Mind the gap: Patterns of red blood cell product usage in South Africa, 2014 - 2019.

BACKGROUND: A key component of any successful healthcare system is the availability of sufficient, safe blood products delivered in an equitable manner. South Africa (SA) has a two-tiered healthcare system with public and privately funded sectors. Blood utilisation data for both sectors are lacking. Evaluation of blood utilisation patterns in each healthcare sector will enable implementation of systems to bring about more equality. OBJECTIVES: To conduct a critical evaluation of red blood cell (RBC) product utilisation patterns at the South African National Blood Service (SANBS). METHODS: Operationally collected data from RBC requests submitted to SANBS blood banks for the period 1 January 2014 - 31 March 2019 were used to determine temporal RBC product utilisation patterns by healthcare sector. Demographic patterns were determined, and per capita RBC utilisation trends calculated. RESULTS: Of the 2 356 441 transfusion events, 65.9% occurred in the public and 34.1% in the private sector. Public sector patients were younger (median (interquartile range (IQR)) 33 (22 - 49) years) than in the private sector (median (IQR) 54 (37 - 68) years), and mainly female in both sectors (66.2% in the public sector and 53.4% in the private sector). Between 2014 and 2018, per capita RBC utilisation decreased from 11.9 to 11.0/1 000 population in the public sector, but increased from 34.8 to 38.2/1 000 population in the private sector. CONCLUSIONS: We confirmed distinctly different RBC utilisation patterns between the healthcare sectors in SA. Possible drivers for these differences may be healthcare access, differing patient populations and prescriber habits. Better understanding of these drivers may help inform equitable public health policy.

Olfactory Cues From Host- and Non-host Plant Odor Influence the Behavioral Responses of Adult Drosophila suzukii (Diptera: Drosophilidae) to Visual Cues.

While trapping methods for Drosophila suzukii Matsumura (Diptera: Drosophilidae) have typically relied on fermentation volatiles alone or in association with a visual stimulus, the relative contribution of visual and olfactory stimuli to the food- and host-seeking behavior of D. suzukii is poorly understood. This study quantified the type of response exhibited by male and female D. suzukii to color and the effects that volatiles (fermentation, fresh fruit, and leaf) exert on the outcome. Seven-, four- and two-choice assays were used to quantify interactions between visual and olfactory cues. When no volatiles were present in a seven-choice assay, D. suzukii preferred red, black, and green pigments. Black and red were preferred when yeast odors were present, and black alone was the most attractive color when blueberry odor was present. A strawberry leaf terpenoid, ß-cyclocitral, seemed to have overridden the flies' response to color. In four-choice assays, blueberry odor was more likely to interact synergistically with color than yeast or ß-cyclocitral. This study demonstrates that D. suzukii modulates the response to multimodal sensory modalities (vision and olfaction) depending, to some extent, on the type of olfactory stimuli. Our findings also provide insight into the relative importance of vision as a function of odor quality in this invasive species.

A 4-year retrospective study of tonsillectomy rate and admission rate of tonsillitis and complications in the East of England and nationally.

OBJECTIVES: Guidance set out by Scottish Intercollegiate Guidelines Network (SIGN) sought to restrict the frequency of elective tonsillectomy in reaction to the recognised and substantial risks of the procedure, namely pain and bleeding. With stricter criteria in place before a patient can undergo tonsillectomy, patients must endure more episodes of tonsillitis than was previously the case. The cost of managing tonsillitis and its complications as an inpatient is substantial to the NHS and also to the economy as a whole in missed work days. The authors sought to establish if the reduced rate of tonsillectomy performed had any effect on the rate of acute hospital admission for tonsillitis or the associated abscesses-peritonsillar, parapharyngeal and retropharyngeal. METHODS: A retrospective multi-centre study reviewed admission data across a 4-year period. The rate of tonsillectomies performed for recurrent tonsillitis across four trusts in Mid-Essex was compared with the number of admissions for tonsillitis, peritonsillar, parapharyngeal and retropharyngeal abscesses. National hospital episode statistics data over a 5-year period was also analysed. RESULTS: For the regional data in 2015, 979 tonsillectomies were performed across the four centres, reducing to 875 in 2018. There was no trend in the rates of acute tonsillitis requiring admission but the rates of peritonsillar abscess increased from 156 to 192 cases per year in the same period. This correlation was found not to be statistically significant in the measured sample size. The National hospital episode statistics data showed a significant correlation between tonsillectomy rates and admissions from complications of tonsillitis as well as the associated abscesses. CONCLUSION: This study shows that the reduced tonsillectomy rate was correlated with an increased number of admissions with peritonsillar abscess regionally. Nationally reduced tonsillectomy rate is significantly associated with increased admissions with tonsillitis and all its complications. A decreased rate of tonsillectomy may be increasing the rate of serious tonsillitis. This has an impact on patient morbidity, an increasing financial burden on the NHS and the UK economy.

