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Antimicrobial efficacy of biocides tested on skin using an ex-vivo test.

An ex-vivo test was used to evaluate the activity of antimicrobials against three microorganisms, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. The ex-vivo test is a carrier test using freshly excised animal skin samples maintained in viable conditions for a short period of time. Skin samples came from a veterinary practice and were excised from either dogs or cats. The antimicrobial activity of povidone iodine, chlorhexidine diacetate, cetrimide and benzalkonium chloride was also evaluated with suspension and glass-carrier tests. Generally, the activity of the antimicrobials tested was reduced when applied to the skin surface. Apart from povidone iodine (2%) against S. aureus, the biocides investigated failed to achieve a 5 log10 reduction in bacterial titre when tested with the ex-vivo method. There was no significant difference in reduction of bacterial titres after treatment with antimicrobials between the glass-carrier and the suspension tests. Furthermore, the drying process of bacterial inoculum was less detrimental on skin than on glass surfaces. This study confirmed that the activity of a biocide tested in suspension or on an inanimate surface did not reflect its activity when tested on skin. Further development of the ex-vivo test may be useful, especially for testing the antimicrobial activity of formulations with antiseptic properties.

Animals↗

The use of the rapid exchange grip test in detecting sincerity of effort, Part II: validity of the test.

The rapid exchange grip (REG) test was developed to identify patients exerting insincere effort. The premise of the REG test is that a maximal, sincere effort yields a "negative REG," in which peak static grip (SG) scores are greater than peak REG scores, and that a submaximal, insincere effort yields a "positive REG," in which REG scores are greater than SG scores. There is disagreement in the literature concerning what constitutes a positive REG test, suggesting that the REG may not be a valid measure of sincerity of effort. The purpose of the present study was to investigate the validity of the REG test by examining its premise as well as its sensitivity and specificity values. The 146 uninjured subjects performed a series of randomized grip strength tests, exerting both maximal and submaximal efforts. The tests included the REG at hand switch rates of 45 rpm (REG-45) and 60 rpm (REG-60), the maximal static grip test (MSGT), and the five-rung test (5R). Our findings supported the concept of a "negative REG" for both REG maneuvers and both comparative SG tests. The concept of a "positive REG," however, was supported only when peak REG scores were compared with peak 5R scores. The authors found relatively low sensitivity and specificity values, suggesting that the REG test may not be sensitive or specific enough to effectively detect sincerity of effort. The authors discuss the likelihood that mistakes will be made when the REG test is used to diagnose sincerity of effort and the possible consequences of making such mistakes.

Adolescent↗

The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test.

The purpose of this study was to determine the validity of the belly-press test as a clinical test for the subscapularis muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the subscapularis muscle. EMG data of 7 muscles (upper subscapularis, lower subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the subscapularis muscle greater than all other muscles, indicating that both tests are valid and specific for evaluation of the subscapularis muscle (P <.05). The belly-press test was found to activate the upper subscapularis muscle significantly more than the lift-off test (P <.05), whereas the lift-off test was found to pose a significantly greater challenge to the lower subscapularis muscle than the belly-press test (P <.05). These findings may improve the clinical testing and assessment of the subscapularis muscle.

Adult↗

Ring-testing and field-validation of a terrestrial model ecosystem (TME)--an instrument for testing potentially harmful substances: effects of carbendazim on soil microarthropod communities.

The effects of the fungicide carbendazim (applied in the formulation Derosal) on soil microarthropod communities was determined in three Terrestrial Model Ecosystem (TME) tests and a field-validation study for a period of 16 weeks after application. TMEs consisted of intact soil columns (diameter 17.5 cm: length 40 cm) taken from a grassland field. The TMEs for the two tests (pre-test and ring-test) in Amsterdam, The Netherlands, were taken from the same site where the field-validation study was performed, the third TME test (pre-test) was performed in Bangor, Wales. Collembola communities showed large variations in numbers and no effects of carbendazim on species diversity were seen. Mites were not determined to species but only to four main taxonomic groups (Astigmata, Cryptostigmata, Mesostigmata, Prostigmata). Mite numbers in both TME and field soils also showed rather large variations and it was difficult to find consistent effects of carbendazim treatment. Principal response curve (PRC) analysis was performed to further evaluate effects of carbendazim on Collembola and mites in the TME and field tests. This multivariate technique demonstrated significant effects of carbendazim on Collembola communities in one TME test and the field-validation study but not in the other two TME tests, while mite communities showed significant effects in two TME tests but not in the third TME test and the field-validation study. NOECs for the effect of carbendazim on Collembola and mite communities derived from these PRC analyses ranged from 0.36 to 87.5 kg a.i./ha.

