To tell or not to tell - disclosure of autism in the workplace.

Autism, sometimes called an 'invisible disability', can lead to different difficulties for young adults entering the workplace as well as maintaining the job. One of the questions young adults with autism face: should he/she/they disclose the information about their autism to the employer? This current study aims to fill a gap in research on the young adult population with autism in the workplace, particularly within the Latvian context. Four young adults (aged 18-26) living and working in Latvia, who have identified themselves as having autism, job seekers and employees with strong language and intellectual abilities, and their mothers participated in this study. Qualitative semi-structured interviews were conducted to gather in-depth data from participants; after that, an inductive content analysis was made. The results reveal that young adults do not disclose that they have autism to neither co-workers nor employers, yet at the same time, they are ready to disclose it to close friends outside of the workplace. Four main reasons for not disclosing their status on the autism spectrum emerged. To begin with, young adults did not want to be treated differently; they wanted to be perceived as 'normal'. Second, they feared social stigma. Third, they did not feel there could be any benefits by disclosing their autism to their employer. Finally, it is much more important to explain to their employer what the often-unique limitations of each specific young person with autism are and how to overcome them than to just inform only of their autistic status.

In training emergency physicians the carotid artery Doppler with passive leg raise, does previous sonographic experience influence scan time and competency?

BACKGROUND: Determination of fluid responsiveness (FR) associated with intravascular fluid resuscitation in hypotensive patients poses a challenge, with current best evidence methods fraught with poor retest reliability and difficulty in image acquisition (Osman, Crit Care Med 2007; 35: 64; Marik, Crit Care Med 2009; 37: 2642). Doppler carotid blood flow with passive leg raise (PLR) is a recent modality for determining FR (Marik, Chest 2013; 143: 364). PURPOSE: This study aimed to determine whether emergency physicians with limited ultrasound experience can reliably acquire this skill. METHOD: This prospective study recruited 60 emergency physicians with varying experience, who underwent a 3-step learning programme. Participants performed carotid velocity time integral (VTi) Doppler on healthy subjects, followed by repeat measurements in the PLR position. A 16-point checklist and time recorded were assessed for each sonographer, with each participant completing a post-study questionnaire to evaluate perceived competence and ease of skill acquisition. RESULTS: Of the 60 emergency physicians recruited, 37 (61.6%) were inexperienced and 23 (38.4%) were experienced. Against the 16-point assessment, 61% completed assessment without any errors. Fifty-six out of 60 (94.3%) completed the assessment to acceptable standard with errors recognised and corrected, and four participants (6.7%) made critical errors without correction (Figure 1). Average (±SEM) total scan time was 4:52 ± 0:19, with no significant difference found between inexperienced and experienced groups. CONCLUSIONS: This study demonstrated feasibility to train emergency physicians, demonstrating that average FR assessment was obtained within 5 min, with no difference between prior experience in scan quality/time taken. 94% completed the scan to acceptable standards, demonstrating ease of carotid Doppler flow with PLR to provide critical information in management of the hypotensive patient.

Shaken but prepared: Analysis of disaster response at an academic medical centre following the Boston Marathon bombings.

Over the last decade, there has been a rise in the number of mass casualty incidences (MCIs) and their subsequent effect on hospital systems. While there has been much discussion over improving procedures to treat victims of MCIs, there has not been a thorough, systems-based analysis concerning the costs incurred by hospitals during such events. Here the authors examine the history of the Hospital Incident Command Center and how its evolution at Tufts Medical Center helped mitigate the damage following the Boston Marathon Bombings. Tufts' unique variations to the Hospital Incident Command Center include strategic communication hierarchies and a 'zero cost centre' financial system which both provided for a quick and adaptive response. Operating in collaboration with the Conference of Boston Teaching Hospitals encouraged coordination and preparation during emergency situations such as mass casualty events. The direct and indirect effects on Tufts Medical Center stemming from the Boston Marathon Bombings were analysed. Tufts MC treated 36 victims immediately following the MCI. The estimated total cost during the week of April 15 to April 19, 2013 was $776,051. The cost was primarily comprised of lost revenue from cancelled outpatient and inpatient hospital services, as well as expenses incurred due to overtime pay, salary expenses, PPE kits and hospitality services. Finally, the authors examine ways to reduce the future costs during emergency situations through increasing communication with employees, understanding the source of all direct expenses, and mitigating excess risk by developing partnerships with other hospital systems.

