OBJECTIVE

To identify bedside variables that aid in diagnosis of acute coronary syndrome (ACS) and might facilitate rapid triage of patients aged>> or = 65 years.

METHODS

Prospective, observational study of consecutive patients aged>> or = 65 years with suspicion of ACS presenting to our emergency department (ED). Patients' medical characteristics were collected at baseline and during a 1-month follow-up period. We identified variables independently associated with ACS by multivariate analyses and bootstrapping techniques.

RESULTS

Among 399 patients, 124 (31.1%) received a diagnosis of ACS (61 acute myocardial infarction, 63 unstable angina). We surveyed multiple clinical and ECG variables to develop a predictive model which included the following variables: male sex, history of coronary artery disease, typical chest pain, dyspnea, epigastric pain, pathological Q-wave, ST-segment elevation (area under the receiver operating characteristic curve (AUC) 0.79, 95% confidence interval 0.71 to 0.82). With the addition of cardiac troponin I to the model the AUC increased to 0.83 (0.79 to 0.88). We used these findings to create the Heart Attack Risk for aged Patient (HARP) scale. Our data suggest that patients with a low HARP score might be safely managed without further testing.

CONCLUSIONS

A model based on variables easily available at ED presentation from history, physical examination, and electrocardiography, can help ED physicians to identify seniors at very low risk of ACS.

This paper presents a novel algorithm that extends HARP to handle 3D tagged MRI images. HARP results were regularized by an original regularization framework defined in an anatomical space of coordinates. In the meantime, myocardium incompressibility was integrated in order to correct the radial strain which is reported to be more challenging to recover. Both the tracking and regularization of LV displacements were done on a volumetric mesh to be computationally efficient. Also, a window-weighted regression method was extended to cardiac motion tracking which helps maintain a low complexity even at finer scales. On healthy volunteers, the tracking accuracy was found to be as accurate as the best candidates of a recent benchmark. Strain accuracy was evaluated on synthetic data, showing low bias and strain errors under 5% (excluding outliers) for longitudinal and circumferential strains, while the second and third quartiles of the radial strain errors are in the (-5%,5%) range. In clinical data, strain dispersion was shown to correlate with the extent of transmural fibrosis. Also, reduced deformation values were found inside infarcted segments.

BACKGROUND

A harmonized protocol (HarP) for manual hippocampal segmentation on magnetic resonance imaging (MRI) has recently been developed by an international European Alzheimer's Disease Consortium-Alzheimer's Disease Neuroimaging Initiative project. We aimed at providing consensual certified HarP hippocampal labels in Montreal Neurological Institute (MNI) standard space to serve as reference in automated image analyses.

METHODS

Manual HarP tracings on the high-resolution MNI152 standard space template of four expert certified HarP tracers were combined to obtain consensual bilateral hippocampus labels. Utility and validity of these reference labels is demonstrated in a simple atlas-based morphometry approach for automated calculation of HarP-compliant hippocampal volumes within SPM software.

RESULTS

Individual tracings showed very high agreement among the four expert tracers (pairwise Jaccard indices 0.82-0.87). Automatically calculated hippocampal volumes were highly correlated (rL/R = 0.89/0.91) with gold standard volumes in the HarP benchmark data set (N = 135 MRIs), with a mean volume difference of 9% (standard deviation 7%).

CONCLUSIONS

The consensual HarP hippocampus labels in the MNI152 template can serve as a reference standard for automated image analyses involving MNI standard space normalization.

Some studies have suggested that omega-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect on the growth of cancer cells and therefore have the potential to increase the efficacy of cancer chemotherapeutic drugs. Considering that omega-3 PUFAs are present abundantly in harp seal oil, we investigated the effect of seal oil on the cytotoxicity and apoptosis induced by paclitaxel in 2 breast cancer cell lines, MCF-7 and MDA-MB-231, respectively. Cytotoxicity evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay revealed that the concentration of paclitaxel that is required for 50% inhibition of cell growth in the presence of seal oil was significantly lower than that of paclitaxel alone. Apoptosis assessment based on morphological changes and DNA fragmentation results indicated that more cells treated with paclitaxel in combination with seal oil underwent apoptosis than with paclitaxel alone. Western blot analysis showed that the expression of B cell lymphoma-2 (Bcl-2) protein, an apoptosis inhibitory protein, in both cell lines was decreased more significant by paclitaxel in combination with seal oil than by paclitaxel alone. In addition, seal oil alone was found to induce apoptosis in both cell lines tested, which appeared to be due to the increased intracellular lipid peroxides produced. It is therefore concluded that paclitaxel in combination with seal oil demonstrated enhanced cytotoxicity and apoptosis in MCF-7 and MDA-MB-231 cells compared to paclitaxel alone, and the use of seal oil may be beneficial in the treatment of breast cancer.

