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Background: A cluster of sternal surgical site infections caused by Pseudomonas aeruginosa led to sampling of shower heads in patient rooms. Multiple subtypes of Pseudomonas aeruginosa were found and were genetically diverse from the patient isolates. Visible biofilm was found in showerheads in the cardiothoracic ward. Ways of minimizing formation and persistence of biofilm in the shower heads were sought. Methods: A low-dose chlorination dosing system was introduced in September 2018 to the circulating warm-water system supplying the building block where the cardiac surgery ward is situated. Of the 145 showers in that block, 70 shower heads were sampled and the shower heads were replaced. Of these, 35 were sampled at 3 months and 35 were tested at 6 months (biofilm prevention group). Of the remaining 70 shower heads, 35 were tested at 3 months and 35 at 6 months (biofilm removal group). Heterotrophic colony count (HCC) in CFU/mL was chosen as the outcome measure. Analysis was conducted in accordance with AS 4276.3.2 (2003). The microbial growth data followed a log-normal distribution due to the exponential growth of bacteria. The natural log of the data was therefore calculated, and results from each period were compared using analysis of variance (ANOVA). Free chlorine residual levels were controlled using a combination of feed-forward and oxidation reduction potential (ORP) feedback control, and levels were retested and adjusted during the review period using N,N-diethyl-p-phenylenediamine (DPD) chemistry. Results: Mean and median levels of log HCC data are shown in Fig. 1. We detected a statistically significant difference in HCC between the 6-month-old untreated shower heads (group B) and treated shower heads (Group D) (P < .001). Hypochlorite was generally dosed at a concentration of 0.5 mg/L free chlorine for the first 3 months, and 1.5 mg/L for the second 3 months. Approximately 65% of the chlorine was lost as it travelled around the system. Discussion: Waterborne pathogens, especially multiresistant Gram-negative bacilli, have been increasingly recognized as hospital-acquired pathogens. Many instances of the transmission of these pathogens have been reported, from premise plumbing to patients, and have been confirmed using molecular typing techniques. Conclusions: A low-dose chlorination system of the circulating warm-water supply seemed effective in preventing biofilm formation and reducing existing biofilm in shower heads using HCCs as a measure of biofilm. This information adds to the potential armamentarium for controlling the spread of these waterborne pathogens.
Access to cutting-edge technologies is essential for investigators to advance translational research. The Indiana Clinical and Translational Sciences Institute (CTSI) spans three major and preeminent universities, four large academic campuses across the state of Indiana, and is mandate to provide best practices to a whole state.
To address the need to facilitate the availability of innovative technologies to its investigators, the Indiana CTSI implemented the Access Technology Program (ATP). The activities of the ATP, or any program of the Indiana CTSI, are challenged to connect technologies and investigators on the multiple Indiana CTSI campuses by the geographical distances between campuses (1–4 hr driving time).
Herein, we describe the initiatives developed by the ATP to increase the availability of state-of-the-art technologies to its investigators on all Indiana CTSI campuses, and the methods developed by the ATP to bridge the distance between campuses, technologies, and investigators for the advancement of clinical translational research.
The methods and practices described in this publication may inform other approaches to enhance translational research, dissemination, and usage of innovative technologies by translational investigators, especially when distance or multi-campus cultural differences are factors to efficient application.
We show that Ringrose's diagonal ideals are primitive ideals in a nest algebra (subject to the continuum hypothesis). This answers an old question of Lance and provides for the first time concrete descriptions of enough primitive ideals to obtain the Jacobson radical as their intersection. Separately, we provide a standard form for all left ideals of a nest algebra, which leads to insights into the maximal left ideals. In the case of atomic nest algebras, we show how primitive ideals can be categorized by their behaviour on the diagonal and provide concrete examples of all types.
It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach.
To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories.
Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS).
Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not.
Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.
Since opening in 1863 Broadmoor Hospital, in Crowthorne, Berkshire, 30 miles west of London, has admitted or readmitted over 2000 women. This is a tiny proportion of the women who have been incarcerated in prison over this time, but the level of public interest and ethical issues involved in their care, far outweighs the number of cases. Their stories and reasons for admission are of great interest and complexity.
At first infanticide was the usual offence resulting in admission, but with increasing knowledge of the causes and consequences of mental illness, and new legislation to deal with it, reasons for admission became much more varied. Arson became the commonest reason for admission in recent years. Also, over the last 40 years, those admitted are younger and stay for a shorter time.
The treatment of the disturbed and often tragic women patients in Broadmoor has also changed. Primitive surgery and blunderbuss drug regimes have evolved into multidisciplinary practices and widely varied therapies.
