Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections

OBJECTIVE: To assess agreement in diagnosing surgical site infection (SSI) among healthcare professionals involved in SSI surveillance. METHODS: Case-vignette study done in 2009 in 140 healthcare professionals from seven specialties (20 in each specialty, Anesthesiologists, Surgeons, Public health specialists, Infection control physicians, Infection control nurses, Infectious diseases specialists, Microbiologists) in 29 University and 36 non-University hospitals in France. We developed 40 case-vignettes based on cardiac and gastrointestinal surgery patients with suspected SSI. Each participant scored six randomly assigned case-vignettes before and after reading the SSI definition on an online secure relational database. The intraclass correlation coefficient (ICC) was used to assess agreement regarding SSI diagnosis on a seven-point Likert scale and the kappa coefficient to assess agreement for superficial or deep SSI on a three-point scale. RESULTS: Based on a consensus, SSI was present in 21 of 40 vignettes (52.5%). Intraspecialty agreement for SSI diagnosis ranged across specialties from 0.15 (95% confidence interval, 0.00-0.59) (anesthesiologists and infection control nurses) to 0.73 (0.32-0.90) (infectious diseases specialists). Reading the SSI definition improved agreement in the specialties with poor initial agreement. Intraspecialty agreement for superficial or deep SSI ranged from 0.10 (-0.19-0.38) to 0.54 (0.25-0.83) (surgeons) and increased after reading the SSI definition only among the infection control nurses from 0.10 (-0.19-0.38) to 0.41 (-0.09-0.72). Interspecialty agreement for SSI diagnosis was 0.36 (0.22-0.54) and increased to 0.47 (0.31-0.64) after reading the SSI definition. CONCLUSION: Among healthcare professionals evaluating case-vignettes for possible surgical site infection, there was large disagreement in diagnosis that varied both between and within specialties

Enzyme replacement therapy for mucopolysaccharidosis VI: evaluation of long-term pulmonary function in patients treated with recombinant human N-acetylgalactosamine 4-sulfatase

Pulmonary function is impaired in untreated mucopolysaccharidosis type VI (MPS VI). Pulmonary function was studied in patients during long-term enzyme replacement therapy (ERT) with recombinant human arylsulfatase B (rhASB; rhN-acetylgalactosamine 4-sulfatase). Pulmonary function tests prior to and for up to 240 weeks of weekly infusions of rhASB at 1 mg/kg were completed in 56 patients during Phase 1/2, Phase 2, Phase 3 and Phase 3 Extension trials of rhASB and the Survey Study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and, in a subset of patients, maximum voluntary ventilation (MVV), were analyzed as absolute volume in liters. FEV1 and FVC showed little change from baseline during the first 24 weeks of ERT, but after 96 weeks, these parameters increased over baseline by 11% and 17%, respectively. This positive trend compared with baseline continued beyond 96 weeks of treatment. Improvements from baseline in pulmonary function occurred along with gains in height in the younger group (5.5% change) and in the older patient group (2.4% change) at 96 weeks. Changes in MVV occurred earlier within 24 weeks of treatment to approximately 15% over baseline. Model results based on data from all trials showed significant improvements in the rate of change in pulmonary function during 96 weeks on ERT, whereas little or no improvement was observed for the same time period prior to ERT. Thus, analysis of mean percent change data and longitudinal modeling both indicate that long-term ERT resulted in improvement in pulmonary function in MPS VI patients

Deeply Dredged Submarine HIMU Glasses from the Tuvalu Islands, Polynesia: Implications for Volatile Budgets of Recycled Oceanic Crust

Ocean island basalts (OIB) with extremely radiogenic Pb-isotopic signatures are melts of a mantle component called HIMU (high µ, high 238U/204Pb). Until now, deeply dredged submarine HIMU glasses have not been available, which has inhibited complete geochemical (in particular, volatile element) characterization of the HIMU mantle. We report major, trace and volatile element abundances in a suite of deeply dredged glasses from the Tuvalu Islands. Three Tuvalu glasses with the most extreme HIMU signatures have F/Nd ratios (35.6 ± 3.6) that are higher than the ratio (∼21) for global OIB and MORB, consistent with elevated F/Nd ratios in end-member HIMU Mangaia melt inclusions. The Tuvalu glasses with the most extreme HIMU composition have Cl/K (0.11–0.12), Br/Cl (0.0024), and I/Cl (5–6 × 10−5) ratios that preclude significant assimilation of seawater-derived Cl. The new HIMU glasses that are least degassed for H2O have low H2O/Ce ratios (75–84), similar to ratios identified in end-member OIB glasses with EM1 and EM2 signatures, but significantly lower than H2O/Ce ratios (119–245) previously measured in melt inclusions from Mangaia. CO2-H2O equilibrium solubility models suggest that these HIMU glasses (recovered in two different dredges at 2500–3600 m water depth) have eruption pressures of 295–400 bars. We argue that degassing is unlikely to significantly reduce the primary melt H2O. Thus, the lower H2O/Ce in the HIMU Tuvalu glasses is a mantle signature. We explore oceanic crust recycling as the origin of the low H2O/Ce (∼50–80) in the EM1, EM2, and HIMU mantle domains