Long-range air dispersion of Candida auris in a cardiothoracic unit outbreak in Hong Kong.

BACKGROUND: Nosocomial outbreaks of Candida auris, a multidrug-resistant fungus, are increasingly reported worldwide; the mode of transmission has usually been reported to be via direct contact. Some studies previously suggested potential short-distance air dispersal during high-turbulence activities, but evidence on long-range air dispersal remains scarce. AIM: To describe a C. auris nosocomial outbreak involving two wards (H7, 5E) in two local hospitals. METHODS: Samples were taken from patients, ward surfaces (frequently touched items and non-reachable surfaces) while settle plates were used for passive air sampling to investigate possible contributions by direct contact and air dispersal. Epidemiological and phylogenetic analyses were also performed on the C. auris isolates from this outbreak. FINDINGS: Eighteen patients were confirmed to have asymptomatic C. auris skin colonization. C. auris was expectedly identified in samplings from frequently touched ward items but was also isolated in two samples from ceiling supply air grilles which were 2.4 m high and inaccessible by patients. Moreover, one sample from a corridor return air grille as far as 9.8 m away from the C. auris cohort area was also positive. Two passive air samplings were positive, including one from a cubicle with no confirmed cases for four days, suggesting possible air dispersal of C. auris. Whole-genome sequencing confirmed clonality of air, environment, and patients' isolates. CONCLUSION: This is the first study to demonstrate potential long-range air dispersal of C. auris in an open-cubicle ward setting. Ventilation precautions and decontamination of out-of-reach high-level surfaces should be considered in C. auris outbreak management.

The self-healing of defects induced by the hydriding phase transformation in palladium nanoparticles.

Nanosizing can dramatically alter material properties by enhancing surface thermodynamic contributions, shortening diffusion lengths, and increasing the number of catalytically active sites per unit volume. These mechanisms have been used to explain the improved properties of catalysts, battery materials, plasmonic materials, etc. Here we show that Pd nanoparticles also have the ability to self-heal defects in their crystal structures. Using Bragg coherent diffractive imaging, we image dislocations nucleated deep in a Pd nanoparticle during the forward hydriding phase transformation that heal during the reverse transformation, despite the region surrounding the dislocations remaining in the hydrogen-poor phase. We show that defective Pd nanoparticles exhibit sloped isotherms, indicating that defects act as additional barriers to the phase transformation. Our results resolve the formation and healing of structural defects during phase transformations at the single nanoparticle level and offer an additional perspective as to how and why nanoparticles differ from their bulk counterparts.

Inflammatory pseudotumour of the temporomandibular joint.

Head and neck inflammatory pseudotumors (IPs) are rare, idiopathic, non-neoplastic lesions that most commonly affect the orbit, but may involve other areas such as the larynx, oropharynx, paranasal sinuses, and meninges. We report the case of a 55-year-old man who presented with progressive left-sided hearing loss, aural fullness, and otalgia. Computed tomography and magnetic resonance imaging (MRI) detected a soft-tissue mass in the left temporomandibular joint (TMJ). Histopathologic examination showed overlying squamous epithelium with hyperkeratosis, parakeratosis, subepithelial fibrosis, and chronic inflammatory infiltrate, which were consistent with an IP. Radiologic images and MRI indicated an ill-defined soft tissue involving the roof and posterior aspect of the TMJ, extending into the anterior external auditory canal. Our case was treated with a 2-week course of high dose prednisone (1 mg/kg) and a 2-week taper with resolution of symptoms. Two years after treatment, the patient shows no evidence of recurrence on MRI.

Suprathermal plasma analyzer for the measurement of low-energy electron distribution in the ionosphere.

It is commonly believed that an energy transfer from thermal to suprathermal electrons (

Greater osteoporosis educational outreach is desirable among Chinese immigrants in Chinatown, Chicago.

