The objective of this study was to describe the treatment of OPC a large Canadian referral center, highlighting trends in treatment choice and outcome. METHODS: This is a cross-sectional retrospective review of clinical practice at Sunnybrook Health Science Centre (Toronto, ON). This investigation documents type of first-line treatment, rates of treatment failure, rates of surgical salvage, and 5-year disease-free survival. This study also asses the therapeutic impact of free-flap reconstruction on the use of a postoperative tracheostomy and/or percutaneous endoscopic gastrostomy tube. RESULTS: The majority of oropharyngeal cancer patients presented with regionally metastatic disease (stage III-IV) and underwent concomitant chemoradiation as first-line treatment. Just over half of patients who failed chemoradiation were eligible for salvage surgery. Forty-six percent of salvage patients recurred at approximately 6 months, and died approximately 12 months following the first sign of disease recurrence. Five-year survival for salvage patients stage II, III, IVA, and IVB was 100%, 54.5%, 53.8%, and 50%, respectively. The incidence of percutaneous endoscopic gastrostomy tubes and tracheostomies was comparable between patients who underwent free-flap reconstruction and patients who did not. CONCLUSION: The modality of choice for first-line treatment of oropharyngeal cancer is concomitant chemoradiation. The moderate failure rate following chemoradiation and the modest survival rate following salvage surgery could indicate that selected patients may benefit from undergoing surgery as first-line treatment. While this study did not show that functional outcomes were better for free-flap patients, it is highly likely that those who received a free-flap did better then they would have had they not undergone reconstructive surgery. More research regarding the therapeutic effects of free-flaps in OPC survivors is needed

Master\u27s Recital

List of performers and performances

Mojave Applied Ecology Notes Summer 2009

BLM and wildfire protection in the Mojave, studies of the sticky ringstem flowering phenology in Lake Mead NRA, restoration work within gypsum soils, post-fire response synthesis for Mojave and Sonoran desert

Viewpoint: A response to Screening and isolation to control methicillin-resistant Staphylococcus aureus: Sense, nonsense, and evidence

Surveillance and isolation for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) has become a controversial topic, one that causes heated debate and appears to be surrounded by both politics and industrial conflicts-of-interest. There have been calls from numerous authors for a movement away from rigid mandates and toward an evidence-based medicine approach. However, much of the evidence can be viewed with an entirely different interpretation. Two major studies with negative findings have had an adverse impact on recommendations regarding active detection and isolation (ADI) for MRSA. However the negative findings in these studies can be explained by shortcomings in study implementation rather than the ineffectiveness of ADI. The use of daily chlorhexidine bathing has also been proposed as an alternative to ADI in ICU settings. There are shortcomings regarding the evidence in the literature concerning the effectiveness of daily chlorhexidine bathing. One of the major concerns with universal daily chlorhexidine bathing is the development of bacterial resistance. The use of surveillance and isolation to address epidemics and common dangerous pathogens should solely depend upon surveillance and isolation\u27s ability to prevent further spread to and infection of other patients through indirect contact. At present, there is a preponderance of evidence in the literature to support continuing use of surveillance and isolation to prevent the spread of MRSA