Animals↗

Phenol red thread test vs Schirmer's test: a comparative study.

AIM: To measure the agreement between Schirmer's and phenol red thread tests in detecting dry eyes. PATIENTS AND METHODS: A total of 103 patients attending preoperative cataract assessment clinic who agreed to be involved in the study were recruited. Each patient had one eye examined by both tests in a random order by two different investigators who were unaware of the results of the other test. Dry eye symptoms were assessed using an interviewer-administered questionnaire. The data were collected after the study period and analysed using kappa statistics to assess the agreement between the two tests. RESULTS: Schirmer's test was positive in 25 patients when a cutoff point of 5 mm was used and positive in 41 patients with a cutoff point of 10 mm. Phenol red thread test was positive in four patients when a cutoff point of 10 mm was used and in 32 patients with a cutoff point of 20 mm. Kappa ranged from 0.067 to 0.3 indicating very weak agreement between the two tests. In all, 27% of the patients had symptoms of dry eyes; however, the agreement between each test and the symptoms was very poor. CONCLUSION: There is very weak agreement between Schirmer's test and phenol red thread tests and between each test and symptoms of dry eyes.

Adult↗

Evaluation of the Premi Test and comparison with the One-Plate Test for the detection of antimicrobials in kidney.

The Premi Test, a test kit designed for the rapid screening of antimicrobial residues in meat, fish and eggs, was evaluated and compared with the (modified) One-Plate Test, an agar diffusion assay. The performance characteristics described for qualitative, screening methods in Commission Decision 2002/657/EC were used for the evaluation. The Premi Test was found to detect a range of antimicrobials to MRL levels in kidney fluid but to have poorer sensitivity for some antimicrobials such as tetracyclines, sulphonamides, flumequine and streptomycin. The test was found not to be sensitive for the banned antimicrobial chloramphenicol. The One-Plate Test was found to detect most tetracyclines and flumequine to MRL levels but to be less sensitive than the Premi Test for most of the other classes of antimicrobials. Neither test alone provides a comprehensive screening test for antimicrobial residues in kidney at MRL levels. However, the Premi Test is fast, easy to use and rugged and, in combination with other antimicrobial tests, may be used to provide a comprehensive screening system for antimicrobials in tissues.

Animals↗

Human immunodeficiency virus testing experience and hepatitis B vaccination and testing status of healthcare workers in South Carolina: implications for compliance with US Public Health Service guidelines.

OBJECTIVE: To assess the previous human immunodeficiency virus (HIV) testing experience and the hepatitis B (HB) vaccination and testing status of healthcare workers potentially involved in invasive surgical procedures. DESIGN: Anonymous questionnaire survey. SETTING: Tertiary care and community-teaching medical center and affiliated healthcare facilities in Greenville County, South Carolina. PARTICIPANTS: Physicians (including residents in training), dentists, nurses and surgical technicians working in the operating room and labor/delivery areas. RESULTS: Of 506 responding physicians and dentists (65% of the sample), 60% previously had had a test for HIV, and 72% had received HB vaccine. Testing had occurred most often because of a requirement by an insurance company or because of blood donation. Eighty percent of tested respondents had their most recent test within 2 years of the time of the survey (August 1991). Of 145 responding nurses and surgical technicians (73% of the sample), 26% had had a test for HIV and 77% had received HB vaccine. CONCLUSIONS: The majority of surgeons and dentists in Greenville County, South Carolina, already have been tested for HIV for a variety of reasons and thus are aware of their HIV infection status, at least as of the time of the most recent test. The majority of local healthcare workers who are potentially involved with invasive surgical procedures have received HB vaccine. Programs developed in response to recent US Public Health Service guidelines should take HIV testing of healthcare workers for any reason into consideration and should emphasize HB vaccination and testing for vaccine-induced HB immunity.

AIDS Serodiagnosis↗

Desired elements of HIV testing services: test recipient perspectives.