Political pressure groups campaigning against the admission of mentally ill women to high security hospitals have succeeded in changing government policy. Three high security units in England will be reduced to one, accommodating only the most dangerous women. The rapidly growing range of public and private medium security units will treat all other women detained under the Mental Health Act.
This is a time of change in the treatment of mentally abnormal women offenders in England. It presents an opportunity for those of us who care about these women to share knowledge and experience with professionals from other countries.
Emerging from four nations romantic scholarship and recent historical revisionism, this chapter challenges the negative view of the liminal period 1798–1800 as a dark and silent moment, following the collapse of United Irish republicanism and its associated publications. Pushing beyond 1798, public print and private correspondence discoveries in relation to key figures among elite and working-class circles alike yield evidence of continued collaboration towards the goal of a more high-brow, if less overtly political, northern periodical culture in Ireland. These circles contributed to several ‘enlightened’ periodicals like the Belfast Monthly Magazine (1808–14) and the Belfast Literary Journal (1815), which enabled a productive collision of politically radical writers like James Orr, Dr William Drennan, and Samuel Thomson with the ascendancy of conservatives, particularly the coterie poets of Bishop Thomas Percy. This chapter focuses on a key study of a short-lived Belfast periodical, The Microscope and Minute Observer (1799–1800), a unique publication that represents the convergence of Enlightenment, antiquarian, and romantic literary energies at a pivotal point of historical flux.
The afterword revisits the major themes of the book but also points to the particularly important role of Irish writers in articulating critiques of empire, unsurprising in view of their nation’s subject relation within the United Kingdom. This final section also addresses the question of slavery, now seen as the greatest contradiction in Enlightenment political thought and practice, noting that this issue becomes prominent politically and theatrically in the last decades of the eighteenth century. Early Whig hostility to extractive colonial policy, recently uncovered by Steven Pincus, suggests however that mainstream anti-slavery positions may have emerged earlier than previously believed, suggesting potential rethinking of such tragedies as Oroonoko and Young’s The Revenge.
English Enlightenment dramas set in the new world frequently depicted European oppression; from John Dennis’s Liberty Asserted (1704) through Aaron Hill’s Alzira (1736) to Arthur Murphy’s Alzuma (1767), playwrights present actions highly critical of European colonialism. These plays put indigenous critiques of European invasion into circulation, drawing on and rearticulating the writing of Incan Garcilaso de la Vega and Adario, Lahontan’s interlocutor in his famous Dialogue. Rather than regarding such discourse as European projection, I argue that the voices of protesting Incas and Mohawks be recognized as “energumen” or discourse of the other, whose critiques of empire, slavery and forced conversion shaped the development of progressive thought in Europe.
This chapter focuses on Joseph Addison and Richard Steele as primary proponents of Enlightened culture in late Stuart England. Often seen now as ineffectual witnesses to the human costs of expanding commerce and imperialism, Addison and Steele were important as advocates of religious toleration, universal education, cultural relativism and hostility to extractive colonialism. Drawing a parallel between their modelling of empathetic persuasion in their periodical papers with Steele’s practice as a sentimental dramatist, I show how his playwriting sought to create national sympathy across sectarian, ethnic and ideological boundaries in order to create empathy for outsiders. This was a particularly urgent issue for Steele, who suffered all his career because he was Anglo-Irish.
The introduction provides a survey of recent scholarship on the English Enlightenment and situates this study in that context. Recognizing that there a plethora of “Enlightenments,” even within a particular state such as Britain, itself a composite monarchy of nations, I argue that late Stuart and Georgian drama included articulations of radical as well as conservative Enlightened positions, notably in regard to religious toleration, imperial oppression and social hierarchy. I link my analysis of Islamic and indigenous American voices within eighteenth-century plays to recent scholarship that identifies European dependence on non-European literary, theological and technological sources in the creation of Enlightenment.
This chapter focuses on dramatizations of what John Marshall identifies as the central issue of the early Enlightenment, religious toleration, also a crucial pillar of Whig ideology. Addison and Steele were both advocates of toleration, and their fellow dramatists were no less enthusiastic. I analyse John Hughes’s The Siege of Damascus (1718), a play that remained widely popular through the century, famous for its tense scene of religious testing. The play was based on the work of pioneering Arabist Simon Ockley and offers an object lesson in the way a respectful account of Arab history was put into wide circulation. Other plays that used Near Eastern settings, such as Aaron Hill’s Zara (1735) and James Thomson’s Edward and Eleonora (1739) shared Hughes’s tolerationist agenda. By contrast, I also present plays with a much more conservative perspective on religious difference, including John Brown’s Barbarossa (1754).