UNLABELLED: Osteoporosis beliefs were assessed in immigrant Chinese women in Chinatown, Chicago. Results from a survey utilizing the Osteoporosis Health Belief Scale showed that women expressed concern about osteoporosis but lacked both knowledge of preventive care and health motivation. INTRODUCTION: The objective of this study was to assess osteoporosis beliefs in immigrant Chinese women in Chinatown, Chicago. METHODS: In a community-based health fair, osteoporosis knowledge and self-efficacy among postmenopausal Chinese immigrants were assessed using the translated Osteoporosis Health Belief Scale. Bone mineral density (BMD) was assessed with calcaneal ultrasound. RESULTS: The study population included 94 women with mean age of 51 +/- 9 years, mean length of residence in the United States of 9 +/- 7 years, and 73% (n = 76) of whom were recent immigrants. Women expressed concern about the seriousness of osteoporosis and their relative susceptibility to osteoporosis. In particular, women with a prior fracture reported higher seriousness to osteoporosis. Nonetheless, women exhibited low health motivation and low awareness of the benefits of calcium and exercise. Bone densitometry results corresponded to a T score of -1.2 +/- 1.5. Multiple regression analysis revealed that a younger age and longer length of residence in the USA were associated with higher BMD. CONCLUSION: Chinese immigrant women in Chicago exhibit concern regarding osteoporosis, but are unaware of the benefits of calcium and exercise, and exhibit low health motivation. Chinese women in Chinatown lack necessary knowledge about osteoporosis to develop adequate self-efficacy. Public health initiatives should be undertaken among recent immigrant Chinese women.

Parallel implementation of electronic structure energy, gradient, and Hessian calculations.

ACES III is a newly written program in which the computationally demanding components of the computational chemistry code ACES II [J. F. Stanton et al., Int. J. Quantum Chem. 526, 879 (1992); [ACES II program system, University of Florida, 1994] have been redesigned and implemented in parallel. The high-level algorithms include Hartree-Fock (HF) self-consistent field (SCF), second-order many-body perturbation theory [MBPT(2)] energy, gradient, and Hessian, and coupled cluster singles, doubles, and perturbative triples [CCSD(T)] energy and gradient. For SCF, MBPT(2), and CCSD(T), both restricted HF and unrestricted HF reference wave functions are available. For MBPT(2) gradients and Hessians, a restricted open-shell HF reference is also supported. The methods are programed in a special language designed for the parallelization project. The language is called super instruction assembly language (SIAL). The design uses an extreme form of object-oriented programing. All compute intensive operations, such as tensor contractions and diagonalizations, all communication operations, and all input-output operations are handled by a parallel program written in C and FORTRAN 77. This parallel program, called the super instruction processor (SIP), interprets and executes the SIAL program. By separating the algorithmic complexity (in SIAL) from the complexities of execution on computer hardware (in SIP), a software system is created that allows for very effective optimization and tuning on different hardware architectures with quite manageable effort.

Identification of selected hormonally active agents and animal mammary carcinogens in commercial and residential air and dust samples.

In order to characterize typical indoor exposures to chemicals of interest for research on breast cancer and other hormonally mediated health outcomes, methods were developed to analyze air and dust for target compounds that have been identified as animal mammary carcinogens or hormonally active agents and that are used in commercial or consumer products or building materials. These methods were applied to a small number of residential and commercial environments to begin to characterize the extent of exposure to these classes of compounds. Phenolic compounds, including nonylphenol, octylphenol, bisphenol A, and the methoxychlor metabolite 2,2-bis(p-hydroxyphenyl)-1,1,1-trichloroethane (HPTE), were extracted, derivatized, and analyzed by gas chromatography/mass spectrometry (GC/MS)-selective ion monitoring (SIM). Selected phthalates, pesticides, polycyclic aromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs) were extracted and analyzed by GC/MS-SIM. Residential and workplace samples showed detectable levels of twelve pesticides in dust and seven in air samples. Phthalates were abundant in dust (0.3-524 micrograms/g) and air (0.005-2.8 micrograms/m3). Nonylphenol and its mono- and di-ethoxylates were prevalent in dust (0.82-14 micrograms/g) along with estrogenic phenols such as bisphenol A and o-phenyl phenol. In this 7-sample pilot study, 33 of 86 target compounds were detected in dust, and 24 of 57 target compounds were detected in air. In a single sample from one home, 27 of the target compounds were detected in dust and 15 in air, providing an indication of chemical mixtures to which humans are typically exposed.

