Bayesian evidence and epidemiological implications of environmental contamination from acute respiratory infection in long-term care facilities.

Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8-95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9-72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.

Haploidentical hematopoietic stem cell transplantation in children with high-risk hematologic malignancies: outcomes with two different strategies for GvHD prevention. Ex vivo T-cell depletion and post-transplant cyclophosphamide: 10 years of experience at a single center.

Forty patients with high-risk hematologic malignancies, median age 9 years, underwent haploidentical-HSCT from April 2005 to April 2015. Seventeen patients were transplanted with CD3-depleted PBSCs by negative selection (TCD group) following a reduced-intensity conditioning regimen (RIC), and 23 patients received T-cell-replete PBSCs followed by post-transplantation cyclophosphamide (PT-Cy group) after myeloablative conditioning (n=16) or RIC (n=7). Outcomes are reported for the TCD and PT-Cy recipients, respectively. Engraftment was achieved in 88% versus 100%. Median time to neutrophils>500/µL was 10 days versus 15 days. Platelets>20 000/µL occurred at a median of 16 days versus 20 days, respectively. Transplant-related mortality (TRM) was 24% versus 26% at 1 year. The cumulative incidence (CI) of grade III-IV acute GvHD was 7% versus 5%, and chronic GvHD 9% versus 53% (P=0.029). Relapse at 2 years was 31% versus 24%. Actuarial overall survival rates at 2 years were 47% versus 48%. Causes of death were infections (n=3), sinusoidal obstructive syndrome (n=4), acute GvHD (n=2) and relapse (n=9). These results indicate that haploidentical-HSCT is feasible in Uruguay. The TRM rate is of concern and should be the focus of continuing attention. Chronic GvHD risk was higher in the PT-Cy approach, so modifications are justified.

Attitudes toward occupations for deaf youth in Sweden.

The study investigated the expressed advice of parents, teachers, and Deaf community leaders regarding careers for deaf students in Sweden. The research was conducted: (a) in a country where consensus has been achieved on recognition and accommodation of the educational needs of deaf students; (b) in a city with a very high concentration of deaf individuals, a continuum of educational facilities, and support for deaf students ranging from preschool through college; and, (c) in a community with a strong and active deaf organization and parent organization. The authors found that, despite many advances in the country, communication in the language of the greater society is a potent factor in limiting occupational possibilities for the Deaf.

Attitudes of teachers and parents in India toward career choices for deaf and hearing people.

The attitudes of teachers and parents of deaf children in India toward career choices for deaf and hearing people were investigated with respondents rating the suitability of eight professions for an imagined group of equally qualified deaf and hearing advisees. The attitudes of parents and teachers in India were found to be similar to those reported in previous studies conducted in the United States, Italy, England, and South Africa and showed that the hearing status of the imagined advisees selectively influenced the respondents' ratings of their suitability for those professions. These results suggested that differences in the availability of educational or technological support for deaf people do not necessarily lead to differences in attitudes regarding career choices for deaf people.

Repeated direct fetal intravascular high-dose immunoglobulin therapy for the treatment of Rh hemolytic disease.

Recently, administration of high-dose intravenous immunoglobulin (HDivIG) either to the mother or the neonate has been proposed in an effort to prevent progressive hemolysis in Rh(D) perinatal disease, but no cases have been published with direct fetal HDivIG administration. We report a case in which HDivIG was repeatedly administered by cordocentesis to a fetus affected by Rh(D) disease from 28 to 36 weeks gestation, at doses of approximately 450 mg/kg. The fetus required no transfusions, and the neonatal evolution was satisfactory. The treatment, performed at three weeks intervals, seemed to be useful in preventing fetal hemolysis. No fetal complications were present. Recurrent administration of HDivIG therapy to the fetus in cases of severe Rh(D) disease, appears to be feasible and free of serious complications to the fetus or the mother.

Cumulative trauma disorders among educational interpreters. Contributing factors and intervention.

Upper extremity cumulative trauma disorders became a potentially significant occupational hazard among sign language interpreters at the National Technical Institute for the Deaf in the 1988-89 academic year. The following case control study was conducted to identify factors that might play a role in developing, exacerbating, and maintaining upper extremity cumulative trauma disorders among interpreters. Investigations were conducted to determine whether medical status, physical capacities, interpreting styles, pain, fatigue, and job stress differed among NTID's sign language interpreters. This report provides a general summary of selected findings as well as a conceptual framework that should help clarify the factors associated with upper extremity cumulative trauma disorders in sign language interpreters. The results indicated that the upper extremity cumulative trauma disorder diagnosed most often is tendinitis rather than a nerve entrapment syndrome (e.g., carpal tunnel syndrome). Analysis of the frequency of potential biomechanical risk factors indicated that those reporting pain demonstrated higher frequency of hand and wrist deviations from the neutral position, higher frequency of the upper extremities leaving a predefined work space, fewer rest breaks during interpreting sessions, and higher evaluator ratings of pace of finger and hand movements. Specific features of interpreting styles were associated with increased pain and fatigue.

Primary structure of the glycans of porcine pancreatic lipase.

The glycan primary structure of the main glycopeptide fraction obtained by pronase and carboxypeptidase A digestions of porcine pancreatic lipase has been investigated by 500-MHz 1H-NMR spectroscopy and methylation analysis. The results demonstrate that the glycopeptide fraction was a mixture containing the following structures: (formula; see text)

Leukapheresis in a patient with Sézary syndrome.

A patient with Sézary syndrome refractory to cytotoxic agents underwent leukapheresis on the Aminco continuous flow centrifuge. Five procedures were performed over a 15-day period. A total of 6.9 X 10(9) cells were removed. The patient's skin lesions and lymphadenopathy regressed. Repeated removal of the buffy coat by leukapheresis has not resulted in thrombocytopenia. It is concluded that cytapheresis may be effective in this clinical condition even when the peripheral leukocyte count is normal.