Multilocus sequence typing (MLST) has been applied to 266 Campylobacter jejuni isolates, mainly from veterinary sources, including cattle, sheep, poultry, pigs, pets, and the environment, as well as isolates from human cases of campylobacteriosis. The populations of veterinary and human isolates overlap, suggesting that most veterinary sources should be considered reservoirs of pathogenic campylobacters. There were some associations between source and sequence type complex, indicating that host or source adaptation may exist. The pig isolates formed a distinct group by MLST and may well represent a potential pig-adapted clone of C. jejuni. A subset (n ‫؍‬ 82) of isolates was reanalyzed with a second MLST scheme which provided a unique set of isolates that had been analyzed at a total of 12 loci. The distribution of isolates among the complexes in each of the two schemes was similar but not identical. In addition to isolates from human outbreaks, one group of isolates that were not epidemiologically linked was also identical at all 12 loci. This group of isolates is believed to represent another stable strain of C. jejuni.

We have compared a new Portex tracheal tube with the Oxford tube in performing simulated grade 3 difficult intubations. The Portex tube was modified so that the bevel faced backwards, as in the Oxford tube. A gum elastic introducer was used with both tubes. The time taken and number of attempts needed were recorded, with changes in arterial pressure, heart rate and incidence of sore throat. Both tubes were successful in avoiding the problem of obstruction at the cords, which occurs when a standard Magill tube is used with an introducer. Thus the new tube has the merits of the Oxford tube without the disadvantages of rubber. It is suitable for both easy and difficult intubations with advantages in safety, cost and convenience. An unexpected but important finding was a clear learning effect, despite both investigators being familiar with the technique at the outset. Over the course of the study, intubation time decreased progressively (P < 0.001). This provides new evidence of the need for trainees to practise the art of intubation when the cords are not visible. Our estimate of the learning "half-life" was 15 intubations; we conclude that 30 simulated grade 3 intubations would be a reasonable objective for trainees before handling high-risk cases.

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Study Objectives: Dehydration in children is a common diagnosis in US emergency departments (ED) with 179 million cases of acute gastroenteritis occurring annually, resulting in some 600,000 hospitalizations and an estimated 5,000 deaths. Current methods for identifying hypovolemia in children all have poor sensitivity and specificity. In adults, point-of-care Ultrasonography (POCUS) has emerged as an objective, noninvasive, rapid, inexpensive and validated tool to assess a patient's intravascular volume status. However, in pediatrics there is mixed support of POCUS to assess intravascular volume. The primary objective of this study was to assess collapsibility index (CI) as measured by respiratory variation to establish reference values for the inferior vena cava (IVC) and aorta (IVC/Ao Ratio) in longitudinal and transverse views by age, weight, height and Broselow-Luten color groups. A secondary objective was to determine which method of sonographic measurement was more reliable. Methods: This was a single-center, prospective, convenience study of patients who presented to the ED between January-December 2016 for complaints other than dehydration. Patients 4 months to 8 years of age, whose parent/legal guardian provided informed consent, were enrolled. Patients were recruited based on their color grouping on the Broselow-Luten tape, with a goal of at least 28 patients per group. Ultrasound examinations measured the IVC diameter in both a long and transverse axis during one respiratory cycle and the transverse aorta was measured at its maximal diameter. Results: There were 255 patients enrolled with fifteen excluded for inadequate data, leaving 240 for analysis. Fifty percent were female, most were African American (AA, 86%) followed by White (W, 7%), which was higher than our ED population of (AA, 65%; W, 30%), mean age was 2.67 years. Distribution over the color zones: (14) Pink, (28) Red, (33) Purple, (35) Yellow, (42) White, (31) Blue, (34), Orange, (23) Green. Goals for enrollment were met or exceeded in all groups, expect pink and green. Summary statistics of sonographic measurement as per age, height and weight were done and the bi-variate correlations between IVC long min-max, IVC Cross min-max, and aorta min-max with the set of variables age, height, weight and color zone, were all moderate or strong positive correlations (Pearson's correlation coefficients ranging from 0.56 to 0.75, all p<.001). Conclusions: The IVC and aorta longitudinal and transverse measurements show a positive correlation with age, weight, height and Broselow-Luten color group, indicating that as the patient grows the IVC and aorta increase in a predictable manner. The strongest association was with the Broselow-Luten color groups. Transverse measurements of the IVC and aorta proved more reliable, especially in the smaller-sized children due trunk movement with normal respiration in the long axis plane.