Best laid plans: effective implementation of re-engineering recommendations.

Continuing pressures on health care funding have led most hospitals to undertake re-engineering and restructuring projects to reduce operating expenses. Unfortunately, savings often turn out to be less than anticipated, as the projects falter in the implementation stage. As part of a two-year process improvement and expense reduction project, Toronto's St. Michael's Hospital developed an aggressive and comprehensive implementation process to ensure that it met its savings targets and maintained its financial viability. This article outlines the Hospital's implementation strategy and reviews the project's major challenges and key success factors.

How to move things around a hospital: transport logistics at St. Michael's.

Ongoing fiscal restraint challenges hospitals to focus their resources primarily on core services. Support services receive much less attention. This article describes the experience of Toronto's St. Michael's Hospital when it re-engineered its transport logistics by consolidating centralized support services into a logistics department and creating new roles and processes to enhance patient care.

The effect of age on the change in deformity after anterior débridement surgery for tuberculosis of the spine.

STUDY DESIGN: This article evaluates how an immature spine responds to anterior débridement surgery (without bone grafting) for spinal tuberculosis during growth and development. Sixty-three patients were studied, 29 of whom were children aged 10 years or less at the time of surgery, whereas the remaining 34 subjects were adults. These patients were the subject of the Medical Research Council Working Party's prospective study, started in Hong Kong in the mid-1960s. OBJECTIVES: To evaluate how an immature spine responds to débridement surgery for tuberculosis, during growth and development, to determine whether there are differences in the longitudinal pattern of deformity between children and adults, and to determine the influence of disproportionate spinal growth on the progression of deformity in children. SUMMARY OF BACKGROUND DATA: All patients were followed prospectively for a mean period of 19.6 years after débridement surgery. The mean age at surgery for children (n = 29) was 4.3 years and for adults (n = 34) 35.3 years. METHODS: The kyphos and deformity angles were measured from lateral spinal radiographs obtained at preoperative evaluation and postoperatively at 6 months, 1 year, 5 years, and at final follow-up evaluation using an electronic digitizer. RESULTS: The results showed that the longitudinal pattern of changes in the mean kyphos and deformity angles in young children presented a picture slightly different from that in adults. The mean angles were increased at the 6-month and at 1-year evaluations after débridement surgery in both groups. Afterward, in children there was some spontaneous correction in these mean angles, whereas in adults these angles showed variation according to the site of lesion during the follow-up years. Statistical analysis according to the site of spinal lesion showed that in thoracic tuberculosis, there was an increase in kyphos and deformity angles at the 6-months postoperative evaluation (more in children than in adults). There were no significant changes in these angles from the 1-year to the final follow-up evaluations. In thoracolumbar tuberculosis, there were significant increases in kyphos and deformity angles at the 6-month postoperative evaluation, and thereafter adults did not show any significant change until final follow-up examination, whereas children showed a tendency toward spontaneous correction, although this finding was not statistically significant. In lumbar tuberculosis, there was an equal tendency toward spontaneous correction in children and adults from 1 postoperative year onward. CONCLUSIONS: The authors could find no evidence of disproportionate posterior spinal growth, which has been suspected in the past to be a factor involved in contributing to progression of kyphotic deformity after anterior débridement surgery for spinal tuberculosis.

Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis.