Temperature regulation in harp seal pups (Pagophilus groenlandicus) has been studied by in vivo measurements of oxygen consumption, body temperatures and in vitro determinations of the thermal values of a fur sample. The experimental animals were restrained and exposed to natural wheather conditions. Solar irradiance above 600 W/m (global radiation) caused hyperthermia. Computer simulations based on the thermal values of the fur indicated that heat dissipation from primarily the limbs is a prerequisite for avoiding hyperthermia under natural weather conditions. Further simulations showed that the lower critical temperature of a lean newborn harp seal pup with standard metabolism is only--1 degree C while it is depressed to--59 degree C as the pup grows, aquire a 10 cm thick layer of blubber and the metabolism increases to 1.5 times standard. High metabolism and tolerance to low deep body temperatures (35 degree C) seems a prerequisite for thermal balance in the harp seal pup under cold conditions.

The HepA-related protein (HARP/SMARCAL1) is an ATP-dependent annealing helicase that is capable of rewinding DNA structures that are stably unwound due to binding of the single-stranded DNA (ssDNA)-binding protein Replication Protein A (RPA). HARP has been implicated in maintaining genome integrity through its role in DNA replication and repair, two processes that generate RPA-coated ssDNA. In addition, mutations in HARP cause a rare disease known as Schimke immuno-osseous dysplasia. In this study, we purified HARP containing complexes with the goal of identifying the predominant factors that stably associate with HARP. We found that HARP preferentially interacts with RPA molecules that are bound to the DNA-dependent protein kinase (DNA-PK). We also found that RPA is phosphorylated by DNA-PK in vitro, while the RPA-HARP complexes are not. Our results suggest that, in addition to its annealing helicase activity, which eliminates the natural binding substrate for RPA, HARP blocks the phosphorylation of RPA by DNA-PK.

Helicobacter species are widely distributed in the gastrointestinal system of humans and many animal taxa. Investigations of natural infections are essential to elucidating their role within the host. The feces of fur seals Arctocephalus pusillus doriferus and sea lions Neophoca cinerea from 3 separate captive populations, as well as a wild colony from Kangaroo Island, Australia, were examined for the occurrence of Helicobacter spp. The feces from several wild silver gulls Larus novahollandiae were also investigated. As detected by PCR, 18 of 21 samples from captive and 12 of 16 samples from wild seals were positive for Helicobacter spp. Three species were identified in these animals. Whilst one possibly novel type was identified from wild fur seals, the majority of wild and captive individuals had the same species. This species also occurred in more than 1 seal type and in silver gulls, and shared a 98.1 to 100% identity to other Helicobacter spp. from harp seals and sea otters. A similar sequence type to species identified from cetaceans was also detected in several captive seals. This study reports for the first time the presence of Helicobacter spp. in wild and captive seals and demonstrates the diversity and broad-host range of these organisms in the marine host.

Homogenous strain analysis (HSA) was developed to evaluate regional cardiac function using tagged cine magnetic resonance images of heart. Current cardiac applications of HSA are however limited in accurately detecting tag intersections within the myocardial wall, producing consistent triangulation of tag cells throughout the image series and achieving optimal spatial resolution due to the large size of the triangles. To address these issues, this article introduces a harmonic phase (HARP) interference method. In principle, as in the standard HARP analysis, the method uses harmonic phases associated with the two of the four fundamental peaks in the spectrum of a tagged image. However, the phase associated with each peak is wrapped when estimated digitally. This article shows that special combination of wrapped phases results in an image with unique intensity pattern that can be exploited to automatically detect tag intersections and to produce reliable triangulation with regularly organized partitioning of the mesh for HSA. In addition, the method offers new opportunities and freedom for evaluating myocardial function when the power and angle of the complex filtered spectra are mathematically modified prior to computing the phase. For example, the triangular elements can be shifted spatially by changing the angle and/or their sizes can be reduced by changing the power. Interference patterns obtained under a variety of power and angle conditions were presented and specific features observed in the results were explained. Together, the advanced processing capabilities increase the power of HSA by making the analysis less prone to errors from human interactions. It also allows strain measurements at higher spatial resolution and multi-scale, thereby improving the display methods for better interpretation of the analysis results.

