Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

Genomic DNA hybridizes with the same rate constant on the QCM biosensor as in homogeneous solution.

Hybridization rates of sheared, genomic E. coli DNA in 0.14 M, pH 6.7 phosphate buffer at 65 degrees C were determined by: (1) observing the rate of absorbance decrease at 260 nm due to self-hybridization in solution; and (2) measurement of the rate of mass increase caused by hybridization between DNA in solution and DNA photografted to polystyrene. The latter measurement was done using a quartz crystal microbalance (QCM). In both the spectrophotometric and QCM experiments the probe was identical to the target, as both were taken from the same sample of sheared E. coli DNA. In the QCM measurements, viscoelastic effects were made negligible by drying the biopolymer layer on the QCM's surface before taking the frequency readings. Our purpose was to explore the effect of immobilizing DNA on its hybridization rate constant. A second-order constant of 2.32 +/- 0.09 x 10(-6) ml microg(-1) s(-1), n = 14, for hybridization in solution was obtained spectrophotometrically, while the QCM experiment gave a constant of 2.2 +/- 0.3 x 10(-6) ml microg(-1) s(-1), n = 6. These values are not statistically different. The reaction half-lives for the spectrophotometric and QCM experiments were 6.5 h and 13 min, respectively. The shorter half-life on the QCM can be explained solely by the much greater reactant concentration in the QCM experiment. About 25% of the DNA was inactivated by the attachment reaction. After correcting for this, the surface-attached DNA hybridized with the same rate constant as DNA free in solution. Therefore, it is concluded that, in these specific experiments with genomic DNA, the immobilized regions must have been short compared to the length of the molecules. The data demonstrate the high hybridization rate obtainable when nucleic acids are hybridized in a thin-film, micro-volume reaction on a non-porous surface.

Rapid SLT gene detection on polyethylene-coacrylic acid film without molecular labels or surface-fouling agents.

The commercially available copolymer of 10 mol% acrylic acid and polyethylene is easily formed into a nonfluorescing, non-polynucleotide-adsorbing film. The film has surface carboxylate functions whose concentration can be increased by heating to 80 degrees C in 30% NaOH. The carboxylate groups will react at pH approximately 7 with commercially available, oligo-DNA, 2-8 ng/microl, that has been synthesized with a C(12)-alkylamino tail on the 5'-end. The reaction is mediated with water-soluble carbodiimide reagent and is assumed to result in a primary amide bond between the polymer film and the modified oligo-DNA. The tethered oligo-DNA retains its hybridization activity, and its surface concentration is sufficient to permit qualitative, labelless detection of hybridized target by fluorescence after brief staining with ethidium bromide. The film is used to detect Shiga-like toxin gene II (SLT-II) from Escherichia coli O157:H7 after asymmetric, capillary, PCR amplification, and a 4-h hybridization. Captured target may be removed from the film using distilled water, after which the film can be used again without noticeable loss of activity. The method provides relatively rapid detection of PCR amplimers without having to use molecular labels, or surface-fouling agents.

QCM response to solvated, tethered macromolecules.

When the quartz crystal microbalance (QCM) is operated in contact with solution and used to detect inertia increases caused by macromolecules binding to its surface, resonance frequency shifts are reported in the literature to be greater than, less than, and the same as an identical macromolecular mass would cause as a dry layer. A previous report of wet and dry M13 DNA giving the same, linear frequency versus mass response is examined. The M13 data are shown to follow the reciprocal of the square root of mass, not the reported linear relationship. New experiments on RNA duplexes oscillated in solution are reported. A lossy polymer layer is placed between the QCM and RNA. When changes in density, viscosity, and included water are eliminated, the response remains linear for a constant adlayer thickness. The expectation that response per unit mass should decrease with distance from the QCM surface is demonstrated. Total decoupling of mass lying beyond the acoustic overlayer is also demonstrated. The present results are placed in context with recently published results from a study of progressively thicker protein layers bound to the QCM.

Detection of poly (U) hybridization using azido modified poly (A) coated piezoelectric crystals.