STUDY DESIGN: The effectiveness of duration of antituberculous chemotherapy in conjunction with radical surgery for tuberculosis of the spine is reported. One hundred fourteen patients were followed prospectively for a mean period of 14.6 years after radical resection of the tuberculous lesion and reconstruction of the resultant gap with bone graft. OBJECTIVE: To evaluate the efficacy of short-course antituberculous chemotherapy in relation to the standard 18-month chemotherapy in conjunction with radical surgery for tuberculosis of the spine. SUMMARY OF BACKGROUND DATA: One hundred fourteen patients who were subjects of the Medical Research Council's (London, UK) prospective study underwent radical resection of the lesion and anterior arthrodesis of the spine. These patients received 6, 9, and 18 months of antituberculous chemotherapy. Those who received 6- and 9-month chemotherapy received streptomycin, rifampicin, and isoniazid. Streptomycin was given for the first 3 months, and the other two drugs were continued for 6 or 9 months. Those who received 18 months of chemotherapy were given streptomycin (first 3 months), sodium para-aminosalicylic acid, and isoniazid. METHODS: These patients were followed longitudinally, and at each visit, clinical and radiologic data were collected at 1-month intervals up to 3 months postoperatively, at 3-month intervals to 30 months postoperatively, at 6-month intervals up to 5 years postoperatively, and at 12-month intervals to the conclusion of study (minimum, 10 years). For assessment of spinal deformity, the "deformity angle" was measured on lateral spinal radiographs obtained at each visit. RESULTS: Six-month, 9-month, and 18-month chemotherapeutic regimens in association with radical surgery produced similar clinical results with no recurrence or reactivation of tuberculosis. The changes in deformity angles at final follow-up evaluation compared with 6-month postoperative values were not statistically significantly different in the groups who underwent 6 months, 9 months, and 18 months of chemotherapy. CONCLUSIONS: The authors' findings show that a 6-month chemotherapeutic regimen combined with surgical excision and bone grafting is adequate for management of tuberculosis of the spine, as it produced clinical and radiologic results comparable with the 18-month chemotherapeutic regimen.

The effect of age on the change in deformity after radical resection and anterior arthrodesis for tuberculosis of the spine.

We compared the long-term changes in spinal deformity after a radical operation for tuberculosis of the spine in thirty-three children who were ten years old or younger at the time of the operation with those of seventy-one adult patients who were at least eighteen years old at the time of the operation. The spinal deformity was measured with use of the angles of kyphosis and deformity as assessed on lateral spinal radiographs made preoperatively and postoperatively at six months, one year, and five years and at the most recent follow-up evaluation (at a mean of fifteen years). We detected no significant difference in the mean angles of kyphosis and deformity between the children and the adults postoperatively at any follow-up evaluation; thus, we found that growth of the posterior portion of the spine does not contribute to the progression of deformity after a radical anterior procedure. The children who had tuberculosis of the thoracic spine had much better correction than the adults at the six-month follow-up examination. This correction was maintained. However, there were no such differences in the correction of the deformity between the adults and the children who had tuberculosis of the thoracolumbar or the lumbar spine. Our findings clearly show that a short anterior spinal arthrodesis done at an early age was not associated with progression of deformity during growth and development in our patients. The longitudinal pattern of changes in deformity was similar in the children and the adults, and there was no evidence of disproportionate posterior spinal growth contributing to the progression of deformity after anterior spinal arthrodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal changes in spinal deformity after anterior spinal surgery for tuberculosis of the spine in adults. A comparative analysis between radical and debridement surgery.

Of 112 patients who entered the Medical Research Council's prospective study on the surgical management of spinal tuberculosis, 105 were available for review at a mean follow-up of 15.3 years postoperatively. All these patients were age 18 years or more at the time of surgery. Seventy-one patients had radical surgery; the remaining 34 underwent debridement surgery. The longitudinal changes in spinal deformity were evaluated using kyphus and deformity angles from lateral spinal radiographs obtained at preoperative evaluation, postoperatively at 6 months, 1 year, and 5 years, and at final follow-up. The mean kyphos and deformity angles showed correction after radical surgery at 6 months' evaluation; thereafter there were minimal variations up to final follow-up. Those who underwent debridement surgery showed an increase in these angles at 6 months postoperative evaluation; thereafter there were practically no changes in thoracic and thoracolumbar tuberculosis, whereas in lumbar tuberculosis there was spontaneous correction from 1 year post-surgery onward. The changes in mean kyphos and deformity angles at 6 months postoperative evaluation from their preoperative values were significantly different between the two surgical groups, where radical surgery produced better correction. Thus, the choice of surgery--radical or debridement--is important in determining the fate of spinal deformity in the management of tuberculosis of the spine.

Titanium-mesh block replacement of the intervertebral disk.

