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Immunocompromised patients are at risk for infections due to above-ceiling activities in hospitals. Mobile dust-containment carts are available as environmental controls, but no published data support their efficacy. Using microbial air sampling and particle counts, we provide evidence of reduced risk of fungal exposure during open ceiling activities.
A widespread response to the pressures placed on the ecological condition of rivers is the design and implementation of environmental flow regimes in domestic regulatory frameworks for water. Environmental interests in water are not confined to hydrological functioning but include relationships between water resources and human cultural and economic livelihoods, including those of Indigenous communities. Since the mid-1980s there has been some provision for environmental flows in Chilean law. However, the legal and policy requirements are limited in scope and have been poorly implemented by regulatory institutions. In this article we critically examine the treatment of environmental flows in Chilean legal and policy frameworks. We argue that there is an urgent need for a comprehensive minimum flow regime in Chile to protect the environmental qualities of rivers, which must also reflect and provide for Indigenous water rights and interests. The developing constitutional crisis in Chile, the most significant political crisis since the end of the Pinochet dictatorship (1973–90), highlights the need to revisit the sensitive and unresolved issues of water governance and equity.
To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals.
Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States.
2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports.
Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate.
In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017.
The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.
Free-living amoeba of the genus Acanthamoeba are ubiquitous protozoa involved in opportunistic and non-opportunistic infection in humans, such as granulomatous amoebic encephalitis and amoebic keratitis. Both infections have challenging characteristics such as the formation of the resistant cysts in infected tissues, hampering the treatment and most usual diagnosis depending on time-consuming and/or low sensitivity techniques. The use of monoclonal antibodies presents itself as an opportunity for the development of more effective alternative diagnostic methods, as well as an important and useful tool in the search for new therapeutic targets. This study investigated the possibility of using a previously produced monoclonal antibody (mAb3), as a diagnostic tool for the detection of Acanthamoeba trophozoites by direct and indirect flow cytometry and immunofluorescence. Immunoprecipitation assay and mass spectrometry allowed the isolation of the antibody's target and suggested it is a transporter part of the CPA (cation: proton antiporter) superfamily. In vitro tests indicate an important role of this target in Acanthamoeba's encystment physiology. Our results support the importance of studying the role of CPA2 transporters in the context of acanthamoebiasis, as this may be a way to identify new therapeutic candidates.
SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.
Since its beginnings as a subdiscipline of psychology (e.g., Allport, 1937; Shand, 1914), personality psychologists have pursued two different, though related goals (see e.g., Cervone, 2005; Mischel & Shoda, 1998). The first goal is to construct a general theory of the person, understood as the integrated whole of the several subsystems of the mind. The second goal is to describe and explain the important psychological differences between individuals, that is, those relatively stable psychological attributes of individuals that allow us to uniquely characterize them and to distinguish them from each other. Most psychologists would agree that the emotion system is a central subsystem of personality, and that interindividual differences traceable to this system are important for describing individuals. However, if one accepts this, then it follows immediately that, to attain its goals, personality psychology must consider the emotions. In accordance with this conclusion, (1) most classical personality theorists proposed an affective (or affective–motivational) system as a core system of the mind (see, e.g., Shand, 1914; Murray, 1938), and emotions also play a prominent role in recent theories of personality (e.g., Mischel & Shoda, 1995). Furthermore, (2) most taxonomic models of stable and general (transsituational) psychological dispositions (usually called personality traits) include a subset of dispositions that refer directly or indirectly to emotions (see the second part of this chapter). Nonetheless, the in-depth investigation of emotions from a personality perspective has only begun comparatively recently, in the wake of an upsurge of interest in emotions that arose in the 1980s and continues to this day. Since that time, the previously largely separate fields of personality psychology and emotion psychology – the latter being the subdiscipline of psychology that studies emotions – are becoming increasingly integrated, to the benefit of both fields.
A large proportion of antibiotic use associated with hospitalization occurs immediately after discharge, representing an important focus for antimicrobial stewardship programs. This review identified few studies evaluating the effect of interventions aimed at improving discharge antibiotic prescribing. Antimicrobial stewardship to improve postdischarge antibiotic prescribing is an unmet need warranting further study.
The Khao Wong Prachan Valley of central Thailand is one of four known prehistoric loci of copper mining, smelting and casting in Southeast Asia. Many radiocarbon determinations from bronze-consumption sites in north-east Thailand date the earliest copper-base metallurgy there in the late second millennium BC. By applying kernel density estimation analysis to approximately 100 new AMS radiocarbon dates, the authors conclude that the valley's first Neolithic millet farmers had settled there by c. 2000 BC, and initial copper mining and rudimentary smelting began in the late second millennium BC. This overlaps with the established dates for Southeast Asian metal-consumption sites, and provides an important new insight into the development of metallurgy in central Thailand and beyond.
In prehistoric coastal and western-central Thailand, rice was the dominant cultivar. In eastern-central Thailand, however, the first known farmers cultivated millet. Using one of the largest collections of archaeobotanical material in Southeast Asia, this article examines how cropping systems were adapted as domesticates were introduced into eastern-central Thailand. The authors argue that millet reached the region first, to be progressively replaced by rice, possibly due to climatic pressures. But despite the increasing importance of rice, dryland, rain-fed cultivation persisted throughout ancient central Thailand, a result that contributes to refining understanding of the development of farming in Southeast Asia.
To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda.
In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis.
Rutsiro District, Western Province, Rwanda.
Participants included twenty-four mothers (median age 32 years) with children 6–23 months old.
We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children’s food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care.
Mothers’ infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.