A technique has been developed which uses AT-cut, 9 MHz piezoelectric crystals for the immobilization of single stranded nucleic acids and the subsequent hybridization reactions. This hybridization technique is based on detecting small changes in mass on the surface of a piezoelectric crystal which occur upon immobilizing azido containing probe nucleic acid on the surface and hybridizing complementary target nucleic acid to previously immobilized probe. The immobilized probe could be used for repeated hybridization tests. The hybridization assays were performed in solution and the frequency measurements were performed in the dry state.

Ethnic differences in parenting children in fearful situations.

Administered Zabin and Melamed's (1980) Child Development Questionnaire in their native languages to 20 Haitian, 20 Hispanic, 20 black American, and 20 white American mothers in a public hospital setting to inquire how they dealt with their children in various fearful situations. The white Americans were significantly more likely than black Americans or Haitians to report use of modeling and reassurance, whereas Haitians were less likely than the other groups to report use of these methods. Conversely, the Haitians were more likely than some of the other groups to report use of force in these situations. There were no significant differences in the groups' reported use of positive reinforcement or in reinforcement of dependency once two culturally inappropriate items were removed. The reported differences, especially those involving Haitians, were interpreted as reflecting historical and cultural trends.

Singlet and triplet reactivity in the photoreduction of oxonine(3,7-diaminophenoxazin-5-ium chloride) by iron (II).

The oxazine dye, oxonine (3,7-diaminophenoxazin-5-ium chloride), 1, is photoreduced by Fe (II) sulfate in dilute sulfuric acid. The reaction mechanism is analogous to that for the photo-reduction of thiazine dyes by Fe (II), the most important difference being that reduction of oxonine occurs predominantly from its excited singlet state, S1, rather than from the triplet state, T1. The latter is formed with an intersystem crossing (isc) quantum yield of ca 1.7 x 10(-3). The quenching of S1 by Fe (II) has a rate constant kSQ = 2.2 +/- 0.1 x 10(9) M-1 s-1 and affords the one electron reduced product, semioxonine (R), with a limiting quantum yield, phi SR, of 0.26 +/- 0.02. In contrast, quenching of T1, generated by bromide ion quenching of S1 or by diacetyl sensitization, occurs with KTQ approximately 1.2 x 10(6) M-1 s-1, extrapolated to zero ionic strength, and affords R with a limiting probability, phi TR = 1.1 +/- 0.2. Three possible reasons for the lower quantum yield of the more exothermic S1 reduction are discussed. These are energy transfer from S1 to Fe (II), different rates of escape of R from the encounter complex as a consequence of the different states of protonation of R as initially formed from S1 and T1, and spin allowed back electron transfer in an exciplex formed between S1 and Fe (II). Evidence is also presented for a very low probability (ca 1%) induced isc from the encounter of S1 with paramagnetic Fe (II). Rate parameters for other processes important to the overall reduction mechanism such as disproportionation of R to leucooxonine L and oxonine, k(R)DIS = 1.7 +/- 0.2 x 10(9) M-1 s-1, oxidation of R by Fe (III), k(R)OX = 1.5 +/- 0.1 x 10(5) M-1 s-1, and oxidation of L by Fe (III), kLOX = 1.1 +/- 0.1 x 10(3) M-1 s-1, have also been measured. These results are contrasted with those for the closely related thionine/Fe(II) photoredox reaction, the most well understood system for photogalvanic energy conversion.

Effects of parent presence on children's reactions to injections: behavioral, physiological, and subjective aspects.

Observed 47 children ranging in age from 13 months to 7 years 9 months receiving injections as part of a regular visit to a pediatric clinic. Twenty-three children were randomly assigned to a condition with parent (mainly mothers) present and 24 to a condition with parent absent. During the medical procedure, the child's reactions were observed via videotape (for later behavioral coding) and physiological recording (to measure heart rates). Following the injection, data were collected on the child's preference of condition (either parent present or parent absent) for future injections. Older children (but not younger ones) showed significantly more behavioral distress when the parent was present. However, the oldest children's preference of condition for future injections was overwhelmingly that of parent present (86%).