A prospective clinical trial was conducted involving patients with prolapsed lumbar intervertebral disk proven myelographically, who had anterior diskectomy and disk replacement with a titanium-mesh block implant. A pilot study was done in 1971 on six patients. In this trial, 28 patients were operated on with informed consent. Twenty-three had a minimum of five years' follow-up study. There were 14 men and boys, and nine women and girls. The average follow-up period was eight years and four months (range, five to 12 years three months). The average age at operation was 36 years four months (range, 13-66 years). Symptomatic improvement were divided into three groups. Sixteen patients were in Group 1, three in Group 2, and three in Group 3. Flexion-extension radiographs showed 14 patients with no movement between the vertebral bodies adjacent to the operated disk, five with minimal movement, and four with definite movement. At the implant-bone interface, no radiolucent zone was seen in 18 patients, and a definite radiolucent zone was seen in five. Twenty implants were intact, three implants had developed a crack, and three were deformed. There were no complications. The titanium-mesh block implant is an effective substitute for autogenous bone grafting in interbody fusion.

17-year prospective study of surgical management of spinal tuberculosis in children. Hong Kong operation compared with debridement surgery for short- and long-term outcome of deformity.

A comparative analysis of the short and long-term results of two surgical procedures, radical excision or debridement, for the management of spinal tuberculosis in children is reported. Eighty children (47 treated with radical surgery and 33 with debridement) were prospectively studied and followed to maturity (mean follow-up, 17 years postoperatively). The kyphus and deformity angles were measured from lateral spinal radiographs using an electronic digitizer. The results can be summarized as follows: 1) Long-term clinical outcome of the two surgical procedures were equally good for recovery of neurologic deficit and relief of pain. There was no incidence of reactivation and/or recurrence of tuberculous lesion in either group; 2) The mean changes in kyphus and deformity angles at the 6-month postoperative evaluation compared to their preoperative value were significantly different for the two surgical groups. There was an overall correction in these angles after radical surgery, whereas there was a deterioration after debridement surgery; 3) There were no significant differences in the changes in kyphus or deformity angles at final follow-up from their 6-month postoperative measurements between the two surgical groups; 4) The majority of children (56%) showed an improvement in deformity angle of 5 degrees or more after radical surgery at the 6-month postoperative evaluation, whereas 69% of children showed deterioration after debridement surgery; 5) At final follow-up in lumbar tuberculosis, 60% of patients in the debridement group had 10 degrees or more kyphus angle, whereas only one patient in the radical group had a kyphotic lumbar spine due to graft failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Mutations for the autosomal recessive and autosomal dominant forms of polycystic kidney disease are not allelic.

The autosomal dominant form of polycystic kidney disease (ADPKD) has been linked to the alpha-globin gene locus on 16p. Linkage studies between the autosomal recessive type (ARPKD) and the 3' HVR of the alpha-globin gene cluster showed that the ARPKD and ADPKD are not allelic.

Avascular necrosis of the dens: a follow-up study.

In order to determine the long-term consequences of avascular necrosis of the dens following halo-pelvic traction, 83 patients who had had their halo-pelvic apparatus removed at least five years previously were studied. Avascular necrosis of the dens was found in 31 patients (37%) within one year of removal of the apparatus, but after a minimum of five years the early bony changes had resolved and there was no evidence of atlantoaxial instability. However, 19% of patients who had had avascular necrosis had moderate or severe neck symptoms.

Surgical treatment of scoliosis following poliomyelitis. A review of one hundred and ten cases.

We reviewed the cases of 110 patients with paralytic scoliosis due to poliomyelitis who were operated on. In the lumbar region, anterior Dwyer instrumentation with posterior fusion gave excellent correction of scoliosis and pelvic obliquity. In the more rigid thoracic curves, combined anterior Dwyer instrumentation and posterior fusion gave better results than posterior fusion alone, but had more morbidity. Long c-shaped curves benefited more from a combined anterior Dwyer procedure at the apex of the curve and long posterior Harrington instrumentation. Traction was found to be of use only in rigid curves and in those larger than 80 degrees. With combined anterior and posterior fusion, there was a pseudarthrosis rate of 7 per cent in lumbar curves, none in thoracic curves, and 12.5 per cent in long c-shaped curves. The pseudarthrosis rate rose to more than 25 per cent in patients who had a posterior fusion alone.