Effect of pH and oxygen on biofilm formation in acute otitis media associated NTHi clinical isolates.

OBJECTIVES/HYPOTHESIS: Biofilms occur in animal models of acute otitis media (AOM) and in children with recurrent AOM (rAOM) and chronic otitis media with effusion (OME). We therefore studied the ability of nontypeable Haemophilus influenzae (NTHi) strains from children to form biofilms in vitro under conditions we presumed occurred in the middle ear during AOM, rAOM, and OME. STUDY DESIGN: Evaluate NTHi isolates for biofilm formation across a pH range under aerobic, microaerophilic, and anaerobic conditions. METHODS: Using a crystal violet biofilm assay we studied 12 NTHi pediatric clinical isolates to investigate biofilm formation over a pH range of 4.5 to 10 under aerobic, microaerophilic, and anaerobic conditions. RESULTS: Our findings included: 1) not all clinical NTHi strains form biofilms (75% did); 2) the pH of middle ear fluid collected from AOM (n = 170; age range, 4-36 months), rAOM (n = 54; age range, 7-36 months), and OME (n = 30; age range, 9-60 months) subjects tested immediately after withdrawal was similar (mean = 8.0;range 7.0-9.0); 3) biofilms formed optimally at pH 8.0, a finding that is consistent with previous studies by other investigators; 4) biofilms did not form under aerobic conditions as likely occurs in AOM, whereas under microaerophilic and anaerobic conditions biofilm formation was observed as likely occurs during rAOM and OME. CONCLUSIONS: We concluded that biofilm formation by NTHi does not occur in all strains, occurs best where the pH = 8.0 and in anaerobic conditions as likely occurs in children during rAOM and OME. However, biofilm formation is limited or absent under aerobic conditions as likely occurs during AOM. LEVEL OF EVIDENCE: NA.

Ultrasound imaging and characterization of biofilms based on wavelet de-noised radiofrequency data.

The ability to non-invasively image and characterize bacterial biofilms in children during nasopharyngeal colonization with potential otopathogens and during acute otitis media would represent a significant advance. We sought to determine if quantitative high-frequency ultrasound techniques could be used to achieve that goal. Systematic time studies of bacterial biofilm formation were performed on three preparations of an isolated Haemophilus influenzae (NTHi) strain, a Streptococcus pneumoniae (Sp) strain and a combination of H. influenzae and S. pneumoniae (NTHi + Sp) in an in vitro environment. The process of characterization included conditioning of the acquired radiofrequency data obtained with a 15-MHz focused, piston transducer by using a seven-level wavelet decomposition scheme to de-noise the individual A-lines acquired. All subsequent spectral parameter estimations were done on the wavelet de-noised radiofrequency data. Various spectral parameters-peak frequency shift, bandwidth reduction and integrated backscatter coefficient-were recorded. These parameters were successfully used to map the progression of the biofilms in time and to differentiate between single- and multiple-species biofilms. Results were compared with those for confocal microscopy and theoretical evaluation of form factor. We conclude that high-frequency ultrasound may prove a useful modality to detect and characterize bacterial biofilms in humans as they form on tissues and plastic materials.

Differentiation of banding patterns between Streptococcus mutans and Streptococcus sobrinus isolates in rep-PCR using ERIC primer.

