Pseudomonas gladioli was isolated from 11 patients with cystic fibrosis. It resembled Pseudomonas cepacia on the selective and differential medium OFPBL, producing yellow colonies after 48 to 72 h of incubation. Isolates were characterized biochemically, by DNA hybridization, and by cellular fatty acid analysis. A review of the clinical status of selected patients colonized by P. gladioli did not reveal any apparent association of this organism with infections complications of cystic fibrosis. Thus, the clinical implications may differ depending on which of these two closely related species is reported by laboratories. Determination of the fatty acid profile of isolates by gas chromatography may be a useful adjunct to biochemical characterization as a means of identification. In contrast to P. cepacia, most isolates of P. gladioli contained 3-OH Clo0o fatty acid under the growth conditions used.

A selective and differential medium, OFPBL (oxidation-fermentation base supplemented with agar, lactose, and two antimicrobial agents), for the isolation of Pseudomonas cepacia from respiratory specimens of patients with cystic fibrosis was developed and tested. Among 725 specimens submitted from seven centers over a 4to 6-month period, 58 (8%) yielded P. cepacia on OFPBL; only 19 of these were recovered on MacConkey or sheep blood agar (P < 0.001). No isolate was recovered on MacConkey or sheep blood agar alone. Ranges of recovery rates among centers were 0 to 15% on OFPBL and 0 to 10% on MacConkey or sheep blood agar. Ninety percent of P. cepacia isolates were detected on OFPBL in c3 days. Other nonfermenters and yeasts isolated on OFPBL were distinguished from P. cepacia by failure to acidify the medium. The new medium was clearly superior to MacConkey and sheep blood agars for the isolation of P. cepacia from the respiratory secretions of patients with cystic fibrosis. Patients with cystic fibrosis (CF) are predisposed to colonization and acute and chronic pulmonary infections caused by microorganisms such as Staphyloccoccus auri-eus, Haeinophilus influence, Psezidom7ionas aeruginosa, and Pseudoinonas cepac-ia (2, 6, 7, 12). It has been hypothesized that lytic enzymes of these microbes or of inflammatory cell origin contribute to progressive destruction of lung tissue (1, 2, 6, 9) and, hence, the limited life expectancy associated with CF. Recognition of the colonizing or infecting agents of the respiratory tract in individuals with CF may permit specific antimicrobial therapy to be used. However, culture media which permit the isolation of these important bacterial pathogens from complex mixtures of other oropharyngeal flora must be used. Various selective media for S. auireus, H. influenzae, and P. aeruginosa have been described and shown to facilitate detection of these species in sputum (8, 13). Until recently, the recognition of P. cepacia in cultures of respiratory specimens has been complicated by the lack of a similarly useful selective culture method for this organism. Gilligan et al. (5) reported a selective medium for isolation of P. cepacia from patients, and Wu and Thompson (14) developed a medium intended for isolation of P. cepacia from environmental samples. We report the development and evaluation of an additional selective and differential medium and the experience with its use in a multicenter study to examine comparative recovery rates of P. cepacia from the respiratory tracts of individuals with CF.

Purpose Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences. Methods Participants were identified using Florida’s Medicaid and State Children’s Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14–18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes. Results Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction. Conclusions Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents’ autonomy to change health risks.

During a 1-year period, the prevalence of thymidine-dependent (TD) Staphylococcus aureus in patients at two geographically distinct cystic fibrosis (CF) centers was determined. Of 200 CF patients who had their respiratory secretions cultured, 95 harbored S. aureus, and 20 (21%) had TD S. aureus as their predominant staphylococcal isolate. All 20 TD S. aureus-positive patients had received trimethoprim-sulfamethoxazole for an average of 30.9 months. It was also observed that TD S. aureus exhibited aberrant colony morphologies or did not grow on media commonly used in CF centers for S. aureus isolation, suggesting that this organism could be missed by routine culture methods. In contrast, all 20 isolates had typical staphylococcal morphology on mannitol salt agar after 48 h of incubation. Mannitol salt agar is recommended for primary isolation of TD S. aureus.

patients were admitted to our hospital for management of propeller related injuries. These injuries ranged in severity from superficial lacerations that did not require closure to severe, devastating injuries with limb loss (Table 1). No patients died of propeller injuries after reaching the hospital during the period of this study. Five of the injuries occurred at very low speed (estimated less than 5 mph) including one patient with two amputations. Five occurred at speeds that were estimated to be greater than 10 mph. Three records did not provide enough information to estimate boat speeds. Eleven injuries occurred in fresh water, one in salt water, and one occurred while on land. Fall from a boat prior to propeller strike occurred in seven patients. Four were in the water from skiing or other activities when struck. The sequence of injury could not be determined for one patient (#9), and one propeller injury occurred while on land. Motorboat Propeller IntroductionOutboard motorboat propeller strikes can cause devastating injury, infection, and death. Approximately 10%-15% of propeller injuries are fatal [1,2]. Motorboat propeller injuries present management problems that may be unfamiliar to trauma surgeons because of the mechanism of injury and bacterial contamination from underwater impact. Severity of injury and complex contamination may not be apparent on initial inspection. It has been noted that these injuries are underreported even though laws are in place requiring all boaters to report boating accidents and injuries to local and national authorities [3]. This paper provides a review of all propeller injuries admitted to Orlando Regional Medical Center during a 6 year period. The mechanical aspects of propeller injuries are presented along with a literature review and recommendations for initial evaluation and management. Methods and MaterialsWith approval from our Institutional Review Board and assistance from the health information management office and coding department at Orlando Health Systems all hospitalized patients with ICD-9 and e-codes pertaining to boating injuries were identified between October 2003 and August 2009. A total of 267 patient encounters were identified in this time period. Further review of those 267 charts identified 13 patients with propeller related injuries. Demographic information, injury and treatment data, complications and outcomes were analyzed. AbstractBackground: Motorboat propeller strikes can cause devastating injury due to injury mechanics and complex contamination. The frequency of these injuries has been under-reported. This paper provides a review of propeller injuries admitted to our hospital over a six-year period. Discussion includes injury mechanics, initial management, literature review, accident statistics, and possible prevention measures.