Sing a cohort of 229 students who had swabs taken on their first day on arrival at university and once more eight or ten days later; this cohort showed a equivalent raise in carriage with overlapping self-assurance intervals. Offered this acquiring, confounding is an unlikely explanation for the rise. The low initial carriage rate seen in both research may perhaps DG172 (dihydrochloride) reflect the effect of the prolonged summer holidays when quite a few students disperse from their established social groups and go away. The improved carriage rates seen with additional social mixing and residence on campus also supports the notion that the rise we described is real. Given nearby understanding of how students have been recruited it is unlikely that confounding could produce such a large effect. Sex was controlled for within the evaluation of carriage threat aspects (table two), despite the fact that this was not described. Most of the students were aged 18 or 19 (89.two ), and 97 had been aged 21 or younger. Ages have been evenly distributed by day, except throughout the final day when the students were slightly older, but restricting the evaluation to these aged 18 and 19, or under 22, shows no important alterations in carriage rates. Age was not associated with carriage, while 0/17 students aged 25 and over had been damaging for meningococci. Many from the isolates from Thursday and Friday towards the finish of the very first swabbingContinuing to use APACHE II scores ensures consistencyEditor–Shann criticises the usage of the APACHE II scoring method as an audit tool for intensive care functionality.1 He has two main arguments. Firstly, he says that the technique is outdated in that it reflects North American standards inside the early 1980s. Secondly, he says that it could mask substandard intensive care performance by magnifying the risk of death within the poorer intensive careLettersunits, where individuals will reach higher scores via inadequate management throughout the very first 24 hours just after admission. He points out, also, that the collection of data is pricey and that the quality of data can differ amongst units. They are undoubtedly fair points, but he overlooks one excellent reason why it is still acceptable to measure APACHE II scores. That explanation is that measuring the scores enables an individual intensive care unit to monitor its functionality against that in previous years, provided it collects the APACHE II data consistently. Just after all, it really is vital for each and every unit to become able to answer what need to be a straightforward question: are we performing better this year than we did 10 years ago I doubt if each and every unit can answer that question. In the intensive care unit exactly where I operate we’ve noted a gradual trend for individuals each to die and to survive with steadily growing APACHE II scores more than the past ten years. We would cautiously argue that we are acquiring better at treating critically ill patients. More than the past five years, on the other hand, the apparent improvement in our overall performance appears to possess reached a plateau, although sufferers are in general managed much more aggressively than just before and staying longer within the unit. That is disquieting, but it no less than enables us to eschew complacency and ask ourselves some difficult inquiries within the hope of producing improvements. Would we’ve got picked up this problem if we had changed our standard scoring method every time a new model came out I believe it unlikely.William Konarzewski clinical director of intensive care Anaesthetic Department, Colchester General Hospital, Colchester, Essex CO4 5JL [email protected] Shann F. Mortality prediction m.