Evaluation of swabbing methods for estimating the prevalence of bacterial carriage in the upper respiratory tract: a cross sectional study.

OBJECTIVES: Bacterial carriage in the upper respiratory tract is usually asymptomatic but can lead to respiratory tract infection (RTI), meningitis and septicaemia. We aimed to provide a baseline measure of Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae and Neisseria meningitidis carriage within the community. Self-swabbing and healthcare professional (HCP) swabbing were compared. DESIGN: Cross-sectional study. SETTING: Individuals registered at 20 general practitioner practices within the Wessex Primary Care Research Network South West, UK. PARTICIPANTS: 10,448 individuals were invited to participate; 5394 within a self-swabbing group and 5054 within a HCP swabbing group. Self-swabbing invitees included 2405 individuals aged 0-4 years and 3349 individuals aged ≥5 years. HCP swabbing invitees included 1908 individuals aged 0-4 years and 3146 individuals aged ≥5 years. RESULTS: 1574 (15.1%) individuals participated, 1260 (23.4%, 95% CI 22.3% to 24.5%) undertaking self-swabbing and 314 (6.2%, 95% CI 5.5% to 6.9%) undertaking HCP-led swabbing. Participation was lower in young children and more deprived practice locations. Swab positivity rates were 34.8% (95% CI 32.2% to 37.4%) for self-taken nose swabs (NS), 19% (95% CI 16.8% to 21.2%) for self-taken whole mouth swabs (WMS), 25.2% (95% CI 20.4% to 30%) for nasopharyngeal swabs (NPS) and 33.4% (95% CI 28.2% to 38.6%) for HCP-taken WMS. Carriage rates of S. aureus were highest in NS (21.3%). S. pneumoniae carriage was highest in NS (11%) and NPS (7.4%). M. catarrhalis carriage was highest in HCP-taken WMS (28.8%). H. influenzae and P. aeruginosa carriage were similar between swab types. N. meningitidis was not detected in any swab. Age and recent RTI affected carriage of S. pneumoniae and H. influenzae. Participant costs were lower for self-swabbing (£41.21) versus HCP swabbing (£69.66). CONCLUSIONS: Higher participation and lower costs of self-swabbing as well as sensitivity of self-swabbing favour this method for use in large population-based respiratory carriage studies.

Coronary blood flow during +Gz stress in +Gz conditioned adult miniature swine.

Four female adult miniature swine were acceleration conditioned for a period of 1 month using repeated acute exposure to simulated aerial combat maneuver profiles which exposed the animals to an average of +4.5G, for 106s. This period of conditioning produced adaptation as evidenced by decreased maximal heart rates during +Gz and by the absence of any +Gz induced gross cardiac pathology. Coronary blood flow was measured in these conditioned animals with the radiolabeled microsphere technique. Blood flows were measured under resting conditions, during 60s exposures to +3Gz and +5Gz and 10 min after +5Gz exposure. Coronary flow was increased 2-3 fold during +3Gz and +5Gz. The regional distribution of coronary blood flow during +Gz was similar to that under resting control conditions. There were no significant differences between coronary blood flows during +Gz in these conditioned animals and the values previously reported from the initial exposure of miniature swine to similar levels of +Gz. These results indicate that 1 month of acceleration conditioning of the types used in these studies has no significant effect on the response of coronary blood flow to +3Gz and +5Gz stress.

Coronary blood flow in conscious miniature swine during +GZ acceleration stress.

One of the factors determining tolerance to +GZ acceleration may be the ability to maintain adequate coronary blood flow. Consequently, the purpose of these studies was to determine the effect of acute exposure (60 s) to several levels of positive acceleration (+GZ) on total and regional coronary blood flow in conscious adult miniature swine. Blood flow was measured with the radiolabeled microsphere technique in chronically instrumented miniature swine during 60-s exposures to accelerations of +3 GZ, +5 GZ, or +7 GZ with anti-G suit support. All levels of acceleration stress caused two- to threefold increases in coronary blood flow. The regional distribution of coronary blood flow during +GZ was similar to that under resting control conditions as long as aortic diastolic pressure was maintained. All left ventricular endocardial/epicardial flow ratios were significantly greater than one, except in two animals, during exposure to +7 GZ. These were the only animals to have aortic diastolic pressures less than 100 Torr during +GZ stress. These studies indicate that, if an animal is able to compensate and maintain a cardiovascular steady State, coronary blood flow will remain adequate for myocardial needs. However, if decompensation occurs and aortic diastolic pressure falls below a critical value, subendocardial blood flow may become inadequate.

Renal blood flow in miniature swine during +GZ stress and anti-G suit inflation.

The effects of +GZ acceleration stress on renal blood flow were studied in chronically instrumented, conscious miniature swine. Renal blood flow was determined using the radiolabeled (46Sc, 85Sr, 141Ce, and 125I) microsphere technique (29 animals) and Doppler-principle flow probes (1 animal). The results obtained with the microsphere technique indicate that +GZ exposure with anti-G suit support caused decreases in renal blood flow throughout the kidney, and that renal blood flow remains decreased for 1-10 min after +GZ stress. Medullary blood flow appeared to recover after +GZ exposure more rapidly than cortical blood flow. The flow probe data also indicate that +GZ stress with or without anti-G suit support results in decreases in renal blood flow, and that anti-G suit inflation in the absence of +GZ can also cause significant decreases. We conclude that the reductions in renal blood flow observed in miniature swine, during +GZ stress with anti-G suit support, may be due to a combination of direct anti-G suit interference and +GZ-induced reflex increases in alpha-constrictor sympathetic tone to the renal vascular bed.

Frank orthogonal vectorcardiograms in humans during and after exposure to +Gz acceleration stress.

Frank orthogonal vectorcardiograms (VCGs) were recorded from 10 subjects prior to, during, and for 15 min after exposures to +3Gz , +5Gz, and +7Gz. The order of acceleration exposure was randomized, with the individual exposures separated by at least 1 week. Standard USAF anti-G suits were worn by all subjects. Detailed analysis of the scalar lead electrocardiograms revealed no abnormalities. There were no consistent signs of conduction disturbances or ischemic ST-T segment changes. The QRS axis of the VCG demonstrated posterior rotation in the sagittal plane and counterclockwise rotation in the transverse plane during +Gz stress. The changes in the VCGs recorded during +Gz stress appeared to be related to rotational changes of the heart due to mechanical stress and/or motion within the thorax. There were no ECG or VCG changes indicative of myocardial ischemia and/or damage during or after +Gz stress.

Regional cerebral blood flow in conscious miniature swine during high sustained +Gz acceleration stress.

The two major factors limiting performance during high +Gz acceleration stress are loss of vision, and loss of consciousness. These symptoms are believed to occur as a result of insufficient blood flow to the retina and brain. This study was conducted to determine the effects of +Gz stress on regional cerebral blood flow. Cerebral blood flow (CBF) was measured in 22 conscious, female, miniature swine with the radio-labeled microsphere technique. Acceleration exposures consisted of 60-S plateaus at +3Gz, +5Gz or +7Gz. Microsphere infusions were made before, during, 1.0-6.0 min after, and 10 min after +Gz. Blood flow to the retina was significantly decreased during exposure to +5Gz and ceased during exposure to +7Gz stress. Mean, resting control CBF was 34 +/- 4 ml/min/100 g. Exposure to +3Gz and +5Gz had no significant effect on CBF. Exposure to +7Gz appeared to cause a redistribution of CBF, with blood flow to the brain stem being preserved and flow to the cerebrum being diminished.