Perceived risk factors and preventive practices of Hepatitis B viral infection among pregnant women in Nigerian hospitals: A cross-sectional study.

OBJECTIVE: The study assessed the perceived risk factors and prevention practices of HBV infection among pregnant women in Nigerian hospitals. STUDY DESIGN: A descriptive cross-sectional study was conducted among 343 pregnant women attending antenatal clinics at two purposefully selected primary health care centers in Ile-Ife. Women were included in the study using systematic sampling. A structured researcher-administered questionnaire was used for data collection. Descriptive and inferential (Chi-square test and Logistic regression) statistical analysis were carried out. RESULTS: More than half (53%) of the respondents had a low perceived risk for hepatitis. Majority (73.5%) had been screened for HBV during the index pregnancy but only 30% received complete doses of HBV vaccine. Respondents who underwent HBV screening during pregnancy (OR = 2.06, 95% CI = 0.94 - 4.5), who had completed Hepatitis B vaccination had reduced odds ratios for perceiving risk factors for Hepatitis B Viral Infection (OR = 0.224, 95% CI = 0.94 - 4.5). CONCLUSION: Pregnant women had a low-risk perception of HBV infection. The low level of risk perception can serve as a basis for developing preventive interventions aimed at educating and empowering expectant mothers in order to prevent HBV infection and its transmission to their children.

Utilization of electronic health records and associated factors among nurses in a faith-based teaching hospital, Ilishan, Nigeria.

Introduction: It has been documented that nurses' use of electronic health records (EHRs) impacts clients' health outcomes positively. Some health facilities, primarily privately owned institutions, introduced EHRs for optimal healthcare. Evidence of such and associated factors among nurses must be documented to improve utilization and quality. Objective: The study assessed the utilization of EHRs and associated factors among nurses in a faith-based teaching hospital. Materials and Methods: This sequential explanatory mixed-methods study involved a sample of all 240 nurses from a teaching hospital where EHRs have been introduced. Quantitative data through semistructured questionnaires were collected and analyzed using Chi-square and logistic regression. Qualitative data were collected from 10 purposively selected nurses using an in-depth interview guide and analyzed through content analysis. Results: The majority of participants reported availability of EHR computer software (62.8%), internet facility (84.2%), and desktops (76.3%), but EHR was poorly utilized (27.3%). Factors significantly associated were nurses who were females [OR (odds ratio) = 1.5, 95% CI (confidence interval), 0.21-11.24], BNSc degrees holders [OR = 4.3; 95% CI, 1.06-17.43]; had computer EHR software [OR = 7.4, 95% CI, 0.83-3.81], and sponsored EHR training [OR = 2.10; 95% CI, 0.24-18.6]. Noncapturing of nursing tasks and nursing standardized language by EHR software, lack of institutional enforcement on EHR use, and absence of clear EHR policies were the main identified themes for the key barriers to using EHRs. Conclusion: EHR was poorly utilized among nurses. Gender, educational qualification, EHR resources, and sponsored training were factors significantly associated with the use. There is an urgent need for comprehensive EHR packages, sustained sponsored training, and formulation of EHR policy for effective EHR implementation.

Aortic sinus aneurysm communicating with the main pulmonary artery, and a concurrent patent ductus arteriosus, in a dog.

This is the first report of an aortic sinus aneurysm with a communication to the main pulmonary artery, resulting in left-to-right shunting, diagnosed in vivo in a dog. There was also a second left-to-right shunt through a patent ductus arteriosus. Computed tomography (CT) angiography was used to confirm both congenital anomalies and assess the relative contributions of the two left-to-right shunts to left-sided volume overload.

Measures of Neural Similarity.

