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Background:Clostridioides difficile infection (CDI) is a major contributor to morbidity and mortality in patients with hematologic malignancy. Due to both immunosuppression and frequent antibiotic exposures, up to one-third of inpatients receiving chemotherapy or stem-cell transplant develop CDI. Transmission of C. difficile in healthcare facilities occurs due to environmental surface contamination and hand carriage by healthcare workers from colonized and infected patients. We investigated the effectiveness of enhanced room cleaning in collaboration with environmental services (EVS) staff to prevent CDI transmission and infection.
Methods: From April 1, 2018, to September 30, 2018, a multimodal enhanced cleaning intervention was implemented on 2 oncology units at the Hospital of the University of Pennsylvania. This intervention included real-time feedback to EVS staff following ATP bioluminescence monitoring. Additionally, all rooms on the intervention units underwent UV disinfection after terminal cleaning. We performed a system-level cohort study, comparing rates of CDI on the 2 study units to historic and 2 concurrent control units. Historic and concurrent control units received UV disinfection only for rooms with prior occupants with MRSA or CDI. All units during the intervention period received education on the importance of environmental cleaning for infection prevention. Mixed-effects Poisson regression was used to adjust for system-level confounders. Results: A median of 1.34 CDI cases per 1,000 patient days (IQR, 1.20–3.62) occurred during the 12-month baseline period. There was a trend toward a reduced rate of CDI across all units during the intervention period (median, 1.19; IQR, 0.00–2.47; P = .13) compared with all units during the historical period. Using mixed-effects Poisson regression, accounting for the random effects of study units, the intervention was associated with an incidence rate ratio for C. difficile of 0.72 compared to control units (95% CI, 0.53–0.97; P = .03). Average room turnaround time (TAT) increased across all units during the study period, from 78 minutes (IQR 74–81) to 92 minutes (IQR, 85–96; P < .001). Within the intervention period, TAT was higher on intervention units (median, 94 minutes; IQR, 92–98) compared to concurrent control units (median, 85; IQR, 80–92; P = .005). Conclusions: Enhanced environmental cleaning, including UV disinfection of all patient rooms and ATP bioluminescent monitoring with real-time feedback, was associated with a reduction in the incidence of CDI.
To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.
OBJECTIVES/GOALS: An age-dependent restitution defect in our neonatal pig intestinal ischemia model is rescued by unknown factors within homogenized mucosa of weaned pigs. A postnatally maturing network of enteric glia regulates the epithelial barrier, so we aim to show rescue is due to replacement of glial factors. METHODS/STUDY POPULATION: Jejunal tissues from suckling or weaned pigs were assessed by RNAseq and processed for immunofluorescent histology and 3-D volume imaging. Jejunal ischemia was surgically induced in weaned pigs and injured mucosa was recovered ex vivo with or without the glial inhibitor fluoroacetate (FA) while monitoring transepithelial electrical resistance (TER). RESULTS/ANTICIPATED RESULTS: Ingenuity Pathways Analysis of RNAseq data revealed significant suppression of numerous pathways critical for epithelial wound healing in suckling pigs (Z-score <−2 for of nine key pathways). Volume imaging studies confirmed lower density (P≤0.05) and complexity of the subepithelial glial network in suckling pigs. Treatment with FA inhibited TER recovery (P<0.0001) and restitution (P<0.05) in weaned pigs, mimicking the suckling pig phenotype and supporting glia as an important regulator of restitution in our model. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings provide important evidence that a developing glial network may be critical to the postnatal development of intestinal barrier repair mechanisms. Ongoing work will explore glial-epithelial interactions in vitro to further define postnatal development of barrier repair.
Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care.
Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases.
Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population.
A basic tenet of ecotourism is to enhance conservation. However, few studies have assessed its effectiveness in meeting conservation goals and whether the type of tourism activity affects outcomes. This study examines whether working in ecotourism changes the perceptions of and attitudes and behaviours of local people towards the focal species and its habitat and, if so, if tourism type affects those outcomes. We interviewed 114 respondents at four whale shark Rhincodon typus tourism sites in the Philippines to compare changes in perceptions of and attitudes and behaviours towards whale sharks and the wider marine environment. We found that the smaller scale tourism sites had greater social conservation outcomes than the mass or failed tourism sites, including changes in conservation ethics and perceptions of and attitudes and behaviours towards whale sharks and the ocean. Furthermore, of the three active tourism sites, the smallest site, with the lowest economic returns and the highest negative impacts on whale sharks prior to tourism activities, had the largest proportion of respondents who reported a positive change in perceptions of and attitudes and behaviours towards whale sharks and the ocean. Our results suggest that tourism type, and the associated incentives, can have a significant effect on conservation outcomes and ultimately on the ecological status of an Endangered species and its habitat.
This study is the first part of the validation of a French version of the Dutch Eating Behaviour Questionnaire (DEBQ), among a population of obese and normal-weight patients. The questionnaire was administered to 166 subjects. Construct validity was assessed by orthogonal factor analysis with a varimax procedure and reliability was measured by Cronbach's alpha coefficient. Results showed the presence of three major factors (“emotional”, “restrained” and “external eating”) with loadings similar to those of the original questionnaire. A high internal consistency was found in the different scales. This study clearly demonstrates the factorial validity and the reliability of a French version of the DEQB.
This paper considers some of the theoretical and practical problems of conducting cost-utility analyses alongside clinical trials. In order to measure utilities of different health states in a clinical trial a number of critical assumptions have to be made. Some of these assumptions are questionable on a theoretical level, others empirically invalid. The practical problems of measuring utilities are discussed. The standard gamble is shown to be the most validated method of utility measurement, but still based on very strong assumptions. The standard gamble instrument is also costly and difficult to administer in clinical trials. Other instruments are found to be less valid than the standard gamble. It is concluded that although cost-utility analysis seems relevant in some instances, investigators should avoid this assessment of utility and instead measure cost-effectiveness, cost-benefit and quality of life.
In studying the success of abortion-funding bans, Chapter 2 evaluates the rise of a strategy based on claims about the costs of abortion. In the mid-1970s, the antiabortion movement included self-described liberals and conservatives, absolutists and pragmatists, professionals and homemakers. All of these activists focused on a constitutional amendment that would have criminalized abortion, and groups like NRLC and AUL looked for laws that could reduce the abortion rate in the short term. In justifying laws like abortion-funding restrictions, pro-lifers highlighted what they described as the societal costs of paying for abortion. While groups like NARAL and Planned Parenthood reluctantly discussed the impact of abortion-funding bans on poor women, lawyers in the ACLU invited courts to look at the real-world effects of funding prohibitions on taxpayers and low-income women. Resulting in decisions like Maher v. Roe (1977) and Harris v. McRae (1980), this dialogue reflected broader changes in public attitudes about poverty and the social-safety net.
Centered on the period between 1987 and 1992, Chapter 4 evaluates how the relationship between abortion and sex equality became central to both the fate of Roe and debate about the American family. To reassure Republican leaders that pro-life positions had a political payoff, abortion foes emphasized family involvement laws that seemed to enjoy popular support, including laws requiring women to notify their husbands or get their consent. In defending these laws, antiabortion activists insisted that abortion had serious costs for the family. Many on both sides resisted a focus on the costs and benefits of abortion. A new and predominantly evangelical clinic-blockade movement rejected consequence-based arguments in favor of religious ones. Believing that the Court would reverse Roe, larger abortion-rights groups like NARAL played up rights-based claims. In court, however, abortion-rights attorneys contended that if forced to carry their pregnancies to term, young women would lose out on emerging financial, political, or educational opportunities. Soon, these arguments played a key role in the discussion of Roe’s fate. Invoking constitutional equality, lawyers looked at the benefits of keeping abortion legal. These arguments shaped the Court’s decision in Planned Parenthood v. Casey.
Examining the years from 1995 to 2007, Chapter 6 studies how those on opposing sides fought about ways to measure the costs and benefits of abortion when experts disagreed. In this period, larger pro-life groups sponsored a ban on partial-birth abortion. At the start, NRLC mostly urged voters to rely on their own moral compass to see that the procedure should be illegal. Drawing on support from medical experts, abortion-rights supporters responded that dilation and extraction sometimes best protected women’s health. Abortion foes responded that both the mainstream media and organizations like the American College of Obstetricians and Gynecologists were biased. Since the debate turned partly on the costs of abortion (and abortion restrictions) for women, those on opposing sides increasingly fought about what should happen when experts disagreed. Should voters, experts, or individual patients have the final say when a scientific matter was in dispute? How should courts even define scientific uncertainty? Discussion of these questions reflected a larger national conversation about the line between politics and science.
Chronicling the mid-1990s, Chapter 5 traces a debate about the relationship between abortion and health care that evolved in the aftermath of Casey. In explaining how incremental restrictions affected women’s equal citizenship, abortion-rights groups emphasized that regulations denied women crucial health benefits. In the political arena, abortion-rights advocates worked to guarantee coverage of the procedure in national health care reform, to repeal bans on Medicaid funding for abortion, to introduce legislation protecting access to clinic entrances, and to ensure access to medical abortion. In court, abortion-rights attorneys also described clinic blockaders – and all abortion foes – as sexists opposed to health care for women. Women of color offered a new framing of the relationship between health care and abortion, calling not for reproductive rights but for reproductive justice. Furthermore, Casey and the health-based offensive led by the abortion-rights movement caused some abortion opponents to lose faith in a strategy centered on the costs of abortion. To regain prominence, attorneys in groups like AUL and NRLC developed a new way of undermining Roe: If the Court saved abortion rights because women relied on it, the pro-life movement would demonstrate that the procedure damaged their health.
Bringing the story up to the present, Chapter 7 considers how the breach between the two sides widened during battles about religious liberty and health care reform. In 2010, a backlash to President Barack Obama’s health care reform, the Affordable Care Act (ACA), helped to give Republican lawmakers control of most state legislatures. These members of the so-called Tea Party passed an unprecedented number of abortion restrictions. Pro-lifers also joined an attack on the contraceptive mandate of the ACA, arguing that the government had denigrated religious liberty. While pro-lifers accused Planned Parenthood of illegal and immoral actions, abortion-rights supporters described their opponents as misogynist opponents of health care and birth control. In 2016, in Whole Woman’s Health v. Hellerstedt, the Court made claims about the costs and benefits of abortion yet more central to constitutional doctrine. With the retirement of Justice Anthony Kennedy two years later, many expected the Court to overturn Roe. But rather than seeking to appeal to ambivalent voters, antiabortion absolutists pushed strict abortion bans. For their part, abortion-rights supporters tried to expand abortion rights in the states. Decades of debate about the policy costs and benefits of abortion had pushed the two sides even further apart.
The Introduction argues that the terms of the American abortion debate have changed in ways we have mostly missed. When forced to give up on a constitutional amendment banning abortion, pro-lifers sought to control the Supreme Court and reverse Roe. As part of this mission, abortion foes promoted restrictions that would hollow out abortion rights and set up test cases for the Court. But these laws did not obviously advance a right to life since they did not criminalize any abortions. To defend them, abortion foes instead detailed the benefits of specific restrictions – and the costs of abortion itself. Over time, abortion-rights supporters had to identify concrete benefits of abortion, explaining whether legal abortion was good for women and the communities in which they lived. Although some resisted a focus on the costs and benefits of abortion, this shift in the terms of the debated sparked discussions about poverty and abortion, the role of government, the changing American family, the influence of abortion on women’s health, and the nature of scientific uncertainty. And surprisingly, as discussion turned to policy costs and benefits, polarization deepened. Both sides disagreed not only about foundational rights but also about the basic facts.