1. Panic disorder (PD) is an illness that can be acute or chronic and is often complicated by depression, phobias and obsessions. This illness affects at least 10% of the population. 2. Panic disorder has been recognized as a psychopathologic condition for at least 100 years. Over the last several decades, health professionals have changed their view of PD, and in 1987 the DSM-III included PD as a distinctive syndrome. 3. Several studies have shown PD to be a chronic illness with only little to no improvement in 36-40% of the subjects after 1 to 20 years of treatment. Studies also suggest that duration of illness affects the degree of impairment: subjects who had PD for more than 6 months showed more impairment that subjects who had PD for less than 6 months. 4. Several studies show that 50-75% of patients with PD have had at least one episode of major depression. Findings also indicate that subjects with both PD and secondary depression are a more severely ill group. 5. The HARP study is an ongoing 12-site naturalistic, longitudinal examination of patients with current or past PD. One of the major goals of this study is to describe the patterns of the clinical course of PD related disorders. 6. Clinical experience indicates that an estimated 40% of PD patients may need treatment for one year and between 20-40% will require continued maintenance treatment. Long-term treatment may include behavioral therapy and/or medication. 7. Anxiety disorders are common and familial and are consistently higher among women. Panic Disorder is a chronic condition frequently complicated by Axis I and II disorders. Continued long-term maintenance studies of medications and psychotherapy for anxiety disorders is critical in the treatment of this chronic illness.

Heat balance can be difficult for young and/or small animals in polar regions because environmental conditions in combination with small body size or physiological immaturity can increase heat loss. We investigated how thermoregulatory patterns change with ontogeny in 5 age classes of harp seal (Pagophilus groenlandicus) from birth to post-molt to further understand the timing of thermoregulatory development in relation to their potential vulnerability to ongoing fluctuations in the extent and stability of Arctic pack ice. We measured changes in the amount, conductivity, and resistance of the seal pups׳ insulative layers (blubber and fur), the potential for endogenous heat-generation by shivering (muscle enzyme activity), and nonshivering thermogenesis (NST; brown adipose tissue (BAT) uncoupling protein 1 (UCP1) expression and mitochondrial density). There was no significant difference in blubber conductivity among age classes, though the amount of blubber insulation significantly increased from birth to weaning. Pelage conductivity was low (0.12±0.01Wm(-1)°C(-1)) except in 9-day old pups (0.40±0.08Wm(-1)°C(-1)); the significantly higher conductivity may signal the beginning of the molt, and this age group may be the most vulnerable to early water entry. Citrate synthase activity significantly increased (49.68±3.26 to 75.08±3.52μmolmin(-1)gwetweight(-1)) in the muscle; however it is unlikely that increasing a single enzyme greatly impacts heat generation. BAT of younger pups contained UCP1, though expression and mitochondrial density quickly declined, and the ability of pups to produce heat via NST was lost by weaning. While total thermal resistance did not differ, neonatal and early nursing animals gained the majority of their thermal resistance from lanugo (82.5±0.03%); however, lanugo is not insulative when wet, and NST may be important to maintain euthermia and dry the coat if early immersion in water occurs. By late nursing, blubber seems sufficient as insulation (75.87±0.01% of resistance after 4 weeks), but high conductivity of fur may be responsible for retention of UCP1 expression. Weaned animals rely on blubber insulation, and no longer need NST, as wetted fur is no longer a threat to euthermia.

Knowledge on pinniped immunology is still in its infancy. For instance, age-related and developmental aspects of the immune system in pinnipeds need to be better described. The present study examined the phagocytic activity and efficiency of harbour, grey and harp seal leukocytes. In the first part of the study, peripheral blood was collected from captive female harbour seals of various ages. Data showed an age-related decrease in phagocytosis in female harbour seals from sub-adult to adulthood. In the second part of the study, changes in phagocytosis were quantified during lactation in wild newborn harbour, grey and harp seals and in their mothers (harp and grey seals). In newborns of the same age, leukocytes of harbour and harp seals phagocytosed less than those of grey seal pups. The phagocytic activity and efficiency increased significantly from early to mid-lactation in newborn harbour seals, and from early to late lactation in newborn grey seals, which could suggest that the transfer of phagocytosis-promoting factor(s) in colostrum is an important feature of temporary protection for pups. In contrast, no changes in phagocytic activity and efficiency were observed in lactating females of the two seal species, harp and grey, examined. At late lactation, phagocytic activity in both grey and harp seal pups and phagocytic efficiency in grey seal pups were significantly higher than in their mothers. These results could reflect either the capacity of phagocytes of the newborn harp and grey seals to respond to pathogens. Results from this study suggest that the phagocytosis of the seal species examined is not fully developed at birth as it generally increases in pups during lactation. Thereafter, the phagocytic activity of seals appears to decrease throughout adulthood.