BACKGROUND: Streptococcus mutans and Streptococcus sobrinus are considered to be important bacterial species in the initiation of human dental caries. Therefore, the establishment of a reliable genotyping method to distinguish S. mutans from S. sobrinus is of central importance. OBJECTIVE: We assessed the usefulness of repetitive extragenic palindromic polymerase chain reaction (rep-PCR) using ERIC primer banding patterns in differentiating S. mutans and S. sobrinus. DESIGN: Five S. mutans and two S. sobrinus prototype strains and 50 clinical isolates (38 S. mutans serotype c, 4 S. sobrinus serotype d, and 8 S. sobrinus serotype g) were examined. The banding patterns of amplicons generated were compared among the prototype strains and clinical isolates, to find common bands that distinguish S. mutans and S. sobrinus. RESULTS: Multiple banding patterns were seen with all strains tested. The representative strains of S. mutans tested revealed six unique, strong bands at 2,000 bp, 1,700 bp, 1,400 bp, 1,100 bp, 850 bp, and 250 bp, whereas S. sobrinus had seven strong bands at 2,000 bp, 1,800 bp, 1,100 bp, 900 bp, 800 bp, 600 bp, and 550 bp. The band at 1,100 bp was the only band that was observed in both S. mutans and S. sobrinus. Furthermore, most clinical S. mutans isolates revealed identical banding patterns. All S. mutans had amplicons at 1,700 bp, 850 bp, and 250 bp, whereas those of S. sobrinus were at 1,100 bp, 900 bp, and 800 bp. CONCLUSIONS: These results indicate that using rep-PCR with the ERIC primers can distinguish between S. mutans and S. sobrinus.

Real-time quantitative polymerase chain reaction for enumeration of Streptococcus mutans from oral samples.

This study compared SYBR Green real-time quantitative PCR (qPCR) with standard plate counting for the enumeration of Streptococcus mutans in oral samples. Oral samples (n = 710) were collected from high-caries-risk children for quantification of S. mutans by qPCR using primer pairs. The S. mutans copy number was calculated with reference to a qPCR quantification cycle (Cq) standard curve and compared with the absorbance value at 600 nm of a standard suspension of S. mutans UA159. The S. mutans copy number results were evaluated in relation to standard plate count (SPC) results obtained from each sample following culture on Petri plates containing S. mutans selective media and reported as colony-forming units (CFUs). The mean S. mutans copy number calculated from qPCR was higher than the SPC CFUs (1.3 × 10(6) and 1.5 × 10(5) CFUs, respectively). The qPCR values were usually higher in individual samples and qPCR detected the presence of S. mutans 84% (231/276) of the time that the SPC did not, compared with 33% (4/12) of the time when qPCR failed to detect S. mutans and the SPC did. The qPCR technique was found to be more sensitive for detection of S. mutans from oral samples, a method that is not dependent on the viability of the sample taken and therefore is proposed as a more reliable and efficient means of quantification of S. mutans.

Maternal transmission of mutans Streptococci in severe-early childhood caries.

PURPOSE: This study utilized multiple genetic analyses to detect evidence of maternal MS acquisition in children with S-ECC. METHODS: Twenty-seven mother/child pairs were selected from children with 5-ECC preceding dental rehabilitation under general anesthesia. Plaque samples were collected from the mother, child, and the child's carious lesion. Arbitrarily primed-polymerase chain reaction (AP-PCR) genotyped 6-8 MS isolates from each plaque sample, and unique genotypes were identified. Representative MS isolates with unique genotypes were characterized by pulsed-field gel electrophoresis (PFGE). Cluster analysis using the Dice band-based similarity coefficient was used to generate dendrograms from gel bonding patterns. A Dice coefficient >70% indicated similarity or match among PFGE genotypes. RESULTS: In 26% (7/27) of mother/child pairs, all of the child's isolates matched the mother. In 15% (4/27), some of the child's genotypes matched the mother, and in 59% (16/27), no isolates matched the mother. Maternal transmission was a mode of MS acquisition in 41% (11/27) of mother/child pairs, while acquisition from non-maternal sources occurred in 74% (20/27). CONCLUSIONS: MS genotypes that did not match maternal strains were identified in the majority of children (74%) within this S-ECC population. Evidence of maternal transmission was detected in 41% of mother/child pairs.