Hispanic and black American adolescents' beliefs relating to sexuality and contraception.

Popular beliefs and level of scientific knowledge regarding sexuality and contraception were elicited from black and Hispanic inner-city adolescents. Significant differences were found: Hispanic males were the most knowledgeable, Hispanic females the least, and black males and females were intermediate. A cultural basis for the dramatic difference between Hispanic male and female scores is suggested and the need to design culturally appropriate sexuality education classes is discussed. In addition, the data depicted two conflicting beliefs that were held simultaneously by many of the adolescents: Contraception is "good" because it prevents pregnancy, and it is "bad" because the various birth control methods carry serious health hazards for users.

PIP: Popular beliefs and level of scientific knowledge regarding sexuality and contraception were elicited from black and Hispanic adolescents in a major US inner-city area of Miami, Florida. Significant differences were found between the 2 groups. Hispanic males were the most knowledgeable, Hispanic females the least, and black males and females were intermediate. A cultural basis for the dramatic difference between Hispanic male and female scores lies in the Latin American belief that the woman should remain sexually naive (embodied in the Spanish words verguenza, marianismo and decente) and that the male role is one of sexual virility, courage, honor and a provider for his family ('machismo'). In addition, the data depicted 2 conflicting beliefs that were held simultaneously by many of the adolescents: Contraception is "good" because it prevents pregnancy, and it is "bad" because the various birth control methods carry serious health hazards for users. Data indicated that there was a very low level of scientific knowledge, even among those who were pregnant and/or had had a sex education course in school. Data from this and other studies indicate that sexuality and contraceptive education sessions may be made more effective by pretesting participants to determine their general level of knowledge as well as their misconceptions, and by using this information to tailor the content of the sessions to the specific needs of the groups. Differences in gender and ethnic group must also be considered in planning educational activities. (author's modified).

Utilizing a game for both needs assessment and learning in adolescent sexuality education.

PIP: A fact-gathering, experimental game proved to be an effective instrument in the needs assessment phase of an adolescent sexuality educational program aimed at low-income females. The game ("Family Few"), which covered the topics of menstruation and reproduction, was played by 35 Black, Hispanic, and white females aged 13-16 years recruited from medical and psychiatric clinics in Miami, Florida. The goals of the game were to elicit terminology used by participants, identify and correct misconceptions and misinformation, and determine if learning could occur. Although 57% of participants reported prior exposure to formal sex education, misinformation about the need for activity curtailment during menstruation and the importance of early pregnancy detection was widespread. Group members believed they needed to restrict activities involving physical exercise, sexual relations, water, and cold during menses and were not likely to seek medical or family consultation regarding a missed period until the end of the 1st trimester of pregnancy. Also evident was a need for accurate information on the side effects, risk factors, benefits, and effectiveness of contraceptive methods. The group responses enabled the sex educators to prepare a culturally responsive, developmentally oriented curriculum for further work with disadvantaged female adolescents. The group process was ranked highly on the Likert Scale by these teenagers as an enjoyable, useful means of information dissemination and problem solving.^ieng

Association of temperature greater than 41.1 degrees C (106 degrees F) with serious illness.

In a 9-month prospective study conducted in an urban emergency room, 15 children with rectal temperature greater than 41.1 degrees C (106 degrees F) were evaluated. Seven of the 15 patients were admitted to the hospital. Two children who were discharged home required subsequent admission, and six were managed on an ambulatory basis. Eight (53.3%) children had serious disease: two bacterial meningitis, two bacteremia without meningitis, two pneumonia, one pericarditis with effusion, and one Kawasaki disease. In four, the final diagnosis indicated a much more serious illness than was considered initially. The laboratory studies did not correlate reliably with the final diagnosis or need for admission. Children with a rectal temperature greater than 41.1 degrees C are at high risk for a life-threatening illness and should be evaluated for sepsis and meningitis.

Hereditary painful callosities.

An autosomal dominant genodermatosis that is characterized by painful callosities develops over pressure points. Histologically, these lesions are similar to epidermal nevi.