Combined modality therapy incorporating raltitrexed (RTX), a thymidylate synthase inhibitor, and radiation can lead to improved outcome for rectal cancer patients. To increase delivery and treatment efficacy, we formulated a hyaluronic acid (HA) coated nanoparticle encapsulating RTX (HARPs) through layer-by-layer assembly. These particles were determined to have a diameter of ∼115 nm, with a polydispersity index of 0.112 and a zeta potential of -22 mV. Cell uptake in CT26 cells determined through flow cytometry showed a ∼5-fold increase between untargeted and HA-coated particles. Through viability and DNA damage assays, we assessed the potency of the free RTX and HARPs, and found increased DNA damage in cells treated with the RTX-loaded nanoparticles administered concurrently with radiation. In vivo efficacy through tumor growth inhibition was investigated in a syngeneic murine colorectal cancer model. Nanoparticle treatment showed no acute toxicity in vivo, and all treatments showed survival benefits for their respective groups compared to controls. HARPs alone slowed tumor growth, although not significantly. Radiation alone and in combination with the HARPs showed significant growth delay. Notably, the combination treatment significantly hindered tumor progression relative to the HARPs highlighting the benefit of this multipronged treatment. These results provide a foundation for loading RTX in a nanoparticle formulation, and establish a combined radiation and drug dosing schedule to determine optimal tumor growth delay and subsequent treatment efficacy.

OBJECTIVE

To apply a new television system, which displays highly sensitive, high-quality 3-dimensional (3-D) images, in performing experimental ophthalmic surgeries.

METHODS

By combining a high-gain avalanche rushing-amorphous photoconductor (HARP) camera, recently developed in Japan, which has 600 times greater sensitivity than conventional television cameras, and a single-camera, 3-D high-definition television system, which displays high-quality 3-D images, we performed cataract/intraocular lens surgeries and pars plana vitrectomies under various illumination intensities in pig cadaver eyes.

RESULTS

Cataract/intraocular lens surgeries were performed using 7.3% the intensity of ordinary surgical microscopic illumination; vitrectomies were performed using 30.2% the intensity of an ordinary endoillumination probe with the HARP camera and by observing the stereoscopic display of the single-camera 3-D high-definition television system. Images identical to those observed by the surgeon were displayed on the stereoscopic display monitor.

CONCLUSIONS

The system not only allowed surgeries to be performed under lower intensities of operating light but also provided real-time, highly sensitive 3-D images identical to those observed by the surgeon; thus, the device may be effectively used for education, team surgery, and telesurgery.

CONCLUSIONS

The new television system for ocular surgeries to be performed under lower intensities of operating light as well as providing real-time, highly sensitive 3-D images identical to those observed by the surgeon may be effectively used for education and telesurgery.

Cold environmental conditions and small body size promote heat loss and may create thermoregulatory challenges for marine mammals born in polar regions. However, among polar-born phocid seal species there are variations in physical attributes and environmental conditions at birth, allowing for an interesting contrast in thermoregulatory strategy. We compared thermoregulatory strategies through morphometrics, sculp attributes (conductivity and resistance), nonshivering thermogenesis (NST via uncoupling protein 1; UCP1), and muscle thermogenesis (via enzyme activity) in neonatal harp (Pagophilus groenlandicus), hooded (Cystophora cristata), and Weddell seals (Leptonychotes weddellii). Harp seals are the smallest at birth (9.8±0.7 kg), rely on lanugo (82.49±3.70% of thermal resistance), and are capable of NST through expression of UCP1 in brown adipose tissue (BAT). In contrast, hooded seal neonates (26.8±1.3 kg) have 2.06±0.23 cm of blubber, accounting for 38.19±6.07% of their thermal resistance. They are not capable of NST, as UCP1 is not expressed. The large Weddell seal neonates (31.5±4.9 kg) rely on lanugo (89.85±1.25% of thermal resistance) like harp seals, but no evidence of BAT was found. Muscle enzyme activity was highest in Weddell seal neonates, suggesting that they rely primarily on muscle thermogenesis. Similar total thermal resistance, combined with marked differences in thermogenic capacity of NST and ST among species, strongly supports that thermoregulatory strategy in neonatal phocids is more closely tied to pups' surface area to volume ratio (SA:V) and potential for early water immersion rather than mass and ambient environmental conditions.