One fundamental question is what makes two brain states similar. For example, what makes the activity in visual cortex elicited from viewing a robin similar to a sparrow? One common assumption in fMRI analysis is that neural similarity is described by Pearson correlation. However, there are a host of other possibilities, including Minkowski and Mahalanobis measures, with each differing in its mathematical, theoretical, and neural computational assumptions. Moreover, the operable measures may vary across brain regions and tasks. Here, we evaluated which of several competing similarity measures best captured neural similarity. Our technique uses a decoding approach to assess the information present in a brain region, and the similarity measures that best correspond to the classifier's confusion matrix are preferred. Across two published fMRI datasets, we found the preferred neural similarity measures were common across brain regions but differed across tasks. Moreover, Pearson correlation was consistently surpassed by alternatives.

Screening for viral hepatitis prior to rituximab chemotherapy.

In 2008, the CDC published guidelines recommending screening of all persons undergoing treatment with rituximab to identify persons at risk of hepatitis B virus (HBV) reactivation. We evaluated implementation of this recommendation in veterans, who are at increased risk of HBV, and determined characteristics of those screened. We also evaluated a control setting, rates of hepatitis C virus (HCV) screening among the same rituximab-treated patients. There are no guidelines that recommend HCV screening prior to initiation of rituximab. Medical records of patients receiving rituximab between January 2006 and December 2012 were reviewed according to two time periods: 2006-2008 (period 1, pre-guidelines) and 2009-2012 (period 2, post-guidelines). Patient demographics, concomitant chemotherapy regimen (protocol, dose, duration), treatment indication, risk factors for hepatitis infection (substance abuse, homelessness, human immunodeficiency virus (HIV)), and HBV/HCV screening status were documented. During the study period, 102 patients were treated with rituximab (49 in period 1 and 53 in period 2). During periods 1 and 2, 22 and 32 % of rituximab-treated patients were screened for HBV, respectively (p = 0.375). Treatment during 2009 was the only significant predictor of HBV screening in the adjusted model (p = 0.01). For HCV during periods 1 and 2, 22 and 21 % of patients were screened, respectively (p = 1.00). There were no significant predictors of HCV screening. Rates of screening for HBV among rituximab-treated patients were low, both before and after dissemination of guidelines recommending universal HBV screening of rituximab-treated patients.

Ensuring the safety of vaccine cell substrates by massively parallel sequencing of the transcriptome.

Massively parallel, deep, sequencing of the transcriptome coupled with algorithmic analysis to identify adventitious agents (MP-Seq™) is an important adjunct in ensuring the safety of cells used in vaccine production. Such cells may harbour novel viruses whose sequences are unknown or latent viruses that are only expressed following stress to the cells. MP-Seq is an unbiased and comprehensive method to identify such viruses and other adventitious agents without prior knowledge of the nature of those agents. Here we demonstrate its utility as part of an integrated approach to identify and characterise potential contaminants within commonly used virus and vaccine production cell lines. Through this analysis, in combination with more traditional approaches, we have excluded the presence of porcine circoviruses in the ATCC Vero cell bank (CCL-81), however, we found that a full length betaretrovirus related to SRV can be expressed in these cells, a factor that may be of importance in the production of certain vaccines. Similarly, insect cells are proving to be valuable for the production of virus like particles and sub-unit vaccines, but they can harbour a range of latent viruses. We show that following MP-Seq of the Trichoplusia ni (High Five cell line) transcriptome we were able to detect a contaminating, latent nodavirus and identify an expressed errantivirus genome. Collectively, these studies have reinforced the role of MP-Seq as an integral tool for the identification of contaminating agents in vaccine cell substrates.

Streptococcal infection in dogs: a retrospective study of 393 cases.

Streptococcus spp are opportunistic pathogens that normally reside in the upper respiratory, intestinal, lower urinary, and genital tracts but can cause localized infection or septicemia in dogs of all ages. A retrospective study of streptococcal infection in 393 dogs was conducted to identify the species of Streptococcus isolated, determine demographics of affected dogs, and characterize the disease processes associated with infection. The major streptococcal species isolated were S canis (88 cases, 22.4%), S dysgalactiae ssp equisimilis (13, 3.3%), and S equi ssp zooepidemicus (4, 1.0%). Sex was not a risk factor (P > .30). Fetuses and neonates were more likely to have streptococcal infection than were other age groups (P < .001). Streptococcal septicemia was considered an important cause of abortion and neonatal death and was isolated from all samples submitted for aerobic culture from dogs in that age group. There was a seasonal trend, with dogs more likely to have streptococcal infection in summer months. In dogs for which a disease process was identified, streptococcal infection was associated with dermatitis (29 dogs), pneumonia (24 dogs), adult septicemia (13 dogs), and fetal/neonatal septicemia leading to abortion or neonatal death (16 dogs). Identification of other clinically significant bacterial, viral, fungal, and parasitic organisms was common (267 of 393 dogs, 68%), especially in dogs with dermatitis or pneumonia. Infection with Streptococcus spp should be considered in the differential diagnosis in cases of abortion, septicemia, dermatitis, and pneumonia in dogs. Clinical significance of isolation of streptococcal organisms should be interpreted in context of clinical signs and pathologic findings.

Ovarioscopy and laparoscopic removal of a large right adnexal cyst.

The combination of ovarioscopy and laparoscopy can be used to remove a large adnexal cyst.

An integrated instrument for rapidly deforming living cells using rapid pressure pulses and simultaneously monitoring applied strain in near real time.

Because many types of living cells are sensitive to applied strain, different in vitro models have been designed to elucidate the cellular and subcellular processes that respond to mechanical deformation at both the cell and tissue level. Our focus was to improve upon an already established strain system to make it capable of independently monitoring the deflection and applied pressure delivered to specific wells of a commercially available, deformable multiwell culture plate. To accomplish this, we devised a custom frame that was capable of mounting deformable 6 or 24 well plates, a pressurization system that could load wells within the plates, and a camera-based imaging system which was capable of capturing strain responses at a sufficiently high frame rate. The system used a user defined program constructed in Labview(®) to trigger plate pressurization while simultaneously allowing the deflection of the silicone elastomeric plate bottoms to be imaged in near real time. With this system, up to six wells could be pulsed simultaneously using compressed air or nitrogen. Digital image capture allowed near-real time monitoring of applied strain, strain rate, and the cell loading profiles. Although our ultimate goal is to determine how different strain rates applied to neurons modulates their intrinsic biochemical cascades, the same platform technology could be readily applied to other systems. Combining commercially available, deformable multiwell plates with a simple instrument having the monitoring capabilities described here should permit near real time calculations of stretch-induced membrane strain in multiple wells in real time for a wide variety of applications, including high throughput drug screening.

Comparison of functional and radiological outcomes after computer-assisted versus conventional total knee arthroplasty: a matched-control retrospective study.

PURPOSE: To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). METHODS: Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. RESULTS: No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI=30 kg/m2 or more), computer-assisted TKA provided better alignment than the conventional technique. CONCLUSION: Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.

Real-time multiplex PCR assay for rapid detection and toxintyping of Clostridium perfringens toxin producing strains in feces of dairy cattle.

Clostridium perfringens is an anaerobic, gram-positive, spore-forming bacterium associated with a wide variety of diseases in domestic animals and humans. We have developed dual-labeled fluorescence hybridization probe (TaqMan((R)))-based real-time multiplex PCR assay for detection of toxin genes alpha (cpa), beta (cpb), iota (ia), epsilon (etx), beta2 (cpb2) and enterotoxin (cpe) of C. perfringens directly from cattle feces. The assay was standardized using ATCC reference strains of C. perfringens producing alpha, beta, iota, epsilon and enterotoxin, respectively. The assay for detection of beta2 toxin gene was standardized using a field strain of C. perfringens producing beta2 toxin. The minimum detection limit for the real time PCR assay ranged from 5 to 70 pg of DNA for the six toxin genes. A total of 307 fecal samples collected from seven dairy herds in Pennsylvania were analyzed using the multiplex assay. The real-time PCR assay revealed that cpa, cpb, ia, etx, cpb2 and cpe were detected in 68 (28.2%), 6 (2.5%), 6 (2.5%), 4 (1.6%), 164 (68%) and 11 (4.5%) of 241 PCR positive samples, respectively. The findings of the study revealed that C. perfringens beta2 toxin producing strains were widely prevalent in lactating cows in Pennsylvania and they may play an important role in C. perfringens associated diarrheal diseases.

