Drug-Resistant Bacteria Kill 7th Person at NIH Hospital .

An antibiotic-resistant strain of Klebsiella pneumoniae has killed a seventh patient at the NIH Clinical Center in Bethesda, Maryland, the Washington Post reports.

Since the outbreak began in August 2011, the bacteria have infected 19 patients at the federal hospital, which only sees the sickest of the sick patients. Eleven of these patients died. Six of those deaths were directly attributed to the bacteria.

The hospital implemented strict infection control measures that included replacing plumbing where the bacteria lived, building a wall to isolate infected patients, and hiring hand-washing monitors. The measures appeared to work. For six months, no patients were diagnosed with Klebsiella pneumoniae until this most recent case — a boy with a compromised immune system — was diagnosed in July.

Source: Washington Post

‘Code Creep’ Adds Billions to Clinicians’ Medicare Fees .

Between 2001 and 2110, Medicare has been billed increasingly for office visits at higher-paying codes, an investigation by the nonprofit Center for Public Integrity shows.

The study of over 360 million claims finds the percentage of office visits billed at the highest-reimbursing codes grew from 25% in 2001 to 40% in 2010, according to the Washington Post. Defenders of the shift say that the Medicare population has become older, but research doesn’t bear that out. This so-called “upcoding” cost Medicare an extra $11 billion over the decade studied.

One problem, according to analysts, is that reviewing a claim can cost about as much as the overcharge itself (roughly $40).

Emergency-room billings are also showing upcoding. One researcher characterized the defense that ER patients are presenting sicker as “total nonsense.”

Source: Washington Post


NYC Health Board Approves Ban on Big Sodas

The New York City Board of Health overwhelmingly approved a ban last week prohibiting the sale of large sodas and other sugary beverages in containers with capacities over 16 oz. at restaurants, street carts, and movie theaters, the New York Times reports.

Convenience stores and some newsstands would be exempt. Unless struck down in the courts, the measure, intended to combat obesity, is slated to take effect March 12.

Source: New York Times



Snow on Mars: NASA Spacecraft Spots ‘Dry Ice’ Snowflakes.

A spacecraft orbiting Mars has detected carbon dioxide snow falling on the Red Planet, making Mars the only body in the solar system known to host this weird weather phenomenon.

The snow on Mars fell from clouds around the planet’s south pole during the Martian winter spanning 2006 and 2007, with scientists discovering it only after sifting through observations by NASA’s Mars Reconnaissance Orbiter (MRO). The Martian south pole hosts a frozen carbon dioxide — or “dry ice” — cap year-round, and the new discovery may help explain how it formed and persists, researchers said.

“These are the first definitive detections of carbon-dioxide snow clouds,” lead author Paul Hayne, of NASA’s Jet Propulsion Laboratory (JPL) in Pasadena, Calif., said in a statement. “We firmly establish the clouds are composed of carbon dioxide — flakes of Martian air — and they are thick enough to result in snowfall accumulation at the surface.”

The find means Mars hosts two different kinds of snowfall. In 2008, NASA’s Phoenix lander observed water-ice snow — the stuff we’re familiar with here on Earth — falling near the Red Planet’s north pole,.

Hayne and his team studied data gathered by MRO’s Mars Climate Sounder instrument during the Red Planet’s southern winter in 2006-2007. This instrument measures brightness in nine different wavelengths of visible and infrared light, allowing scientists to learn key characteristics of the particles and gases in the Martian atmosphere, such as their sizes and concentrations.

The research team examined measurements the Mars Climate Sounder made while looking at clouds — including one behemoth 300 miles (500 kilometers) wide — from directly overhead, and from off to the side. These combined observations clearly revealed dry-ice snow falling through the Red Planet’s skies, researchers said.

“One line of evidence for snow is that the carbon-dioxide ice particles in the clouds are large enough to fall to the ground during the lifespan of the clouds,” said co-author David Kass, also of JPL. “Another comes from observations when the instrument is pointed toward the horizon, instead of down at the surface.”

“The infrared spectra signature of the clouds viewed from this angle is clearly carbon-dioxide ice particles, and they extend to the surface,” Kass added. “By observing this way, the Mars Climate Sounder is able to distinguish the particles in the atmosphere from the dry ice on the surface.”

Astronomers still aren’t entirely sure how the dry ice sustaining Mars’ south polar cap — the only place where frozen carbon dioxide exists year-round on the planet’s surface — is deposited. It could come from snowfall, or the stuff may freeze out of the air at ground level, researchers said.

“The finding of snowfall could mean that the type of deposition — snow or frost — is somehow linked to the year-to-year preservation of the residual cap,” Hayne said.

Dry ice requires temperatures of about minus 193 degrees Fahrenheit (minus 125 Celsius) to fall, reinforcing just how cold the Martian surface is.

The study will be published in an upcoming issue of the Journal of Geophysical Research. Hayne performed the research while a postdoc at Caltech in Pasadena.

Source: Yahoo news



How Nanotechnology Could Reengineer Us?


Nanotechnology is an important new area of research that promises significant advances in electronics, materials, biotechnology, alternative energy sources, and dozens of other applications. The graphic below illustrates, at a personal level, the potential impact on each of us. And where electrical measurement is required, Keithley instrumentation is being used in an expanding list of nanotechnology research and development settings.


Is Helicobacter pylori Eradication Sufficient for Bleeding Ulcers?

A prospective study suggests that peptic ulcer rebleeding is very unusual after H. pylori eradication and that maintenance antiulcer therapy may not be needed.

Helicobacter pylori infection is associated with peptic ulcer disease, and eradication of the infection reduces ulcer recurrence. The need for maintenance acid-reduction therapy in this setting is controversial.

To explore this issue, investigators at 10 university hospitals in Spain prospectively studied 1000 patients with endoscopically documented bleeding peptic ulcers and H. pylori infection. Participants were treated until eradication of the infection was confirmed by breath test. Thereafter, they received no acid-reduction therapy and were told not to take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). They returned at 1-year intervals for a clinical examination and a breath test for H. pylori. If signs or symptoms of upper gastrointestinal bleeding occurred, urgent endoscopy was performed.

All participants were followed for at least 12 months (total, 3253 patient-years of follow-up). Recurrence of peptic ulcer bleeding was rare, occurring in three participants during year 1 and two during year 2. All five cases of rebleeding involved either H. pylori reinfection or NSAID use. The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16%–1.16%) overall and 0.15% (95% CI, 0.05%–0.36%) per patient-year of follow-up.

Comment: These findings provide excellent evidence that H. pylori eradication is sufficient therapy for peptic ulcer patients — even if they had bleeding — in the absence of other causes for ulcers. Forty-one percent of the patients in this study had previously used NSAIDs or aspirin. Without a control group in which NSAIDs are continued, we cannot assess the effect of H. pylori eradication alone, but if such agents are avoided, H. pylori eradication appears to be definitive ulcer therapy. The real clinical challenge is to keep these patients from taking NSAIDs and identify those at high risk for H. pylori reinfection to determine who should be considered for continued antiulcer therapy.

Source: Journal Watch Gastroenterology





Lactate Level Correlates with Prognosis in Patients with Suspected Infection.

This large study identified a nearly linear relationship between lactate level and mortality.

To analyze the relationship between blood lactate levels and mortality in patients with suspected infection, researchers reviewed charts from 2596 patients who were admitted from the emergency department (ED) with suspected infection (inferred from administration of antibiotics in the ED) and who had blood lactate levels measured in the ED.

Overall in-hospital mortality was 14.4%, and the median initial lactate level was 2.1 mmol/L. The initial lactate level was >4 mmol/L in 17.6% of patients. Mortality rose continuously across a continuum of incremental lactate elevations, ranging from 6% in patients with lactate levels <1.0 mmol/L to 39% in patients with levels of 19 to 20 mmol/L.

Comment: We can draw two important conclusions from this study. First, patients with suspected infection who have lactate levels <4 mmol/L still are at risk of dying, so physicians should not base their evaluation of illness severity and patient risk solely on lactate level. Second, mortality risk increases with increasing lactate level, making resuscitation of patients with higher levels a priority.

Source: Journal Watch Emergency Medicine