Harp seals are born on the drifting ice of the North Atlantic Ocean during arctic winter when temperatures of -20 degrees C, occasionally in combination with wind of 10 m/s, might prevail for days. At birth the pups lack subcutaneous blubber and the wet infantile fur has a conductance value of 30.0 W . m-2 . degrees C-1, as compared with only 2.0 W . m-2 . degrees C-1 when dry. While still wet immediately after birth the pups are nevertheless able to retain body core temperature by shivering. This activity leads to reduction of muscle fat and glycogen stores. Nonshivering thermogenesis commences in thermogenic adipose tissue by virtue of loosely coupled mitochondria. Thermogenic adipose tissue is found at birth both as a subcutaneous layer along the back and as internal deposits around venous plexuses in the neck, on the pericardium, on the kidneys, and the abdominal walls. After about 3 days of suckling the subcutaneous adipose tissue loses its thermogenic function being gradually transformed into blubber, whereas the internal deposits persist at least until the pups venture into water at the age of 3-4 wk.

Heparin affin regulatory peptide (HARP), also called Pleiotrophin (PTN), is a polypeptide that displays a high affinity for heparin and that shares approximately 50% sequence homology with Midkine (MK). According to this structural homology, these two molecules constitute a new family of heparin-binding proteins. The biological properties of HARP and MK remain largely a subject of debate. Both proteins have been described as neurite outgrowth promoting agents whereas until recently the mitogenic activity has been controversial. The aim of this review is to summarize the information on HARP with special focus on the recent data relating to its mitogenic properties.

Three harp seal pups, Phoca groenlandica, were captured on the ice of the Gulf of St. Lawrence, and subjected to 3 h of transportation and handling stress. The activities of creatine kinase (CK), aspartate aminotransferase (AspAT), aldolase, alanine aminotransferase, gamma glutamyl transpeptidase, and leucine aminopeptidase were determined in serial blood samples collected for 4 d following the stress episode. Marked elevation of plasma CK activity was observed 3 h after capture. Values returned to normal in 12 h in two seals, and by 24 h in the third. Slight elevations in AspAT were also noted; the remaining enzymes were unaffected. Plasma CK is recommended as a sensitive indicator of handling stress in seals.

The rates of cellulose breakdown, composition of detrital microflora, and density of bacterial populations were determined in the epilimnetic sediments and water columns of two poorly buffered, oligotrophic, Canadian Shield lakes having mean surficial pHs of 4.6 (Bat Lake) and 6.6 (Harp Lake). The decomposition rate was significantly lower in oxic sediment of the acidified lake than of the circumneutral lake, but water column rates were almost identical in the two lakes. These results are explained in terms of the groups of cellulolytic microorganisms which were observed by phase-contrast microscopy as being active at the different sites: fungi in Bat Lake water and Cytophaga-like bacteria in the water and sediment of Harp Lake. Cytophaga-like bacteria were also the main decomposers in Bat Lake sediment, but their activity was restricted at porewater pHs of <5.0. Acridine orange direct counts of bacteria in the top centimeter of sediment ranged from 3.7 x 10 to 1.0 x 10 per g, and counts in planktonic water samples ranged from 4.9 x 10 to 1.2 x 10 per ml. Bacterial densities at most sites decreased significantly (P < 0.001) from August to late October, but did not show a consistent pattern of differences related to pH.

