An examination of nonresponse in a work environment questionnaire mailed to psychiatric health care personnel.

Nonresponse to surveys, which seems to plague work environment studies and studies of health care personnel in particular, may pose problems of generalizability and validity. The aim of this study was to provide an estimate of nonresponse error in a self-administered survey concerning the work environment of psychiatric health care personnel. A random sample of 10% of the original survey population (N?=?693) was selected to participate in a telephone follow-up of a postal survey that had a response rate of 51%. There were no differences between the responders and nonresponders to the postal survey on the exposure or outcome variables. There was no evidence of nonresponse bias in this study, although recall bias may have been a problem. In those cases in which generalizability is deemed important, it is recommended that nonresponse studies be regularly carried out when response rates are less than 100%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short Communication: Scoring of Digital Dermatitis During Milking as an Alternative to Scoring in a Hoof Trimming Chute

Digital dermatitis is a serious problem in dairy production in many countries. In many settings, it is important to evaluate the digital dermatitis status of individual cows or an entire dairy herd. Such an evaluation has traditionally been done in a hoof trimming chute. An evaluation in the milking parlor can take place without disturbing the cows to a large extent, it can be done using less labor compared with an evaluation in a hoof trimming chute, and is cheaper than using a chute. The objective was to evaluate the sensitivity and specificity of a rapid screening method for digital dermatitis in the milking parlor, without using any specialized tools and taking approximately 15 s/cow. All lactating cows in 3 commercial Danish dairy herds were included. Cows were first scored for the presence of digital dermatitis during milking and the next day all cows were scored during hoof trimming. A 6-point nominal scoring system based on a visual inspection of the digital dermatitis lesions was used. For the analysis, the scores were dichotomized (digital dermatitis positive or digital dermatitis negative). Additionally, lesions were classified as small (diameter ≤ 2 cm) or large (diameter >2 cm). Sensitivity and specificity were calculated using observations from the hoof trimming chute as the “gold standard” and observations during milking as the diagnostic test. Relatively large variation was found between herds with an overall sensitivity of 0.65 (95% confidence interval: 0.59 to 0.72) and a specificity of 0.84 (0.81 to 0.87). The sensitivity increased to 0.69 (0.62 to 0.76), when only large lesions were assessed. The method has several advantages compared with evaluation in a chute and may be a useful tool in the daily hoof health management in dairy herds.     

The Energy Concept Adviser—A tool to improve energy efficiency in educational buildings

Educational buildings such as kindergartens, schools and universities display many similar design, operation and maintenance features in most countries. The two most noteworthy similarities amongst these building types are the high energy consumption and the necessity for retrofitting many buildings within this sector. However, studies have shown that during retrofit, energy saving measures are only rarely applied, because the decision-makers lack knowledge of investments and the efficiency of potential energy saving measures. The main goal of the International Energy Agency ECBCS Annex 36 is to provide the educational building decision-makers with sufficient data, information and tools to improve their learning and teaching environments by improving the energy efficiency of their buildings.     

Brain abscess in solid organ transplant recipients receiving cyclosporine-based immunosuppression

There is currently a stark therapeutic void in the treatment of evolving stroke. Although P-selectin is rapidly expressed by hypoxic endothelial cells in vitro, the functional significance of P-selectin expression in stroke remains unexplored. In order to identify the pathophysiological consequences of P-selectin expression and to identify P-selectin blockade as a potential new approach for the treatment of stroke, experiments were performed using a murine model of focal cerebral ischemia and reperfusion. Early P-selectin expression in the postischemic cerebral cortex was demonstrated by the specific accumulation of radiolabeled anti-murine P-selectin IgG, with the increased P-selectin expression localized to the ipsilateral cerebral microvascular endothelial cells by immunohistochemistry. In experiments designed to test the functional significance of increased P-selectin expression in stroke, neutrophil accumulation in the ischemic cortex of mice expressing the P-selectin gene (PS +/+) was demonstrated to be significantly greater than that in homozygous P-selectin-null mice (PS -/-). Reduced neutrophil influx was accompanied by greater postischemic cerebral reflow (measured by laser Doppler) in the PS -/- mice. In addition, PS -/- mice demonstrated smaller infarct volumes (5-fold reduction, P<.05) and improved survival compared with PS +/+ mice (88% versus 44%, P<.05). Functional blockade of P-selectin in PS +/+ mice using a monoclonal antibody directed against murine P-selectin also improved early reflow and stroke outcome compared with control mice, with reduced cerebral infarction volumes noted even when the blocking antibody was administered after occlusion of the middle cerebral artery. These data are the first to demonstrate a pathophysiological role for P-selectin in stroke and suggest that P-selectin blockade may represent a new therapeutic target in the treatment of stroke.     

Percutaneous sclerotherapy of hydronephrosis in a non-functioning kidney

A 27-year-old woman was admitted with an abdominal mass in the right hypochondrium. Ultrasound, intravenous urography and scintigraphy revealed a giant non-functioning hydronephrosis. Because she refused surgery, a percutaneous aspiration with instillation of doxycycline was performed. One year thereafter, the patient was still without recurrence of any symptoms or hydronephrosis.     

The natural history of great toe amputations

The purpose of this study is to report the prevalence of reamputation following resection of the great toe and first ray in adults with diabetes. We abstracted the medical records of 90 diabetic great-toe and first-ray amputees admitted between 1981 and 1991. The most common etiologies of initial amputations were ulcer with soft tissue infection (39%), ulcer with osteomyelitis (32%), and puncture wounds (12%). Sixty percent of all patients had a second amputation, 21% had a third, and 7% had a fourth. Fifteen percent of the patients who had a second amputation had it contralaterally. Seventeen percent subsequently underwent a below-knee amputation and 11% had a Transmetatarsal amputation on the same extremity, 3% had a below-knee amputation, and 2% a transmetatarsal amputation contralaterally. The mean time from the first to the second amputation was approximately 10 months. The results of this study suggest that a large proportion of patients undergoing an amputation at the level of the great toe or first ray have subsequent amputations in the first year following the initial procedure. Additionally, it appears that the contralateral foot may be at significant risk for distal amputation following resection of the hallux or first day.     

Late psychosocial improvement in a case of severe head injury with bilateral fronto-orbital lesions.

Describes the results of a 19-yr follow-up study of a head-injured female patient. At age 17 yrs, the S sustained a blunt head trauma with bilateral fronto-orbital lesions verified by late regional cerebral blood flow. The S presented an extreme state of regression for many months after injury. During the first posttraumatic years no behavioral disorders were reported, but after the 5th yr lack of control, including sexual disinhibition, and lack of motivation became severe problems. More than 10 yrs after the accident, a partner applied a simple program of behavioral modification to the S. After 2 yrs of rigid training, an unexpected improvement in psychosocial adaptation took place. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Signal processing in prolonged EEG recordings during intensive care

Methods for analyzing and displaying EEG signals are discussed. The increasing availability and affordability of powerful computer equipment makes possible the use of ever more sophisticated signal processing techniques, which extract relevant (but not readily discernible) information from long-term EEG recordings and can easily identify important features in the EEG. Whether these techniques are actually taken up in clinical practice is heavily dependent on how well they match clinical requirements. This article concentrates on requirements set in the context of long-term recordings in the ICU that demand the ability to process short-term discrete events as well as long-term trend information. A huge range of potentially useful signal processing techniques exists. This article illustrates the value of some of these techniques for ICU signals using the EEG recordings collected during the IMPROVE project     

Performance of an Adaptive Threshold Receiver in a Dynamic Optical Burst-Switched Network

We compare the performance of a digital receiver operating with both a fixed and adaptive decision threshold in response to gain transients arising from network operation of an optically gain-clamped erbium-doped fiber amplifier. An optical burst switching link, based on a recirculating transmission loop, is used to study the effect of transients accumulated across a number wavelength-routing nodes linked by amplified fiber spans where bursts are added and dropped at each node. The use of an adaptive threshold reduces the amount of optical feedback required by a factor of 6 and, in some cases, allows for unclamped operation.