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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.
The modern healthcare system involves complex interactions among microbes, patients, providers, and the built environment. It represents a unique and challenging setting for control of the emergence and spread of infectious diseases. We examine an extension of the perspectives and methods from ecology (and especially urban ecology) to address these unique issues, and we outline 3 examples: (1) viewing patients as individual microbial ecosystems; (2) the altered ecology of infectious diseases specifically within hospitals; and (3) ecosystem management perspectives for infection surveillance and control. In each of these cases, we explore the accuracy and relevance of analogies to existing urban ecological perspectives, and we demonstrate a few of the potential direct uses of this perspective for altering research into the control of healthcare-associated infections.
To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
Interrupted time series analysis.
The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.
All ICU patients at study hospitals during the study period.
Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line–associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.
Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93–0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94–0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97–0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93–1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.
In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.
To investigate the effectiveness of an online, interactive intervention, referred to as the Green Eating (GE) Project, to motivate university students to adopt GE behaviours.
The study was quasi-experimental and integrated into courses for credit/extra credit. Courses were randomly stratified into experimental or non-treatment control. The 5-week intervention consisted of four modules based on different GE topics. Participants completed the GE survey at baseline (experimental, n 241; control, n 367) and post (experimental, n 187; control, n 304). The GE survey has been previously validated and consists of Transtheoretical Model constructs including stage of change (SOC), decisional balance (DB: Pros and Cons) and self-efficacy (SE: School and Home) as well as behaviours for GE. Modules contained basic information regarding each topic and knowledge items to assess content learning.
The GE Project took place at a public university in the north-eastern USA.
Participants were full-time students between the ages of 18 and 24 years.
The GE Project was effective in significantly increasing GE behaviours, DB Pros, SE School and knowledge in experimental compared with control, but did not reduce DB Cons or increase SE Home. Experimental participants were also more likely to be in later SOC for GE at post testing.
The GE Project was effective in increasing GE behaviours in university students. Motivating consumers towards adopting GE could assist in potentially mitigating negative consequences of the food system on the environment. Future research could tailor the intervention to participant SOC to further increase the effects or design the modules for other participants.
To describe a method of using real patients in teaching ENT to undergraduates and to examine whether being a case patient affected patient satisfaction.
In a cross-sectional study, 68 teaching-involved patients (case patients) with a suspected common ENT illness and 68 matched (in terms of age, sex and region of complaint) control patients evaluated the health service and their encounter with the physician. The students saw the case patients first independently and then saw the patient with the teacher physician. The controls were treated in a normal way.
Fifty-eight case patients (84 per cent) and 65 control patients (95 per cent) answered the questionnaire. The median duration of the visit was significantly longer for the case patients than the controls (115 vs 60 minutes). Almost all patients in both groups graded the overall quality of the health service, and the variables describing various aspects of the setting and the encounter with the physician, as either good or excellent.
Patients who took part in the undergraduate teaching of ENT diseases were equally content with their primary visit as the control patients, even though their visit took a markedly longer time.
Fecal microbiota transplantation (FMT) has been suggested as a new treatment to manage Clostridium difficile infection (CDI). With use of a mathematical model of C. difficile within an intensive care unit (ICU), we examined the potential impact of routine FMT.
Design, Setting, and Patients.
A mathematical model of C. difficile transmission, supplemented with prospective cohort, surveillance, and billing data from hospitals in the southeastern United States.
Cohort, surveillance, and billing data as well as data from the literature were used to construct a compartmental model of CDI within an ICU. Patients were defined as being in 1 of 6 potential health states: uncolonized and at low risk; uncolonized and at high risk; colonized and at low risk; colonized and at high risk; having CDI; or treated with FMT.
The use of FMT to treat patients after CDI was associated with a statistically significant reduction in recurrence but not with a reduction in incident cases. Treatment after administration of high-risk medications, such as antibiotics, did not result in a decrease in recurrence but did result in a statistically significant difference in incident cases across treatment groups, although whether this difference was clinically relevant was questionable.
Our study is a novel mathematical model that examines the effect of FMT on the prevention of recurrent and incident CDI. The routine use of FMT represents a promising approach to reduce complex recurrent cases, but a reduction in CDI incidence will require the use of other methods to prevent transmission.
Change from nonmolecular to molecular testing techniques is thought to contribute to the increasing trend in incidence of Clostridium difficile infection (CDI); however the degree of effect attributed to this versus other time-related epidemiologic factors is unclear.
We compared the relative change in incidence rate (IRR) of healthcare facility–associated (HCFA) CDI among hospitals in the Duke Infection Control Outreach Network before and after the date of switch from nonmolecular tests to polymerase chain reaction (PCR) using prospectively collected surveillance data from July 2009 to December 2011. Data from 10 hospitals that switched and 22 control hospitals were included. Individual hospital estimates were determined using Poisson regression. We used an interrupted time series approach to develop a Poisson mixed-effects model. Additional regression adjustments were made for clustering and proportion of intensive care unit patient-days. The variable for PCR was treated as a fixed effect; other modeled variables were random effects.
For those hospitals that switched to PCR, mean incidence rate of HCFA CDI before the switch was 6.0 CDIs per 10,000 patient-days compared with 9.6 CDIs per 10,000 patient-days after the switch. Estimates of hospital-specific IRR that compared after the switch with before the switch ranged from 0.89 (95% confidence interval [CI], 0.32–2.44) to 6.91 (95% CI, 1.12–42.54). After adjustment in the mixed-effects model, the overall IRR comparing CDI incidence after the switch to before the switch was 1.56 (95% CI, 1.28–1.90). Time-trend variables did not reach statistical significance.
Hospitals that switched from nonmolecular to molecular tests experienced an approximate 56% increase in the rate of HCFA CDI after testing change.
Knowledge of carriage and population dynamics of Staphylococcus aureus is crucial for infection risk assessment and to reveal transmission patterns of strains. We report the prevalence and molecular epidemiology of S. aureus in elderly people (n = 290) living in nursing homes in three cities in the south of Sweden. The overall carriage prevalence rate was 48% when results from nares (31%) and throat (34%) samples were combined. Common spa types were equally distributed but a frequent type, t160, was found only in one of the regions. Carriage of different spa types was detected in 23% of individuals and antimicrobial resistance rates were higher in S. aureus isolates from those carrying more than one spa type. Five of the 21 individuals who carried different spa types were colonized simultaneously with resistant and non-resistant strains. Seventeen per cent of the individuals carried S. aureus of the same spa type on all occasions. Methicillin resistance was not detected. In conclusion we found a high prevalence of S. aureus in this elderly population with a high rate of dual colonization with different spa types. We also found signs of institutional spread of one strain.
Lower absorption, lower refractive index and tunable resistance are three advantages of doped silicon oxide containing nanocrystalline silicon grains (nc-SiOx) compared to doped microcrystalline silicon, for the use as p- and n-type layers in thin-film silicon solar cells. In this study we show how optical, electrical and microstructural properties of nc-SiOx layers depend on precursor gas ratios and we propose a growth model to explain the phase separation in such films into Si-rich and O-rich regions as visualized by energy-filtered transmission electron microscopy.
In the recently completed and formally ratified new series and stage classification of the Ordovician System, the base of the Middle Ordovician Series coincides with the base of the global Dapingian Stage. In the Global Stratotype Section and Point (GSSP) of this stage, which is located at Huanghuachang in southern China, the base of the Dapingian Stage is defined as the level of first appearance of the conodont Baltoniodus triangularis. The fact that this species, along with some other taxa present at the Dapingian GSSP, occurs in many sections in Baltoscandia makes it possible to recognise with considerable precision the level of this global stage boundary in Sweden, Estonia, northwestern Russia, and Denmark. In several, but not all, regions, especially in the East Baltic, the global stage boundary coincides with the base of the regional Volkhov Stage and can be tied to the base of the Megistaspis polyphemus Trilobite Zone. The regionally somewhat different relationships between the position of the global stage boundary and a very widespread hardground complex are probably due to the occurrence of local and/or regional unconformities in the upper Floian–lower Dapingian interval. Although biostratigraphically important graptolites are present in the study interval in some Baltoscandic sections, the precise graptolite correlation of the base of the Dapingian Stage remains somewhat unclear, although it appears to be near, or at, the base of the Isograptus victoriae victoriae Zone (Ca 2).
A novel cryogenic electrostatic storage device consisting of two ion-beam storage rings with a common straight section for studies of interactions between oppositely charged ions at low and well-defined relative velocities is under construction at Stockholm University. Here we consider the prospect of using this new tool to measure cross-sections and rate coefficients for mutual neutralization reactions of importance in interstellar ion chemistry in general and specifically in cosmic pre-biotic ion chemistry.
Microzarkodina is a genus of mainly Middle Ordovician conodonts that has its centre of distribution in Baltoscandia, and much less commonly occurs in southern China, Australia, Argentina and Laurentia. In Baltica a series of species, Microzarkodina russica n. sp., M. flabellum, M. parva, M. bella, M. hagetiana and M. ozarkodella, established themselves successfully. The succession of species ranges from just below the base of the Middle Ordovician (M. russica) to the upper part of the Middle Ordovician (M. ozarkodella). The species are frequently used for biostratigraphical purposes. The largely contemporaneous species Microzarkodina bella and M. hagetiana probably both evolved from M. parva and mostly occurred in separate areas. Microzarkodina ozarkodella probably evolved from M. hagetiana. This present investigation is based on a total of 94,208 elements, collected from 20 sections and one drill-core site in Sweden, one drill-core site and one outcrop in Estonia and two sections in the St Petersburg area in Russia. The Microzarkodina apparatus probably consisted of 15 or 17 elements: four P, two or four M and nine S elements. The S elements include different Sa, Sb1, Sb2, and Sc element types.
An Electromagnetic Brake (EMBR) makes it possible to increase the casting speed
while maintaining or even improving the product quality. For conventional slabs,
the FC mould is most appropriate while for thin slabs, the ruler type EMBR is the
preferred solution. The FC mould features two independently controlled static magnetic
fields, one at meniscus level and another at the bottom of the mould. The upper field
controls the speed flow at meniscus to prevent mould powder entrapments and the lower
field reduces the penetration of the steel jets from the casting nozzle, to facilitate
flotation of inclusions. The FC mould is the only equipment capable of controlling these
parameters independently. It affords effective solutions to reduce pinholes, cracks and
surface or subsurface inclusions. A new closed loop control of the FC mould, the EM
Control, has also been developed, based upon the input of two meniscus level signals
that simulate the meniscus speed. Through 3D transient modelling of the caster
performance, temperatures, steel speed, meniscus level are made available. The two
static fields are then adapted on-line to achieve both low penetration and a constant
Preceding the construction of a future repository of spent nuclear fuel, a descriptive ecosystem model has to be developed in order to meet the demands set by a safety assessment. The descriptive ecosystem model should be able to describe stocks and flows of matter, and processes that may affect these on a broad landscape scale. Here we describe the planned strategy to develop such a model in three steps; the conceptual model, introduction of site-specific data and, transfer and accumulation of matter in the landscape. The suggested method is based on an ecosystem approach using site-specific data. A mass balanced ecosystem model with food webs provide a way of analysing how matter are linked to different ecosystem components through fluxes. It is suggested that estimated inflow and outflow of matter in mass balanced ecosystem units will reduce the potential variation of transport and accumulation of matter by setting the physical and biological limits to the system. In this paper we present a strategy to build a descriptive ecosystem model and shows examples from the ongoing descriptions at Forsmark and Simpevarp in the Swedish site investigation programme to illustrate the ideas.
Conodont faunas from the Eoplacognathus pseudoplanus Zone in five main areas of Middle Ordovician rocks in Sweden are described and discussed and compared with faunas of comparable age from neighbouring areas. The investigation is based on 118 samples which together yielded 175 114 conodont elements. The Swedish conodont faunas are intermediate between shallower-water faunas from the eastern part of Baltica and deeper-water faunas towards the west. Correlation with the Yangtze platform of south-central China is fairly easy, and the occurrence of key taxa, such as Histiodella, makes it also possible to correlate some levels with Laurentia. Although faunal lists for the Swedish localities are almost identical, the conodont taxa have their relative abundance maxima in separate areas: species of Protopanderodus and Periodon are most common in deeper-water settings, Eoplacognathus, Baltoniodus and Microzarkodina characterize intermediate areas, and Semiacontiodus is typical of shallow subtidal environments
Conodont elements other than those with platform ledges along the processes have often been unrecognized or disregarded in reconstructions and phylogenetic discussions of Ordovician “platform conodont genera.” The platform elements are larger than the other element types and often exhibit more rapid evolutionary changes in morphology. Nevertheless, to understand the evolution of, and relationships between and among “platform genera,” it is necessary to also consider the associated ramiform and geniculate elements. Thus, on the basis of large collections, together comprising 10,800 elements from Sweden and southern China, all element types of Lenodus antivariabilis (An, 1981), L. variabilis (Sergeeva, 1963), Yangtzeplacognathus crassus (Chen and Zhang, 1993) and Eoplacognathus pseudoplanus (Viira, 1974) are described and discussed. All these species had seven morphologically distinct element types, and probably seventeen individual elements in each apparatus. Ancestors and descendants of these species are discussed more briefly and it is concluded that the ramiform and geniculate elements also are characteristic within each lineage.
Previous studies of overall arthropod disparity have compared Cambrian and Recent biotas, without considering taxa of intermediate age. This study explored morphological diversity among Carboniferous arthropods, primarily from the well-known Westphalian Mazon Creek Lagerstätte. Over 100 arthropod species, belonging to 48 orders, were examined. The data set is composed of nearly equal numbers of crustacean, arachnid, and insect species, with lower numbers of merostomes. Trilobites have not been found at Mazon Creek. However, some Late Carboniferous trilobite species were included in order to obtain a more representative picture of global Carboniferous arthropod disparity.
The absence, presence, or state of 66 shared characters was recorded for each species, as well as individual autapomorphies. Overall disparity was determined from the Euclidean distance analysis between taxa or variance along principal coordinates analyses (PCO) axes. Results indicate that arthropod disparity has not been greatly reduced throughout the Phanerozoic as was previously suggested. However, the regions of occupied morphospace have rotated over time.
Sorption coefficients are traditionally obtained in batch experiments if the sorbent is strongly or intermediately sorbing. In a batch experiment the rock is crushed and this could increase the surface area as well as induce new and fresh surfaces. Therefore there is some concern whether sorption coefficients obtained in batch experiments represents those of intact rock. Performing sorption experiment by diffusion in intact rock with intermediately and strongly sorbing species seems impossible in practice due to extremely long experimental times. In this paper the possibility of increasing the migration rate in the rock by two of three orders, thus enabling KD measurements of intermediately sorbing species in intact rock, is discussed. The increase in migration ratehas already been achieved successfully in so called through electromigration experiments using non-sorbing species. Here a potential gradient acts as the main driving force. In our experiments the migration rate was increased 320 times by using a potential drop of only 9 volts.