Electrophysiological and Behavioral Responses of Drosophila suzukii (Diptera: Drosophilidae) Towards the Leaf Volatile ß-cyclocitral and Selected Fruit-Ripening Volatiles.

The spotted-wing drosophila, Drosophila suzukii Matsumura (Diptera: Drosophilidae), is attracted to numerous volatile organic compounds (VOCs) emitted from several ripening, small fruit crops. However, the strawberry leaf terpenoid, ß-cyclocitral, is reportedly very attractive to D. suzukii (but not to all Drosophila spp.). This suggests that leaf and fruit VOCs may be critical sources needed to further develop a more species-specific D. suzukii monitoring lure, or semiochemically based attract-and-kill systems. This study investigated the electrophysiological responses of male and female D. suzukii towards selected host fruit-ripening VOCs and ß-cyclocitral, along with behavioral responses toward combined fruit VOCs with ß-cyclocitral. Electroantennogram (EAG) results revealed a positive dose-response, for both sexes, as concentrations increased for all VOCs tested. For ß-cyclocitral, hexyl acetate and methyl butyrate, the mean male EAG responses were significantly greater than the female responses at lower doses. In caged behavioral bioassays, only in the ß-cyclocitral treatments were the mean number of flies captured (sexes combined) significantly greater than that captured in solvent (mineral oil) controls. Our study has demonstrated that while single fruit-based VOCs alone are not enough to cause a strong behavioral attraction by both male and female D. suzukii, the addition of ß-cyclocitral did produce a significant attraction response from both sexes. In both bioassays, males had higher responses to ß-cyclocitral than females, which suggest a greater sensitivity to this compound. Further studies are needed to ascertain the role ß-cyclocitral may play in the development of a more species-specific D. suzukii monitoring lure.

Current opinions regarding the management of pyogenic flexor tenosynovitis: a survey of Pulvertaft Hand Trauma Symposium attendees.

PURPOSE: Pyogenic flexor tenosynovitis (PFT) is recognized as a severe infection of the hand with potentially disastrous outcomes. The mainstay of treatment has been emergent surgical washout. Recent evidence suggests potential for conservative management with a combination of intravenous antibiotics, elevation and splinting. We aim to determine current management of PFT to guide further education and research. METHOD: An electronic survey was distributed to attendees at the Pulvertaft Hand Trauma Symposium in May 2017. The survey was also sent to previous attendees. The survey was compiled by hand surgeons and piloted within a tertiary centre prior to dissemination. Questions focused on three clinical vignettes describing PFT of increasing severity. Responses were analyzed using Surveymonkey. RESULTS: A total of 91 clinicians responded. Almost 50% would proceed to surgical decompression and washout even in patients diagnosed early. This increased to 88% when treating a patient whose diagnosis was delayed. The majority of those advising surgery felt this should be within 24 h. More than 50% advocate active mobilization either immediately or as soon as possible regardless of severity. Almost all would use either general or regional anaesthesia and a two-incision technique with catheter irrigation. CONCLUSIONS: Our survey demonstrates large variation in the management of PFT. Advice from the pre-antibiotic era continues to be followed with some clinicians continuing to advocate open surgery. There is substantial discrepancy regarding duration of immobilization. Further investigation into the management and outcomes of PFT is required to establish best practice guidelines for this rare but potentially devastating condition.

Who should answer the question: "Can I drive with this plaster cast?".

INTRODUCTION: The application of a plaster cast is known to affect driving ability, but patients continue to drive. The individuals and authorities involved in assessing driving safely include doctors, the Driver and Vehicle Licensing Agency (DVLA), police, insurance companies, and patients, but it is unclear who should take responsibility for the advice given, especially in the event of an accident. METHODS: We contacted senior plaster technicians in 348 hospitals in the UK. We recorded their responses regarding advice given to patients on driving in specific casts. Sixteen motor insurance companies and 40 police forces were also contacted in order to canvass their opinions. RESULTS: 188 technician interviews (response rate 54%) were conducted. Only 10% of respondents offered advice unprompted; an average of 48% of patients asked for advice. 88% of respondents referred patients to their motor insurance companies, and also to the DVLA (11.7%), doctor (10.6%), or police (5.9%). Only 20.2% of plaster rooms provided written information. All insurance companies would insure patients provided the doctor had not explicitly objected to driving, but there was no consensus amongst the responses received from police. In the event of an accident after the treating doctor had advised against driving, insurance companies were likely to invalidate the policy, and the police would seek penalty punishment or prosecution. CONCLUSIONS: Although doctors are not specifically trained to assess the ability of patients to drive, insurance companies and police forces place the responsibility on doctors to advise patients. Since current evidence suggests plaster casts can impair driving ability, we suggest patients should be advised not to drive. Patients accept all responsibility if they continue to drive after receiving this specific advice and understanding its implications.