Population dynamics, roost selection and reproductive patterns of some cave bats from Western of Mexico. Almost half of bat species that occur in Mexico use caves as permanent or temporal roosts. However, the ecological studies about cave bat communities are scarce. In this work we studied the population dynamics, roost selection and reproductive patterns of some bats present in El Salitre Cave, Colima, Mexico. We carried out monthly samplings between August 2003-March 2005 using a harp trap for bats capture, we took their biological data and marked some of them with plastic rings. We also explored the cave to locate bat colonies and register microclimatic conditions in each cave section. We captured a total of 16 409 bats of which 31% were Mormoops megalophylla, 24.5% Pteronotus personatus, 23% P. davyi, 8.2% P. parnellii, 5.8% Natalus mexicanus and 5.3% Glossophaga soricina. Macrotus waterhousii, G. morenoi, Desmodus rotundus, Balantiopteryx plicata, and Glyphonycteris sylvestris represented only 2.2% of the captures. Some bat species used the cave as a permanent day roost while others as a seasonal one, and their population size varied markedly along the year and between rainy and dry seasons. Most bat population peaks were linked with their reproductive periods. The Pteronotus species and N. mexicanus exhibited sexual segregation during the breeding season. The mormoopids and N. mexicanus occupied deeper parts of the cave with temperatures >25.8 degrees C and relative humidity >99%. The phyllostomids occupied intermediate sections where the ambient was less hot and humid, with temperatures of 23.2-28.3 degrees C and humidity of 74-89.9%. Some individuals of B. plicata and G. sylvestris were seen occasionally occupying one chamber near the entrance two, where temperature and humidity were of 23.2 degrees C and 84.2%, respectively. The mormoopids and N. mexicanus showed a pattern of seasonal monoestry, synchronized with rainy season. Glossophaga soricina had a pattern of bimodal seasonal poliestry, with one reproductive peak to early of dry season and another to last of this season. Macrotus waterhousii did not exhibit a seasonal pattern, with parturitions occurring throughout the year. Our results indicate a seasonal replacement between several species as well as seasonal movements to other caves. The data indicate that the carrying capacity of the cave is mainly determined by the availability of roosting sites. The selection of roosting sites is linked to the close relationship between microclimatic conditions and the species physiological characteristics. The reproduction of mormoopids and N. mexicanus was mostly influenced by rainfall which determinates food availability.

Some interpretations of ecosystem-based fishery management include culling marine mammals as an integral component. The current Norwegian policy on marine mammal management is one example. Scientific support for this policy includes the Scenario Barents Sea (SBS) models. These modelled interactions between cod, Gadus morhua, herring, Clupea harengus, capelin, Mallotus villosus and northern minke whales, Balaenoptera acutorostrata. Adding harp seals Phoca groenlandica into this top-down modelling approach resulted in unrealistic model outputs. Another set of models of the Barents Sea fish-fisheries system focused on interactions within and between the three fish populations, fisheries and climate. These model key processes of the system successfully. Continuing calls to support the SBS models despite their failure suggest a belief that marine mammal predation must be a problem for fisheries. The best available scientific evidence provides no justification for marine mammal culls as a primary component of an ecosystem-based approach to managing the fisheries of the Barents Sea.

Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention. Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients' daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention. Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results. Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.

OBJECTIVE Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach. DESIGN Point-prevalence study. SETTING This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility. PATIENTS Inpatients on all units excluding psychiatry and obstetrics-gynecology. METHODS CRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution. RESULTS Of 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%-6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%-6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%-11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5-1.5) and 1.5 (95% CI, 0.9-2.6), respectively. No CRE were identified from the inpatient rehabilitation facility. CONCLUSION A baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection. Infect Control Hosp Epidemiol 2017;38:921-929.

Ringed seals (Pusa hispida) are semi-aquatic marine mammals with a circumpolar Arctic distribution. In this study, we investigate the amphibious hearing capabilities of ringed seals to provide auditory profiles for this species across the full range of hearing. Using psychophysical methods with two trained ringed seals, detection thresholds for narrowband signals were measured under quiet, carefully controlled environmental conditions to generate aerial and underwater audiograms. Masked underwater thresholds were measured in the presence of octave-band noise to determine critical ratios. Results indicate that ringed seals possess hearing abilities comparable to those of spotted seals (Phoca largha) and harbor seals (Phoca vitulina), and considerably better than previously reported for ringed and harp seals. Best sensitivity was 49 dB re. 1 µPa (12.8 kHz) in water, and -12 dB re. 20 µPa (4.5 kHz) in air, rivaling the acute hearing abilities of some fully aquatic and terrestrial species in their respective media. Critical ratio measurements ranged from 14 dB at 0.1 kHz to 31 dB at 25.6 kHz, suggesting that ringed seals--like other true seals--can efficiently extract signals from background noise across a broad range of frequencies. The work described herein extends similar research on amphibious hearing in spotted seals recently published by the authors. These parallel studies enhance our knowledge of the auditory capabilities of ice-living seals, and inform effective management strategies for these and related species in a rapidly changing Arctic environment.