Determination of the antibacterial efficacy of a new porphyrin-based photosensitizer against MRSA ex vivo.

Following extensive in vitro screening of new photosensitizers the purpose of the present study was to examine penetration as well as antibacterial efficacy of a lead photosensitizer against MRSA using an ex vivo porcine skin model. Two different applications were performed: (i) preincubation of bacteria in solution with a porphyrin-based photosensitizer XF73 and subsequent application on the ex vivo porcine skin; (ii) application of pure bacteria on the explants followed by an incubation with XF73 in a water-ethanol formulation for up to 60 min under occlusion. The localisation of XF73 was restricted to the stratum corneum. Different concentrations (0-10 microM) of XF73 and different incubation times (5-60 min) were used to determine phototoxicity against methicillin-resistant and methicillin-sensitive S. aureus, which was applied on the explants. Preincubation of S. aureus with 0.1 microM XF73 in solution prior to the application of these XF73-incubated bacteria on the skin demonstrates a higher efficacy (>3 log10) after irradiation. Antibacterial photodynamic inactivation resulted in a approximately 1 log10 (0.1 microM)-3.64+/-0.035 (10 microM) log10 growth reduction independently of the antibiotic resistance pattern of used S. aureus strains. Irradiation of applied bacteria without photosensitizer incubation did not show any marked decrease (<1 log10) of bacteria cell number, indicating a significant phototoxicity of the XF73. Histological evaluations of untreated and treated skin areas upon irradiation within 24 h showed no significant degree of necrosis or apoptosis determined by TUNEL-assay indicating that the porcine skin is still vital. This study demonstrates that this XF73 porphyrin-based photosensitizer had concentration-dependent differences in killing efficacy of MRSA in comparison to skin cells using an ex vivo porcine skin model. The results described here imply that topical delivery of XF73 may be considered as a possible treatment in patients with superficial infections of the skin.

A sea-floor spreading event captured by seismometers.

Two-thirds of Earth's surface is formed at mid-ocean ridges, yet sea-floor spreading events are poorly understood because they occur far beneath the ocean surface. At 9 degrees 50'N on the East Pacific Rise, ocean-bottom seismometers recently recorded the microearthquake character of a mid-ocean ridge eruption, including precursory activity. A gradual ramp-up in activity rates since seismic monitoring began at this site in October 2003 suggests that eruptions may be forecast in the fast-spreading environment. The pattern culminates in an intense but brief (approximately 6-hour) inferred diking event on 22 January 2006, followed by rapid tapering to markedly decreased levels of seismicity.

Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautious enthusiasm.

Telemedicine research addressing user satisfaction abounds in academic literature. Results from patient satisfaction studies indicate exceptionally high levels of perceived satisfaction, often above the rates of expected satisfaction for traditional forms of health delivery. Results from provider satisfaction studies are also generally quite positive; however, data from providers point to higher concerns with delivery barriers and challenges. Even though data from patient and provider satisfaction research suggests overwhelming optimism for this delivery modality, this paper urges cautious embracement of these results for several reasons. First, many of the studies exhibit serious methodological weaknesses related to design and data collection instruments. In addition, the construct of satisfaction is largely undefined and is not clear. Even recognizing these caveats, the results of the study do offer some evidence that patient satisfaction will not impede the deployment of telemedicine, but provider satisfaction merits additional study.

Antimicrobial susceptibility of mastitis pathogens from first lactation and older cows.