Thematic analysis of transcripts from interviews with a purposive sample of 39 voluntary human immunodeficiency virus (HIV) test recipients in Ontario (selected on the basis of HIV serostatus, risk behaviors, region of residence, gender, and testing format) was used to identify elements of HIV testing services of concern to test recipients. Colleague review was used to ensure dependability of findings, and emergent themes were compared with the existing literature on patient satisfaction. Data analysis identified a comprehensive set of 28 service elements, including components related to access and availability (convenience, physical accessibility, familiarity), structure of the service (privacy, and characteristics of the venue, session, and test provider), technical and medical aspects of the testing process (including blood-taking, file maintenance, obtaining informed consent, waiting period, and manner of result provision), and both cognitive and socioemotional aspects of the interpersonal process (including decision-making support, personalized risk information, receipt of appropriate emotional support, and service referrals). Results suggest that information on, and training in, counseling skills for both physician and nonphysician test counselors is important in the provision of quality testing services. Results also suggest that test recipients would appreciate choice in testing service options, and within the test session, individualized information, and counseling.

AIDS Serodiagnosis↗

The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening.

OBJECTIVE: To explore the acceptability of the self-collection of samples for human papillomavirus (HPV) testing in comparison with that of the Pap test. METHODS: The study population consisted of 1069 women 20 years and older who were eligible for coverage through the Mexican Institute of Social Security (IMSS). These women were randomly selected among participants in a larger study to evaluate the use of HPV testing as an alternative in cervical cancer screening. All participants provided a self-collected vaginal sample for HPV testing according to explicit instructions and underwent a Pap test. Afterwards, each woman was interviewed about her experience and opinion regarding the two procedures. Acceptability was measured by a calculated score based on discomfort, pain, embarrassment, privacy, perception of personal treatment during the Pap test, and understanding of how to perform the self-sampling method. RESULTS: Ninety-three percent of women experienced sufficient privacy with the Pap test, whereas 98% of women reported that privacy with the self-sampling procedure was acceptable. The Pap test consistently provoked more discomfort, pain, and embarrassment than self-sampling. Sixty-eight percent of the women who indicated a test preference chose self-sampling. Preference for this method was positively associated with monthly household income. Women reported a preference for self-sampling because it is more comfortable (71.2%) and causes less embarrassment (55.8%). CONCLUSIONS: Self-sampling is more acceptable than the Pap test and could improve coverage rates of early detection programs. The incorporation of self-collected samples to detect HPV could encourage participation in screening programs among those women who reject the Pap test because of the necessary pelvic examination.

Adult↗

Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing.

Physical therapists require an accurate, reliable method for measuring muscle strength. They often use manual muscle testing or hand-held dynametric muscle testing (DMT), but few studies document the reliability of MMT or compare the reliability of the two types of testing. We designed this study to determine the intrarater reliability of MMT and DMT. A physical therapist performed manual and dynametric strength tests of the same five muscle groups on 11 patients and then repeated the tests two days later. The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually. The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. We concluded that both MMT and DMT are reliable testing methods, given the conditions described in this study. Both testing methods have specific applications and limitations, which we discuss.

Adult↗

Make tests and break tests of elbow flexor muscle strength.

The purposes of this investigation were 1) to compare the forces produced by the elbow flexor muscles during make tests and break tests and 2) to determine the reliability of each of the test procedures. I used a hand-held dynamometer to perform two make tests and two break tests on 27 young women. The forces produced by the elbow flexor muscles during break tests were significantly larger than (p less than .001), albeit correlated with (r greater than .80), the forces produced during make tests. Each testing procedure was reliable (r = .909 for make tests; r = .922 for break tests). On the basis of reliability, one type of testing cannot be considered clearly superior to the other.

Adult↗

Test-retest reliability of two tiltboard tests in children.

BACKGROUND AND PURPOSE: Most clinical evaluations of postural control in children are relatively subjective and have not been tested for reliability of scoring. The purpose of this study was to investigate the test-retest reliability of measurements obtained with two tiltboard tests. SUBJECTS: Subjects were 18 children, aged 53 to 81 months (mean = 64.4, SD = 8.3), who were typically developing (TD group) and 18 children, aged 50 to 79 months (mean = 63.3, SD = 8.4), with developmental delays (DD group). METHODS: Each child was tested using the two tilt-board tests and was then retested using the same tests approximately 1 week later. The maximum angle of tiltboard tilt prior to any postural adjustment by the child was recorded. RESULTS: Intraclass correlation coefficients for test-retest reliability (two-way, random-effects, repeated-measures model) ranged from .49 to .54 for the TD group and from .52 to .82 for the DD group. Angles were higher for both groups for the second test. CONCLUSION AND DISCUSSION: The results suggest that these tiltboard tests do not give stable and reliable measurements across test sessions. Before these tests can be used to document change in postural control abilities across time, further research is warranted.