Targeting EGFR and PI3K pathways in ovarian cancer.

BACKGROUND: The epidermal growth factor receptor (EGFR) is expressed in ovarian cancer, but agents targeting this pathway have shown little effect as single agents. This may be due to the presence of alternative pathways, particularly activation of the PI3K/Akt/MTOR pathway. METHODS: We have therefore examined the effect of inhibitors of this pathway (ZSTK474 and sirolimus) in combination with the EGFR inhibitors erlotinib and gefitinib in ovarian cancer primary cell cultures. RESULTS: The single-agent EGFR inhibitors showed little activity, although some activity was seen with the single-agent PI3K inhibitor, ZSTK474. Combinations of ZSTK474 with EGFR inhibitors showed enhanced activity with some evidence of synergy, whereas sirolimus combinations were less active. The results were not explicable on the basis of PIK3CA mutation or amplification, or PTEN loss, although one tumour with a KRAS mutation showed resistance to EGFR inhibitors. However, there was correlation of the EGFR expression with sensitivity to EGFR and resistance to PI3K active agents, and inverse correlation in the sensitivity of individual tumours to agents active against these pathways, suggesting a mechanism of action for the combination. CONCLUSION: Phase I/II clinical trials with these agents should include further pharmacodynamic endpoints and molecular characterisation to identify patients most likely to benefit from this strategy.

Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences.

Blood culture is a vital investigation and can be the first step in obtaining a definitive diagnosis in a patient with presumed sepsis, but can also have serious adverse consequences for the patient. The aim of this study was to evaluate the extent of the blood culture contamination problem at the Lancashire Teaching Hospitals (LTH) and to assess the impact of the introduction of a new blood culture collection kit on the contamination rate. Blood culture contamination rate at the LTH before the introduction of the blood culture collection kit was 9.2%. A fall in contamination rate was observed after kit introduction, to 3.8%, a proportion approaching the American Society of Microbiologists' recommended standard of ≤3%. The reduction in contamination was associated with an unintended, yet sustained, reduction in the total number of blood culture sets collected and an unwanted reduction in the number of genuine Gram-negative bacteraemias. This reduction may reflect education and training issues at the time of the introduction. In the era of 'route cause analyses', it may also reflect fears by junior colleagues of the consequences of being found responsible for a blood culture contaminant. The study recommended continuing with the blood culture kit, but ensuring regular training and education sessions, carried out in a non-blame manner.

Field drains as a route of rapid nutrient export from agricultural land receiving biosolids.

We report research on the environmental risk of incidental nutrient transfers from land to water for biosolids amended soils. We show that subsurface (drainflow) pathways of P transport may result in significant concentrations, up to 10 mg total P l(-1), in the drainage network of an arable catchment when a P source (recent biosolids application) coincides with a significant and active transport pathway (rainfall event). However, the high P concentrations were short-lived, with drainage ditch total P concentrations returning to pre-storm concentrations within a few days of the storm event. In the case of the drainflow concentrations reported here, the results are unusual in that they describe an 'incidental event' for a groundwater catchment where such events might normally be expected to be rare owing to the capacity of the hydrological system to attenuate nutrient fluxes for highly adsorbed elements such as P. Consequently, there is a potential risk of P transfers to shallow groundwater systems. We suggest that the findings are not specific to biosolids-alone, which is a highly regulated industry, but that similar results may be anticipated had livestock waste or mineral fertilizer been applied, although the magnitude of losses may differ. The risk appears to be more one of timing and the availability of a rapid transport pathway than of P source.

Evaluation of the safety of mixed tocopheryl phosphates (MTP) -- a formulation of alpha-tocopheryl phosphate plus alpha-di-tocopheryl phosphate.

The safety of a formulation of mixed tocopheryl phosphates, (MTP) was evaluated in a series of toxicological tests in vivo using rats, mice and rabbits and in vitro using bacterial and mammalian cell cultures. The tests conducted included an oral LD(50) study, three 28-day oral repeat-dose studies, two dermal toxicity tests, an ocular irritation test, mutagenic potential tests, and chromosomal aberrations tests. MTP consists of mono alpha-tocopheryl phosphate (TP) and di-tocopheryl phosphate (T(2)P) and is intended for use as a dietary supplement and for dermal applications in humans and animals. The dermal and oral LD(50) values of MTP were determined to be >1130 mg/kg bw (918 mg tocopherol equivalents/kg bw) in rabbits and rats, respectively. MTP was not a dermal or eye irritant in rabbits and showed no allergenic potential in mice. In the mutagenicity and genotoxicity studies, MTP did not increased the number of revertants in Salmonella typhimurium or Escherichia coli and did not induce chromosomal aberrations in cultured Chinese hamster ovary (CHO) cells. When administered daily for 28 days by gavage at doses up to 955 mg/kg bw/day (780 mg tocopherol equivalents/kg bw/day), MTP produced no consistent, dose-dependent adverse effects in rats.

Nursing research priorities of the National Black Nurses Association.

The purpose of this article is to describe the nursing research priorities of the National Black Nurses Association (NBNA). The NBNA is a professional nursing association representing more than 150,000 black nurses throughout the United States and the Eastern Caribbean. This article describes knowledge gaps in nursing research and presents various findings from research studies aimed at defining research priorities in nursing. Recommended research priorities are discussed that are directed toward improving the health of African Americans and other vulnerable populations. The NBNA urges the National Institutes of Health to increase funding to support research initiatives with an emphasis on women's health, particularly the health of women from diverse cultures. Nursing research programs are steadily yielding results, which enable the nursing profession to meet the goal of using the programs include identification of research priorities, acknowledging the vast disparity in nursing research today.

A response to California's mandated nursing ratios.

PURPOSE: To explore the need for evidence-based health policy, as illustrated by the mandatory staffing bill passed by the California state legislature in 1999. DESIGN: Prospective data were collected from a voluntary sample of California acute care hospital representatives to describe selected patient safety and clinical outcomes and nurse staffing variables at the patient-care unit level. METHODS: Data for descriptive analysis were collected on hospital nurse staffing, patient falls, and pressure ulcers from 257 medical, surgical, medical-surgical combined, step-down, 24-hour observation units, and critical care patient care units in 38 California acute care hospitals from June 1998 to June 1999. FINDINGS: Nursing staffing ratios varied among the 257 units. RNs provided 91% of the nursing care in critical care units. Patients in medical-surgical units received 59% of their care from RNs, 11% from licensed vocational nurses, and 30% from other caregivers. Preliminary data showed no relationships between reported staffing ratios in these hospitals and the incidence of patient falls or hospital-acquired pressure ulcers. CONCLUSIONS: California Nursing Outcomes Coalition (CalNOC) data showed wide variations in staffing ratios, patient falls, and hospital-acquired pressure ulcers among nursing units and hospitals. These early findings indicate the need for additional research before determining minimal RN staffing requirements. Analysis of multiple sources of data may be necessary to determine safe staffing ratios and to provide evidence-based data for public policy.

Insurance reimbursement for surgical facilities.

Insurance reimbursement for ambulatory surgical facilities can be accomplished by following specific rules. Unlike billing for office visits and surgical fees, facility claims are submitted on Health Care Financing Administration forms. The author provides guidelines to assist with submitting and appealing facility fees.(Aesthetic Surg J 2001;21:467-468.).

Game location and officiating bias in English Club Cricket.

One potential contributing factor to the commonly observed home advantage in competitive sport is that officials may be biased in favour of the home team as a result of pressure from spectators. The present study examined officiating behaviour and home advantage, defined as home teams winning over 50% of decided games in English Club Cricket, a sport virtually devoid of spectator influence. Records of game outcomes, as well as dismissals requiring a decision by the umpire, were analysed. The relative frequency of umpiring decisions did not favour either home or away teams. However, a home advantage was found, with the home teams winning 57.1% of decided games (n = 1.449). Considered together, the results suggest that in sports with little or no spectator influence teams may win more often at home for reasons other than biased umpiring decisions, such as familiarity with their home ground or a visiting team's fatigue following travel.

Characterization of chloramphenicol and florfenicol resistance in Escherichia coli associated with bovine diarrhea.