Increasing antimicrobial resistance has become a serious concern worldwide and antimicrobial use in animal agriculture is currently under scrutiny. Mastitis is the most common reason for antibiotic use in dairy herds and thus, antimicrobial resistance of mastitis pathogens has received recent attention. The purpose of this study was to describe and compare antimicrobial susceptibility of mastitis pathogens isolated at calving from first lactation and older cows. A total of 202 bacteria were isolated from intramammary infections (IMIs) within 3 days after calving over a 16-month study period in the Krauss Dairy Research Herd at the Ohio Agricultural Research and Development Center (OARDC) in Wooster, OH. Of these IMIs, 78% were caused by coagulase-negative staphylococci (CNS). Forty-four percent of them were resistant to at least one antibiotic. Most resistance was observed against penicillin, 39% of the isolates from older cows and 26% from first lactation cows being resistant to penicillin (P > 0.05). Also MIC90 for penicillin was higher among isolates from older cows. On the other hand, resistance to tetracycline was more common and MIC90 higher among isolates from first lactation cows than from older cows. Differences in the proportions of resistant isolates between first lactation and older cows were not statistically significant, though. The resistance patterns of the CNS isolated during the study are concordant with antimicrobial usage in the study herd. This is in agreement with the generally accepted notion that selection pressure from the use of antibiotics is a main factor in development of antibiotic resistance.

Nurses begin a national plan for the integration of supportive care in health research, practice, and policy.

The demand for and use of health, social, and other human services is related not to the type or severity of disease but rather to a person's socio-economic, cognitive, and emotional characteristics and environmental circumstances. A workshop on supportive care was held to promote a robust research environment, the creation of new knowledge, the setting of an integrated health research agenda, a focusing of attention on the evolving health-care system, and anticipation of emerging health challenges. While the workshop was intended to address a research mandate for the Canadian Institutes of Health Research, a larger vision emerged, to include advocacy, information system, surveillance, and policy development required by institutional, community, voluntary, private sector, family caregiver, and provider systems. The development of a national supportive care strategy will enable Canadians with disease and disability to live with all of their challenges, and could engage researchers, clinicians, advocacy groups, and people experiencing major health challenges.

Supraventricular arrhythmias in children and young adults with implantable cardioverter defibrillators.

INTRODUCTION: Rapidly conducted supraventricular tachycardias (SVTs) can lead to inappropriate device therapy in implantable cardioverter defibrillator (ICD) patients. We sought to determine the incidence of SVTs and the occurrence of inappropriate ICD therapy due to SVT in a pediatric and young adult population. METHODS AND RESULTS: We undertook a retrospective review of clinical course, Holter monitoring, and ICD interrogations of patients receiving ICD follow-up at our institution between March 1992 and December 1999. Of 81 new ICD implantations, 54 eligible patients (median age 16.5 years, range 1 to 48) were identified. Implantation indications included syncope and/or spontaneous/inducible ventricular arrhythmia with congenital heart disease (30), long QT syndrome (9), structurally normal heart (ventricular tachycardia/ventricular fibrillation [VT/VF]) (7), and cardiomyopathies (7). Sixteen patients (30%) received a dual-chamber ICD. SVT was recognized in 16 patients, with 12 of 16 having inducible or spontaneous atrial tachycardias. Eighteen patients (33%) received > or =1 appropriate shock(s) for VT/VF; 8 patients (15%) received inappropriate therapy for SVT. Therapies were altered after an inappropriate shock by increasing the detection time or rate and/or increasing beta-blocker dosage. No single-chamber ICD was initially programmed with detection enhancements, such as sudden onset, rate stability, or QRS discriminators. Only one dual-chamber defibrillator was programmed with an atrial discrimination algorithm. Appropriate ICD therapy was not withheld due to detection parameters or SVT discrimination programming. CONCLUSION: SVT in children and young adults with ICDs is common. Inappropriate shocks due to SVT can be curtailed even without dual-chamber devices or specific SVT discrimination algorithms.

Food insecurity is positively related to overweight in women.

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI >27.3 kg/m(2) for women and 27.8 kg/m(2) for men. Food insecurity was related to overweight status for women (n = 4509, P < 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P < 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation.