Constant Vigilance Research Articles

Natural radioactivity levels in sediments in Algiers Bay using instrumental neutron activation analysis

Abstract The main objective of this study is to evaluate natural radioactivity levels in sediments collected from different points of Algiers bay. Particular attention was paid to understand correlations between the distribution of uranium and thorium and the geomorphological characteristics of the Bay. Instrumental neutron activation analysis (INAA) has been employed in order to measure the isotopic composition and concentration of uranium and thorium, with emphasis on isotopes, 232Th and 238U. The concentrations reported in Bq kg−1 (dry weight) vary between 19.73 and 34.53 for 238U and between 22.26 and 36.02 for 232Th. The obtained results are within the world typical ranges and did not show any anomalous values. Results revealed clear inverse relationship between activity concentration and grain size. The radioactivity content in sediments had a positive correlation with clay and silt percentage, and a negative correlation with sand percentage. The concentration ratios of 232Th/238U are found to be slightly below the world average value unite (3.94) in sediments. Values below unite indicate that the medium is reductor or the existence of an external source of U-contaminated particles in the bay; Values greater than the unit show either depletion of uranium or enrichment of thorium due to alteration or natural processes in these areas. The strong correlation of uranium and Thorium in samples reflects the source of same origin. The results of the study can be used as basic radiometric data for future sedimentological studies. The situation in the Bay of Algiers is reassuring but the risk of possible contamination cannot be excluded and requires constant vigilance for the preservation of the coast and the Mediterranean from all contamination. The results can also be used as reference data for the monitoring of possible radioactive pollution in the future.

Correlates of Perceived Stress in Parents of Teens with Type 1 Diabetes

Parents of teens with type 1 diabetes (T1D) are responsible for a labor-intensive and complicated daily regimen that has been described as overwhelming and requiring constant vigilance. Parents report high levels of stress, particularly during the adolescent transition. The primary aim of this study was to identify demographic (parent/child age, gender, race/ethnicity, income, marital status), clinical (T1D duration, pump use, CGM use, episodes of hypoglycemia, other health diagnoses) and psychosocial factors (depressive symptoms, family conflict, childhood-illness parenting stress, teen autonomy) associated with perceived stress in parents of teens with T1D. This was a secondary analysis of baseline data from parents (n=162) of teens with T1D (11-16 years) who were enrolled in a study to evaluate a web-based tool to help with the transition of diabetes care. Bivariate correlates of perceived stress were included in a multivariate model analysis. Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), 5.(±3.62) years duration of diabetes, with 75% using an insulin pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. Significant bivariate demographic, clinical, and psychosocial correlates were included in the model, in a stepwise procedure. Multivariate correlates of perceived stress were parent age, teen T1D duration, other teen health diagnosis (R2=0.13, p<.01), family conflict and childhood-illness parenting stress (R2 change=.30, p<.01), and parent depression (R2 change=.18, p<.01), explaining 62% of the variance. Parents of teens with T1D experience high stress and may need additional support to prevent and/or decrease family conflict, childhood-illness parenting stress, and depressive symptoms. Parent stress has health implications not only for parents, but also teens with T1D. Disclosure R. Whittemore: None. R. Delvy: None. J.L. Coleman: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.

Student and Parent Perspectives on Severe Food Allergies at College

IntroductionConstant vigilance to manage severe food allergies (FAs) can lead to high stress. Additional stress may develop during life-course transitions, such as the transition to college. However, few studies have evaluated everyday and FA-related stress in college students with FA and their parents. This analysis examined experiences of 26 college students with FA and their parents. MethodsStudents and parents completed online surveys in a mixed-methods exploratory study of everyday and FA-related stressors, potential contributing factors, and FA management. ResultsFA affected nearly all areas of students' lives. Management required constant vigilance because of issues of trust in others. However, nearly 40% of students did not consistently carry emergency medication to counteract reactions. Parents worried from a distance while learning to trust their child's FA management capabilities. DiscussionAdditional preparation and support for college students with severe FA and their parents may help improve stress and FA management.

RETRACTED ARTICLE: Sudden cardiac arrest under spinal anesthesia in a mission hospital: a case report and review of the literature

BackgroundSudden cardiac arrest following spinal anesthesia is relatively uncommon and a matter of grave concern for any anesthesiologist as well as clinicians in general. There have been, however, several reports of such cases in the literature. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring, and prompt intervention at the first sign of cardiovascular instability should improve outcomes. The rarity of occurrence and clinical curiosity of this entity suggest reporting of this unusual and possibly avoidable clinical event.Case presentationWe report the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in a 25-year-old Cameroonian man. Incidentally, the index patient was successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. He went ahead to have emergency open appendectomy with good post-operative outcome and recovery.ConclusionsThe management of such cardiac arrest under spinal anesthesia is very challenging in resource- limited settings such as ours. Anesthetists and clinicians need to be well informed of this grave complication. A good understanding of the physiologic changes caused by spinal anesthesia and its complications, adequate patient selection, respecting the contraindications of the procedure, adequate monitoring, and constant vigilance are of paramount importance to the eventual outcome.

Alternatives to Autologous Bone Graft in Alveolar Cleft Reconstruction: The State of Alveolar Tissue Engineering.

Alveolar cleft reconstruction has historically relied on autologous iliac crest bone grafting (ICBG), but donor site morbidity, pain, and prolonged hospitalization have prompted the search for bone graft substitutes. The authors evaluated bone graft substitutes with the highest levels of evidence, and highlight the products that show promise in alveolar cleft repair and in maxillary augmentation. This comprehensive review guides the craniofacial surgeon toward safe and informed utilization of biomaterials in the alveolar cleft.A literature search was performed to identify in vitro human studies that fulfilled the following criteria: Level I or Level II of evidence, ≥30 subjects, and a direct comparison between a autologous bone graft and a bone graft substitute. A second literature search was performed that captured all studies, regardless of level of evidence, which evaluated bone graft substitutes for alveolar cleft repair or alveolar augmentation for dental implants. Adverse events for each of these products were tabulated as well.Sixteen studies featuring 6 bone graft substitutes: hydroxyapatite, demineralized bone matrix (DBM), β-tricalcium phosphate (TCP), calcium phosphate, recombinant human bone morphogenic protein-2 (rhBMP-2), and rhBMP7 fit the inclusion criteria for the first search. Through our second search, the authors found that DBM, TCP, rhBMP-2, and rhBMP7 have been studied most extensively in the alveolar cleft literature, though frequently in studies using less rigorous methodology (Level III evidence or below). rhBMP-2 was the best studied and showed comparable efficacy to ICBG in terms of volume of bone regeneration, bone density, and capacity to accommodate tooth eruption within the graft site. Pricing for products ranged from $290 to $3110 per 5 mL.The balance between innovation and safety is a complex process requiring constant vigilance and evaluation. Here, the authors profile several bone graft substitutes that demonstrate the most promise in alveolar cleft reconstruction.

275 Impact of caring for someone with a rare rheumatic condition: views from patients and informal carers

Background: ANCA-associated vasculitis is a rare multisystem disease. Modern therapeutic protocols have turned ANCA-associated vasculitis from an acute frequently fatal disease into a chronic disease requiring long-term immunosuppression. Patients must often manage substantial burdens related to chronic illness and treatment-related side effects. Patients often need help and support to manage their disease. The aim of this study was to explore the experience of patients and of informal carers of patients about the impact of managing a rare rheumatic condition. Methods: A qualitative approach using semi-structured interviews was used. Interviews were conducted with a purposeful sample of 18 pairs of patients with ANCA-associated vasculitis and their informal carers. The interviews were used to explore the participants experience and affects of caring. The interviews were recorded and transcribed as verbatim text and analysed using the framework technique. Results: 18 patients (seven female) [disease: ten granulomatosis with polyangiitis (GPA); four microscopic polyangiitis (MPA); four eosinophilic granulomatosis with polyangiitis (EGPA), age range 34-78, disease duration 1- 20 years. Caregiver and patient perspectives were shared. The emerging themes were the physical and psychological impact of the disease, the need for constant vigilance and fear of the future. Conclusion: Both patients and carers faced a range of challenges in managing a rare condition. From the seriousness of the illness, dealing with the emotional toll and knowing what to expect. This study offers insight into the experiences of patients and informal carers and health care professionals should address individuals’ fears and expectations for recovery. Disclosures: J.M. honoraria; Abbvie, Bristol Myres Squibb. K.G. and R.A.W. have declared no conflicts of interest.

Safety and efficacy of epicutaneous immunotherapy for food allergy.

Food allergy is increasingly common in children, affecting about 4%-8%. The mainstays of management remain allergen avoidance and emergency preparedness to treat allergic reactions with emergency medications. Unfortunately, these approaches are unsatisfactory for many patients and their families as the restrictions, constant vigilance, and unpredictable severity of allergic reactions negatively impact quality of life. In recent decades, there has been significant interest in developing treatments for food allergy that lead to desensitization to increase thresholds for triggering allergic reactions and decrease the risk of reacting to allergen-contaminated food products. Epicutaneous immunotherapy (EPIT) is a novel therapy that is currently under investigation, delivering allergen via repeated applications to the skin and targeting antigen-presenting cells in the superficial skin layers. Murine models have demonstrated that allergen uptake is an active process by skin dendritic cells with subsequent migration to draining lymph nodes. Allergen exposure to the non-vascularized epidermis limits systemic absorption, contributing to the high-safety profile. Results from murine experiments showed that EPIT has comparable efficacy as subcutaneous immunotherapy in terms of challenge outcomes, airway hyper-responsiveness, and immunologic parameters. Several clinical trials of EPIT have recently been completed or are ongoing. Results support the high safety and tolerability of this approach. Efficacy data suggest that the change in threshold eliciting dose following 1year of therapy is less than that seen compared to high-dose (2-4g peanut protein) oral immunotherapy, but more prolonged treatment with EPIT appears to lead to increasing desensitization. Additional data from larger-scale studies should provide a more robust assessment of safety and efficacy of EPIT.

From suffering to resignation: Grounded Theory approach to maternal experience with newborn in phototherapy

Abstract Objectives: understanding the experience of puerperal womenwith newborn in phototherapy treatment in rooming-in care. Methods: qualitative research analyzed according to the Grounded Theory and the results discussed in the light of Symbolic Interactionism. The interviews were audiotaped and transcribed in full. The theoretical saturation was based on the analysis of the 15th interview with puerperal women, undergoing the experience in the maternity of the Public Hospital of São Paulo State. Results: from the analysis emerged four categories (sub processes): getting disappointed with the bad news; feeling recluse, separated from her baby, accountable and with not enough support for care; resigning to the protective role of mother of a baby in suffering and at risk; seeking strategies to deal with the situation. From the realignment of these categories (sub processes) emerged the core category (process): from suffering to resignation in order to deal with the maternal experience with NB in phototherapy. Conclusions: the symbolic intervening component, mother's protective role, prompted her to attempt to cope with the challenging experience by feeling compelled to exercise the function of caretaker. The same way that the rooming-in care team emerged in the experience of the mother, using the same symbol, to hold her accountable for constant vigilance in maintaining the integrity of baby's vision.

Rôle du pharmacien dans un partenariat de télémédecine en hémodialyse : la surveillance microbiologique de l’eau

In French health centers, the pharmacist is responsible for the quality of hemodialysis fluids. In an insular hospital, it is difficult to make bacteriological controls because of the lack of an environmental laboratory. Alternative choices of methods must be seek to facilitate water control and ensure the security of hemodialysis for patients. Controlling the microbiological risk is an essential condition for the good operation of a telemedicine partnership in dialysis. A review of the different methods that has been tried is presented. The hospital has experienced since 2014 a microorganism detection test by ATPmetry. An overview of the results is discussed. The usability of this technique allows quarterly controls on the water treated by reverse osmosis and on fluids after one and two ultrafiltrations from every generator. Cases of non-compliance were due to false positives, which were squashed by verification control in 50% of the cases, and the other non-compliances were fixed by corrective actions. The ATPmetry technique permits the collection of rapid results and verification of the effectiveness of the corrective actions immediately after their implementation. This method has been undertaken in a routine use instead of the reference technique (bacteriological cultures). Assuming a constant vigilance in the quality of dialysis fluids that is a part of a quality approach, the pharmacist is at the heart of the telemedicine partnership developed in hemodialysis on the island.

Constant vigilance: plant functions guarded by resistance proteins.

Unlike animals, plants do not have an adaptive immune system and have instead evolved sophisticated and multi-layered innate immune mechanisms. To overcome plant immunity, pathogens secrete a diverse array of effectors into the apoplast and virtually all cellular compartments to dampen immune signaling and interfere with plant functions. Here we describe the scope of the arms race throughout the cell and summarize various strategies used by both plants and pathogens. Through studying the ongoing evolutionary battle between plants and key pathogens, we may yet uncover potential ways to achieve the ultimate goal of engineering broad-spectrum resistant crops without affecting food quality or productivity.

<i>Candida</i> species as potential nosocomial pathogens – A review

The frequency of nosocomial fungal infections is being increased because of the advent of newer diagnostic and therapeutic techniques. Among various fungal pathogens, Candida spp. are the cause of substantial morbidity and mortality in hospitalized patients, especially among critically ill hospitalized patients. The frequency of non-ablicans spp. of Candida (NAC) causing nosocomial infections is increasing. The Candida infections are usually endogenous, however, the exogenous infections may also occur. The important predisposing factors leading to nosocomial candidiasis include treatment with broad spectrum antibiotics, immunosuppression, malignancy, surgical intervention, diabetes and prolonged hospitalization. Virulence factors like adherence to biotic and abiotic substances and production of hydrolytic enzymes play important role. Also the biofilm forming ability makes it more noxious. Nosocomial Candida infections are difficult to diagnose clinically and refractory to therapy. Therefore, rapid and accurate laboratory diagnosis is very important to provide appropriate antifungal treatment. This review is structured to know the key factors responsible for emergence of Candida spp. as important nosocomial pathogens. The available data suggests that the nosocomial infections caused by Candida spp. should be dealt through awareness and constant vigilance.

Does perioperative skin preparation reduce surgical site infection?

Does perioperative skin preparation reduce surgical site infection?

The use of online forums by people living with HIV for help in understanding personal health information

PurposeEffective self-management of the human immunodeficiency virus/acquired immune deficiency virus (HIV/AIDS) requires constant vigilance over personal health information. Little is known about the contribution of online communities to this endeavour. This paper reports a study to investigate how people living with HIV/AIDS use an online community to try to understand their personal health information by analysing how health information is shared and asked about, and how the community responds to questions. MethodsA webscraper was used to gather all messages in the 200 most recently active threads in an online forum for people living with HIV/AIDS, resulting in a total of 2455 messages. These were filtered for all instances of individuals sharing their personal health information and asking the community for help in understanding it. Thematic analysis was used to determine the types of questions asked, the personal health information shared and the information that was asked about. Messages from the community aiming to address the questions were analysed using a framework of social support. ResultsApproximately 10% of the 2455 messages were found to be involved in this activity: 60 messages contained questions, and 192 messages responded to address the questions. The most frequent type of question was about causation. While users shared a wide variety of information about their health, they most commonly asked about reactions, lab results, and other conditions. Nearly all the messages from the community that aimed to answer the questions provided informational support, which is a type of social support, and the community shared their own personal experiences in these responses. ConclusionsThis study demonstrates that online forums are used by people living with HIV to ask specific questions as a means of understanding their personal health information. The analysis provides a better understanding of the questions that people living with HIV have about their health information, and the types of support they receive from the community. The results provide a basis for further research into community support and self-management and will enable improved tools to support self-management.

Fearful fairy-wrens have the blues

![Graphic][1] Fear of death is a fairly strong motivator. And yet, animals get eaten all the time despite constant vigilance for predators in their midst. The problem is that animals are multi-purpose machines: they eat, they mate, they hunt for food and mates, and so on, and these activities

Delay in Diagnosis of Vertebrobasilar Insufficiency: The Masking Effect of Headache and Coexisting Pain Syndromes

Headaches of vascular and other origins can develop in the midst of work-ups for benign, long-standing pain conditions. The initial attribution of these headaches to benign conditions in the early evaluative process, especially when non-life threatening signs and symptoms are present, is not only frequently plausible but most often correct. Given the frequency with which patients present with a complaint of headache, constant vigilance and re-examination is required to prevent potentially life-threatening conditions from being overlooked as they develop. This case report describes a patient presentation that should serve as a cautionary tale for such a circumstance. Common, concurrent maladies were diagnosed and treated with varying degrees of success, yet the evolution of a potentially life-threatening disease with very similar symptomatology occurred in the midst of the workup. We believe this description will prove of value to established clinicians in their everyday practices, as well as to trainees as they study differential diagnoses. Citation: Daryl Irving Smith, Svetlana Pyatigorskya, Nobuyuki-Hai Tran. Delay in diagnosis of vertebrobasilar insufficiency: the masking effect of headache and coexisting pain syndromes. J Anesth Perioper Med 2017; 4: 231-6. doi:10.24015/JAPM.2017.0019This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Frequency of Dengue virus Infection among Febrile Patients of Lahore

BACKGROUND: Dengue virus infection is one of the major global public health problems. The infection usually occurs with clinical manifestations ranging from an asymptomatic or mild febrile illness as classical dengue fever to the potentially life-threatening illness, dengue hemorrhagic fever and dengue shock syndrome. The objective of the current study was to observe the frequency and diagnosis of primary or secondary dengue viral infection among individuals in Lahore city, Pakistan.METHODS: Study subjects were identified for the presence of dengue diagnostic markers including NS1 antigen, IgM and IgG antibody. The dengue specific antigen NS1 was detected by immonochromatography, while dengue specific antibodies (IgM and IgG) were measured through ELISA.RESULTS: Total 98 (56%) out of 175 febrile cases were found infected by dengue virus. From total 98 confirmed dengue cases, NS1 antigen was detected in 59 (60.20%), IgM antibodies were present in 74 (75.51%) and IgG antibodies were detected in 40 (40.81%) individuals. Statistical analysis reveals correlation of NS1 antigen and IgM antibody among dengue patients with significant P-value (P < 0.01). Results indicated that 58 (59%) were infected by primary infection and 40 (41%) were infected by secondary infection. The most effected age group was 21-30 years (51.02%) and least effected age group was <10 years (3.06%). Males were observed higher in number 61 (62%) as compare to females 37 (38%). Overall, the frequency of dengue virus infections were 56% among undifferentiated febrile patients in Lahore city, Pakistan.CONCLUSION: Dengue is found endemic in city population with increased incidence in monsoon and post monsoon. Constant vigilance of patients and dengue vector control awareness programs among public and health care officials could support in combating dengue.

To err is human: A case-based review of cognitive bias and its role in clinical decision making

To err is human: A case-based review of cognitive bias and its role in clinical decision making

Validação de conteúdo e aparência de um curso online para a vigilância da influenza

In Brazil, acute respiratory infections (ARI) caused by influenza are frequent in the population and demand constant vigilance from the health services, which has urged new educational technologies for coping with the disease. In view of this, the objective of the study is to validate the content and appearance of an online course for influenza management, together with judges with experience in the health surveillance and epidemiological network. It is a methodological study, based on Falkemback's (2015) reference and calculation of content validity index (CVI). After the development of the course, there was the apparent validation, content and pedagogical aspects that involved the training, by judges considered specialists in the areas of distance education and epidemiological and health surveillance in the area of influenza respectively. In total, 13 judges participated in this validation stage and analyzed the following points: Accessibility; Usability; functionality; Content; Relevance; Efficiency and Environment. According to the results, the judges were mostly female, eight were nurses and the other were in the area of dentistry, biology, pharmacy, medicine and veterinary medicine and in relation to the content validity index there was consensus among the participants. At the end, it can be said that the course, through specific pedagogical and didactic resources, is a virtual educational technology that has enabled collaborative learning to facilitate learning about influenza.

The chemical subject: phenomenology and German encounters with the gas mask in the World War I

Employing phenomenological theory, this paper argues that German World War I soldiers’ introduction to the gas mask represents a salient historical moment in the human relationship to modern chemical technology. As a protective device, the gas mask was intended to save soldiers from a horrible death by asphyxiation. In doing so, it forced soldiers to directly confront the new technological landscape of the modern World War I battlefield. While the mask proved genuinely effective in its ability to filter poison gases, it required constant vigilance from gas-weary soldiers. This so-called ‘gas discipline’ would allow men to survive and even thrive in a newly dangerous modern world. However, the physical and mental stress of this existence, often led to breakdowns in soldier discipline and failures in gas protection. Thus, the soldiers’ relationship to the gas mask revealed the limits of technological trust for the earliest ‘chemical subjects’ of the twentieth century.

Trauma hazards in children: An update for the busy clinician.

Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea.