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In a crossover trial, a gown designed to increase skin coverage at the hands and wrists significantly reduced contamination of personnel during personal protective equipment (PPE) removal, and education on donning and doffing technique further reduced contamination. Simple modifications of PPE and education can reduce contamination during PPE removal.
We investigate the effect of constant-vorticity background shear on the properties of wavetrains in deep water. Using the methodology of Fokas (A Unified Approach to Boundary Value Problems, 2008, SIAM), we derive a higher-order nonlinear Schrödinger equation in the presence of shear and surface tension. We show that the presence of shear induces a strong coupling between the carrier wave and the mean-surface displacement. The effects of the background shear on the modulational instability of plane waves is also studied, where it is shown that shear can suppress instability, although not for all carrier wavelengths in the presence of surface tension. These results expand upon the findings of Thomas et al. (Phys. Fluids, vol. 24 (12), 2012, 127102). Using a modification of the generalized Lagrangian mean theory in Andrews & McIntyre (J. Fluid Mech., vol. 89, 1978, pp. 609–646) and approximate formulas for the velocity field in the fluid column, explicit, asymptotic approximations for the Lagrangian and Stokes drift velocities are obtained for plane-wave and Jacobi elliptic function solutions of the nonlinear Schrödinger equation. Numerical approximations to particle trajectories for these solutions are found and the Lagrangian and Stokes drift velocities corresponding to these numerical solutions corroborate the theoretical results. We show that background currents have significant effects on the mean transport properties of waves. In particular, certain combinations of background shear and carrier wave frequency lead to the disappearance of mean-surface mass transport. These results provide a possible explanation for the measurements reported in Smith (J. Phys. Oceanogr., vol. 36, 2006, pp. 1381–1402). Our results also provide further evidence of the viability of the modification of the Stokes drift velocity beyond the standard monochromatic approximation, such as recently proposed in Breivik et al. (J. Phys. Oceanogr., vol. 44, 2014, pp. 2433–2445) in order to obtain a closer match to a range of complex ocean wave spectra.
To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Veterans Affairs hospital and affiliated LTCF.
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
n-3 Fatty acids are associated with better cardiovascular and cognitive health. However, the concentration of EPA, DPA and DHA in different plasma lipid pools differs and factors influencing this heterogeneity are poorly understood. Our aim was to evaluate the association of oily fish intake, sex, age, BMI and APOE genotype with concentrations of EPA, DPA and DHA in plasma phosphatidylcholine (PC), NEFA, cholesteryl esters (CE) and TAG. Healthy adults (148 male, 158 female, age 20–71 years) were recruited according to APOE genotype, sex and age. The fatty acid composition was determined by GC. Oily fish intake was positively associated with EPA in PC, CE and TAG, DPA in TAG, and DHA in all fractions (P≤0·008). There was a positive association between age and EPA in PC, CE and TAG, DPA in NEFA and CE, and DHA in PC and CE (P≤0·034). DPA was higher in TAG in males than females (P<0·001). There was a positive association between BMI and DPA and DHA in TAG (P<0·006 and 0·02, respectively). APOE genotype×sex interactions were observed: the APOE4 allele associated with higher EPA in males (P=0·002), and there was also evidence for higher DPA and DHA (P≤0·032). In conclusion, EPA, DPA and DHA in plasma lipids are associated with oily fish intake, sex, age, BMI and APOE genotype. Such insights may be used to better understand the link between plasma fatty acid profiles and dietary exposure and may influence intake recommendations across population subgroups.
In a randomized trial, a gown designed to allow easy removal at the neck and with increased skin coverage and snugness of fit at the wrist significantly reduced contamination of personnel during personal protective equipment (PPE) removal. Our results suggest that simple modifications of PPE can reduce contamination of personnel.
To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).
A multicenter randomized trial.
In total,16 acute-care hospitals in northeastern Ohio participated in the study.
We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.
Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.
An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.
We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients’ hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care.
We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid–based disinfectant.
To evaluate the efficacy of the peracetic acid–based disinfectant.
Laboratory-based product evaluation.
The commercial peracetic acid–based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present in a “SmartCap” reservoir with the remaining contents of the container. We measured concentrations of peracetic acid in newly activated and in-use product and determined the stability of nonactivated and activated product. We tested the efficacy of the product against C. difficile spores using the American Society for Testing and Materials standard quantitative carrier disk test method.
Measured concentrations of peracetic acid (50–800 parts per million [ppm]) were significantly lower than the level stated on the product label (1,500 ppm), and similar results were obtained for containers from multiple lot numbers and from another hospital. Product with peracetic acid levels below 600 ppm had significantly reduced activity against C. difficile spores. Peracetic acid concentrations were reduced markedly after storage of either activated or nonactivated product for several weeks. The Environmental Protection Agency confirmed the finding of low disinfectant levels and ordered discontinuation of sale of the product.
Use of a defective peracetic acid–based surface disinfectant may have contributed to an increase in healthcare-associated CDI. Our findings highlight the importance of evaluating the efficacy of liquid disinfectants in healthcare settings.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent.
To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980).
Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up.
No variants passed a genome-wide significance threshold (P=5×10–8) in either analysis. Four variants met criteria for suggestive significance (P<5×10–6) in association with response post-treatment, and three variants in the 6-month follow-up analysis.
This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.
The nutrient choline is necessary for membrane synthesis and methyl donation, with increased requirements during lactation. The majority of immune development occurs postnatally, but the importance of choline supply for immune development during this critical period is unknown. The objective of this study was to determine the importance of maternal supply of choline during suckling on immune function in their offspring among rodents. At parturition, Sprague–Dawley dams were randomised to either a choline-devoid (ChD; n 7) or choline-sufficient (ChS, 1 g/kg choline; n 10) diet with their offspring euthanised at 3 weeks of age. In a second experiment, offspring were weaned to a ChS diet until 10 weeks of age (ChD-ChS, n 5 and ChS-ChS, n 9). Splenocytes were isolated, and parameters of immune function were measured. The ChD offspring received less choline in breast milk and had lower final body and organ weight compared with ChS offspring (P<0·05), but this effect disappeared by week 10 with choline supplementation from weaning. ChD offspring had a higher proportion of T cells expressing activation markers (CD71 or CD28) and a lower proportion of total B cells (CD45RA+) and responded less to T cell stimulation (lower stimulation index and less IFN-γ production) ex vivo (P<0·05). ChD-ChS offspring had a lower proportion of total and activated CD4+ T cells, and produced less IL-6 after mitogen stimulation compared with cells from ChS-ChS (P<0·05). Our study suggests that choline is required in the suckling diet to facilitate immune development, and choline deprivation during this critical period has lasting effects on T cell function later in life.
Since the date of the 1935 Paris meeting two total eclipses have been successfully observed. Throughout the long path crossing Siberia and Japan the weather on June 19, 1936 on the whole about lived up to predictions. On account of widely scattered clouds neighbouring expeditions had quite different luck with the weather. In contrast, the June 8, 1937 eclipse was seen throughout the whole track under universally clear skies, which is all the more surprising for the reason that eclipse expeditions to the tropics usually fare badly with the weather. Stewart and Stokley in a ship at sea were able to observe the eclipse with a measured duration of 7 min. 6 sec., the longest period of totality in 1200 years.
(i) 1936, June 19. The Eclipse Committees of Japan and the U.S.S.R. have been making preliminary meteorological studies of the weather conditions along the belt of totality in their respective countries. The Japanese Committee report (Bulldin, Kwasan Observatory, 283, 1934) that, while at the extreme east and west of their totality zone the weather prospects are unfavourable, for the central part, along the north-east coast of the island of Hokkaido, from Esasi to Monpetu and in a region round Syari the weather conditions are as good as in the best seasons of Tokyo and Kyoto in an ordinary year. A pamphlet giving all information is being prepared and will shortly be circulated in astronomical circles, but it may be mentioned that Monpetu and Syari are accessible by rail from the port of Otaru. There is electric current, 100 V, A.c., labour is readily available and accommodation will be possible for small parties.
Decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with Clostridium difficile infection. We demonstrated that a novel sporicidal formulation of ethanol rapidly reduced C. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing.
Infect. Control Hosp. Epidemiol. 2016;37(3):337–339
In this study, shear flows of dry flexible fibres are numerically modelled using the discrete element method (DEM), and the effects of fibre properties on the flow behaviour and solid-phase stresses are explored. In the DEM simulations, a fibre is formed by connecting a number of spheres in a straight line using deformable and elastic bonds. The forces and moments induced by the bond deformation resist the relative normal, tangential, bending and torsional movements between two bonded spheres. The bond or deforming stiffness determines the flexibility of the fibres and the bond damping accounts for the energy dissipation in the fibre vibration. The simulation results show that elastically bonded fibres have smaller effective coefficients of restitution than rigidly connected fibres. Thus, smaller solid-phase stresses are obtained for flexible fibres, particularly with bond damping, compared with rigid fibres. Frictionless fibres tend to align with a small angle from the flow direction as the solid volume fraction increases, and fibre deformation is minimized due to the alignment. However, jamming, with a corresponding sharp stress increase, large fibre deformation and dense contact force network, occurs for fibres with friction at high solid volume fractions. It is also found that jamming is more prevalent in dense flows with larger fibre friction coefficient, rougher surface, larger stiffness and larger aspect ratio.
To determine the effectiveness of a pulsed xenon ultraviolet (PX-UV) disinfection device for reduction in recovery of healthcare-associated pathogens.
Two acute-care hospitals.
We examined the effectiveness of PX-UV for killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) on glass carriers and evaluated the impact of pathogen concentration, distance from the device, organic load, and shading from the direct field of radiation on killing efficacy. We compared the effectiveness of PX-UV and ultraviolet-C (UV-C) irradiation, each delivered for 10 minutes at 4 feet. In hospital rooms, the frequency of native pathogen contamination on high-touch surfaces was assessed before and after 10 minutes of PX-UV irradiation.
On carriers, irradiation delivered for 10 minutes at 4 feet from the PX-UV device reduced recovery of C. difficile spores, MRSA, and VRE by 0.55±0.34, 1.85±0.49, and 0.6±0.25 log10 colony-forming units (CFU)/cm2, respectively. Increasing distance from the PX-UV device dramatically reduced killing efficacy, whereas pathogen concentration, organic load, and shading did not. Continuous UV-C achieved significantly greater log10CFU reductions than PX-UV irradiation on glass carriers. On frequently touched surfaces, PX-UV significantly reduced the frequency of positive C. difficile, VRE, and MRSA culture results.
The PX-UV device reduced recovery of MRSA, C. difficile, and VRE on glass carriers and on frequently touched surfaces in hospital rooms with a 10-minute UV exposure time. PX-UV was not more effective than continuous UV-C in reducing pathogen recovery on glass slides, suggesting that both forms of UV have some effectiveness at relatively short exposure times.
OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide–based sporicidal disinfectant, was as effective as sodium hypochlorite for in vitro killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus, and vancomcyin-resistant enterococci. OxyCide was minimally affected by organic load and was effective in reducing pathogen contamination in isolation rooms
Infect Control Hosp Epidemiol 2014;35(11):1414–1416