Child↗

Oxygen effects on glucose meter measurements with glucose dehydrogenase- and oxidase-based test strips for point-of-care testing.

OBJECTIVES: To determine the effects of different oxygen tensions (Po2) on glucose measurements with glucose dehydrogenase (GD)-based and glucose oxidase (GO)-based test strips, to quantitate changes in glucose measurements observed with different Po2 levels, and to discuss the potential risks of oxygen-derived glucose errors in critical care. DESIGN: Venous blood from healthy volunteers was tonometered to create different oxygen tensions simulating patient arterial Po2 levels. Venous blood from diabetic patients was exposed to air to alter oxygen tensions simulating changes in Po2 during sample handling. Whole-blood glucose measurements obtained from these samples with six glucose meters were compared with reference analyzer plasma glucose measurements. Glucose differences were plotted vs. different Po2 levels to identify error trends. Error tolerances were as follows: a) within +/-15 mg/dL of the reference measurement for glucose levels 100 mg/dL. SETTING AND SUBJECTS: Five healthy volunteers in the bench study and 11 diabetic patients in the clinical study. RESULTS: In the bench study, increases in Po2 levels decreased glucose measured with GO-based amperometric test strips, mainly at Po2 levels >100 torr. At nearly constant glucose concentrations, glucose meter systems showed large variations at low (39 torr) vs. high (396 torr) Po2 levels. Glucose measured with GD-based amperometric and GO-based photometric test strips generally were within error tolerances. In the clinical study, 31.6% (Precision PCx), 20.2% (Precision QID), and 23.0% (Glucometer Elite) of glucose measurements with GO-based amperometric test strips, 14.3% (SureStep) of glucose measurements with GO-based photometric test strips, and 4.6% (Accu-Chek Advantage H) and 5.9% (Accu-Chek Comfort Curve) of glucose measurements with GD-based amperometric test strips were out of the error tolerances. CONCLUSIONS: Different oxygen tensions do not significantly affect glucose measured with the GD-based amperometric test strips, and have minimal effect on GO-based photometric test strips. Increases in oxygen tension lowered glucose measured with GO-based amperometric test strips. We recommend that the effects of different oxygen tensions in blood samples on glucose measurements be minimized by using oxygen-independent test strips for point-of-care glucose testing in critically ill and other patients with high or unpredictable blood Po2 levels.

Blood Gas Analysis↗

Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria.

The clinical assessment of groin pain in athletes is difficult, with the lack of specific clinical tests being in part responsible. Three pain provocation tests used in the diagnosis of chronic groin pain are described and their relationship to defined clinical and MRI criteria has been assessed. Eighty-nine Australian Rules football players with and without groin symptoms underwent clinical examination followed by history. Three pain provocation tests were performed (named as the Single Adductor, Squeeze and Bilateral Adductor tests). All athletes subsequently underwent MRI of their groin region for the presence of significant pubic bone marrow oedema (BMO). Of the 89, 47 were defined as having chronic groin pain, and 46 had significant BMO with 37 having both chronic groin pain and BMO. The three pain provocation tests demonstrated only moderate sensitivity (range 30-65%). Positive predictive values were moderate to high (67-93%) depending upon the individual test. The Bilateral Adductor test was the most sensitive test with the highest positive predictive values. The high specificity (88-93%) demonstrated should be treated with caution due to the study methodology. Three pain provocation tests of potential value in assessing chronic groin pain in athletes are described. If positive, all three pain provocation tests demonstrated a high likelihood for the athlete having MR-detected parasymphyseal pubic BMO. Further research is required on assessing the clinical usefulness of these tests.

Bone Marrow Diseases↗

Comparison of two commercially available test methods with conventional coagulase tests for identification of Staphylococcus aureus.

The API STAPHase (Analytab Products, Inc., Plainview, N.Y.) and SeroSTAT Staph (Scott Laboratories, Fiskville, R.I.) tests were compared to the conventional tube coagulase test and a slide coagulase test by using fresh isolates of members of the family Micrococcaceae. The 4-h, 24-h, and combined readings of the tube coagulase test detected 94.5, 99.5 and 100%, respectively, of 219 Staphylococcus aureus isolates. The API STAPHase, SeroSTAT Staph, and slide coagulase tests detected 95.9, 95.4 and 95.9% of the isolates of S. aureus, respectively. There were no false-positive results with any of the systems when tested with 103 strains of members of the family Micrococcaceae other than S. aureus. We concluded that the STAPHase and SeroSTAT Staph tests were equal in accuracy to the slide coagulase and 4-h tube coagulase tests and were suitable for use in the clinical microbiology laboratory. However, SeroSTAT Staph gave faster results than the API STAPHase, and the test was easier to perform. Also, the false-negative rate was high enough with the STAPHase, SeroSTAT Staph, and the slide coagulase tests that all negative reactions should be confirmed with a tube test.

Bacteriological Techniques↗

Incidence of Neisseria gonorrhoeae isolates negative by Syva direct fluorescent-antibody test but positive by Gen-Probe accuprobe test in a sexually transmitted disease clinic population.

To determine the accuracy of the Syva (Palo Alto, Calif.) direct fluorescent-antibody (DFA) test in comparison with the Gen-Probe (San Diego, Calif.) Accuprobe culture confirmation test, we tested 395 isolates of Neisseria gonorrhoeae from cultures obtained from patients attending a sexually transmitted disease clinic from 1 July 1991 through 30 June 1992. All isolates were tested for DFA reactivity with a polyclonal reagent (Difco Laboratories, Detroit, Mich.) and a monoclonal reagent (Syva, Inc., direct specimen test) and for specific molecular probe reactivity by the Gen-Probe Accuprobe culture confirmation test for N. gonorrhoeae. The 395 isolates gave positive results for the Gen-Probe culture confirmation test and the Difco polyclonal direct specimen test. However, 18 (4.6%) of the isolates were negative for N. gonorrhoeae by the Syva DFA test. With the exception of six beta-lactamase-positive isolates, all isolates that were negative by Syva DFA were sensitive to penicillin, tetracycline, spectinomycin, and ceftriaxone by disk-diffusion susceptibility testing. Auxotyping and serotyping studies indicated that strains negative by Syva DFA consisted of several variants. The frequency of N. gonorrhoeae isolates showing negative results by Syva DFA in this patient population ranged from 0 to 11.5%/month. Laboratories using only the Syva DFA test for confirmation of N. gonorrhoeae may incur a significant risk of misidentification.

Adolescent↗

Evaluation of nucleic acid amplification tests as reference tests for Chlamydia trachomatis infections in asymptomatic men.

Urine ligase chain reaction (LCR) and PCR tests and urethral swab culture were compared for their abilities to detect Chlamydia trachomatis infection in 3,639 asymptomatic men by using one-, two-, and three-test reference standards. Frozen urine at four of five participating centers was also tested by a transcription-mediated amplification assay which was used as a reference test. LCR increased the yield of positive results by 27% and PCR increased the yield of positive results by 26% over the yield of positive results by culture (n = 295). LCR and PCR sensitivities were similar, ranging from 80.4 to 93.5%, depending on the reference standard. Culture sensitivity was substantially less. A multiple-test standard yielded LCR, PCR, and culture specificities of 99.6%, with or without discrepant analysis. Test performance varied among centers partly due to different interpretations of the testing protocols. The study confirms that urine LCR and PCR for the detection of C. trachomatis have substantially improved sensitivities over that of urethral swab culture for testing of asymptomatic men, enabling screening of this important target group. These tests, perhaps in combination, are also candidate reference tests for the conduct of test evaluation studies.

Animals↗

Clinical evaluation of the ZstatFlu-II test: a chemiluminescent rapid diagnostic test for influenza virus.

Exploiting the high sensitivity of the chemiluminescence phenomenon, an accurate and sensitive point-of-care test, called the ZstatFlu-II test (ZymeTx, Inc., Oklahoma City, Okla.), was developed to detect influenza virus infections. The ZstatFlu-II test takes 20 min and requires approximately 2 min of "hands-on" time for operational steps. The ZstatFlu-II test does not distinguish between infections with influenza virus types A and B. ZstatFlu-II test results are printed on Polaroid High-Speed Detector Film, allowing test results to be archived. A prototype version of the ZstatFlu-II test was evaluated during the 2000-to-2001 flu season with 300 nasal aspirate specimens from children at a pediatric hospital. Compared to culture, the ZstatFlu-II test had 88% sensitivity and 92% specificity. The Directigen test had a sensitivity of 75% and a specificity of 93%. The sensitivity of the ZstatFlu-II test was significantly higher than that of the Directigen test (P < 0.0574).

Adolescent↗