The Relationship Between Tort Reform and Medical Utilization

NTRODUCTION: The hidden cost of defensive medicine has been cited by policymakers as a significant driving force in the increase of our nation\u27s health-care costs. If this hypothesis is correct, one would expect that states with higher levels of tort reform will have a decrease in Medicare utilization and that medical utilization will decrease after tort reform is enacted. METHODS: State-level reimbursement data for years 1999 to 2010 (the last year available) was obtained from the Dartmouth Atlas of Health Care. Medical tort rankings for the 50 states were obtained from the Pacific Research Institute (PRI) and correlated with state medical utilization for the year 2010. In 3 states, Mississippi, Nevada, and Texas, data were available to make pretort and posttort reform comparisons. RESULTS: Data analysis between total state Medicare Reimbursements and the PRI\u27s tort rankings showed no significant observed correlation. In 6 Medicare utilization categories (total Medicare, hospital and skilled nursing facility, physician, home health agency, hospice, and durable medical equipment), a negative trend was observed when correlated with PRI tort rankings. This trend does not support the hypothesis that defensive medicine is a major driver of health-care expenditures. Tracking expenditures in the states of Texas, Nevada, and Mississippi, before and after passage of comprehensive medical tort reform gave inconsistent results and did not demonstrate substantial or meaningful total Medicare savings. In Mississippi, there was a trend of decreased expenditures after medical tort reform was passed. However, in Texas, where 80% of the analyzed enrollees resided, there was a trend of progressive increasing expenditures after tort reform was passed. CONCLUSION: The comparison of the Dartmouth Atlas Medicare Reimbursement Data with Malpractice Reform State Rankings, which are used by the PRI, did not support the hypothesis that defensive medicine is a driver of rising health-care costs. Additionally, comparing Medicare reimbursements, premedical and postmedical tort reform, we found no consistent effect on health-care expenditures. Together, these data indicate that medical tort reform seems to have little to no effect on overall Medicare cost savings

Much Work Still to Be Done to Prevent Central Line-Associated Bloodstream Infections

Central Line Associated Bloodstream Infections (CLABSI) are all too common and often fatal events. To estimate the number of preventable CLABSIs, the authors analyzed SIR (Standardized Infection Ratio) and the number of CLABSI data from Hospital Com-pare. Several studies have suggested that an SIR of 0.35 may be achievable. If all institutions were able to perform at this level, then almost 50% of CLABSI would be prevented

Student learning: "the heart of quality" in education and training

This paper surveys the development of various approaches to quality that are essentially learning-centred: &bull;In the Schools sector: a brief overview of the Victorian Quality in Schools project; &bull;In Higher Education: work in progress at two Australian universities (Victoria University of Technology and Swinburne Universities of Technology in Melbourne); and &bull;In Vocational Education and Training: work in progress in re-orienting the policy approach to Quality towards a more flexible and learning-centred model.This paper will argue that when looked at from the perspective of the individual learner, there is a strong case for student learning to be placed at the very heart of Quality Systems in all sectors of education, and also therefore in related sectoral Quality Assurance programs and processes. <br /

View point: gaps in the current guidelines for the prevention of Methicillin-resistant Staphylococcus aureus surgical site infections

The authors advocate the addition of two preventative strategies to the current United State’s guidelines for the prevention of surgical site infections. It is known that Staphylococcus aureus, including Methicillin-resistant Staphylococcus aureus (MRSA), carriers are at a higher risk for the development of infections and they can easily transmit the organism. The carriage rate of Staph. aureus in the general population approximates 33%. The CDC estimates the carriage rate of MRSA in the United States is approximately 2%. The first strategy is preoperative screening of surgical patients for Staph. aureus, including MRSA. This recommendation is based upon the growing literature which shows a benefit in both prevention of infections and guidance in preoperative antibiotic selection. The second is performing MRSA active surveillance screening on healthcare workers. The carriage rate of MRSA in healthcare workers approximates 5% and there are concerns of transmission of this pathogen to patients. MRSA decolonization of healthcare workers has been reported to approach a success rate of 90%. Healthcare workers colonized with dangerous pathogens, including MRSA, should be assigned to non-patient contact work areas. In addition, there needs to be implemented a safety net for both the worker’s economic security and healthcare. Finally, a reporting system for the healthcare worker acquisition and infections with dangerous pathogens needs to be implemented. These recommendations are needed because Staph. aureus including MRSA is endemic in the United States. Policies regarding endemic pathogens which are to be implemented only upon the occurrence of a facility defined “outbreak” have to be questioned, since absence of infections does not mean absence of transmission. Optimizing these policies will require further research but until then we should error on the side of patient safety