Florfenicol, a veterinary fluorinated analog of thiamphenicol, is approved for treatment of bovine respiratory pathogens in the United States. However, florfenicol resistance has recently emerged among veterinary Escherichia coli isolates incriminated in bovine diarrhea. The flo gene, which confers resistance to florfenicol and chloramphenicol, has previously been identified in Photobacterium piscicida and Salmonella enterica serovar Typhimurium DT104. The flo gene product is closely related to the CmlA protein identified in Pseudomonas aeruginosa. The cmlA gene confers nonenzymatic chloramphenicol resistance via an efflux mechanism. Forty-eight E. coli isolates recovered from calves with diarrhea, including 41 that were both chloramphenicol and florfenicol resistant, were assayed for the presence of both flo and cmlA genes. Forty-two of the 44 isolates for which florfenicol MICs were > or =16 microg/ml were positive via PCR for the flo gene. All E. coli isolates for which florfenicol MICs were < or =8 microg/ml were negative for the flo gene (n = 4) Twelve E. coli isolates were positive for cmlA, and chloramphenicol MICs for all 12 were > or =32 microg/ml. Additionally, eight isolates were positive for both flo and cmlA, and both florfenicol and chloramphenicol MICs for these isolates were > or =64 microg/ml. DNA sequence analysis of the E. coli flo gene demonstrated 98% identity to the published GenBank sequences of both serovar Typhimurium flo(St) and P. piscicida pp-flo. The flo gene was identified on high-molecular-weight plasmids of approximately 225 kb among the majority of florfenicol-resistant E. coli isolates. However, not all of the florfenicol-resistant E. coli isolates tested contained the large flo-positive plasmids. This suggests that several of the E. coli isolates may possess a chromosomal flo gene. The E. coli flo gene specifies nonenzymatic cross-resistance to both florfenicol and chloramphenicol, and its presence among bovine E. coli isolates of diverse genetic backgrounds indicates a distribution much wider than previously thought.

Moisture and healing: beyond the jargon.

Moist wound healing is one of the most frequently used, but least understood terms in wound care. Although no reliable operational definitions exist of too little or too much wound surface moisture, a low dressing water vapor transmission rate (WVTR) has proven to be a reliable measure of a dressing's capacity to retain moisture and provide an environment that supports healing. Dressing WVTR is a powerful linear predictor of both full- and partial-thickness healing of standardized acute wounds in vivo (alpha < 0.0001). Moreover, differences in the ability to produce an optimal moist wound environment within a dressing category, such as hydrocolloid dressings, are strongly correlated with dressing WVTR, suggesting that dressings in the same product categories may be associated with significantly different environments for healing. Even though the correlation between dressing WVTR and healing rates is more difficult to ascertain, clinical healing percentages during similar time-frames and healing times of similar wounds also follow patterns predicted by dressing moisture retention. These results suggest that, when other variables are held constant, use of more moisture-retentive dressings generally achieves environments supportive of earlier healing outcomes when compared to less moisture-retentive dressings. Maceration, an unwelcome occurrence with moisture-retentive dressing use on highly exuding wounds, is not consistently associated with increased adverse events. Evidence further suggests that greater dressing moisture retention is associated with fewer clinical infections, greater patient comfort, and reduced scarring.

Pentastomid infections in Nile crocodiles (Crocodylus niloticus) in the Kruger National Park, South Africa, with a description of the males of Alofia simpsoni.

Two Nile crocodiles were obtained from two different localities in the Kruger National Park, one a healthy specimen, the other in a severely debilitated condition. Both were males over 3 m long and both harboured the three pentastome genera Sebekia, Alofia and Leiperia. The genus Sebekia was represented by three species, Sebekia wedli Giglioli, 1922, Sebekia cesarisi Giglioli, 1922 and Sebekia okavangoensis Riley & Huchzermeyer, 1995. Of the genus Alofia two species, Alofia simpsoni Riley, 1994 and Alofia nilotici Riley & Huchzermeyer, 1995 were found. The male of A. simpsoni, formerly unknown, is described and the description of the females emended. Leiperia cincinnalis Sambon, 1922 was the only Leiperia present. Whereas Sebekia and Alofia were recovered from the bronchioles and lung parenchyma, female Leiperia occurred in the trachea and bronchi, and infective larvae as well as immature males and females, were collected from the lungs, the heart and the aorta. Adult Subtriquetra (Family Subtriquetridae) were not present in the nasopharynx of either crocodile. The intensity of infection was low in the healthy crocodile and had no negative effect on the host. In contrast, the debilitated crocodile was heavily infected and its poor condition is ascribed to its high pentastome burden. Histopathology revealed lesions in the tracheal wall and the lungs accompanied by chronic granulomata with secondary fungal infection as well as severe chronic multifocal granulomatous pneumonia.