To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.
We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.
Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.
Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.
Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed.
In this randomized controlled trial we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to (1) guided online CBT-I and sleep diary monitoring (i-Sleep) or (2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety, and perseverative thinking.
At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared with participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety, and perseverative thinking. Effects were maintained at 3 and 6 month follow-up. We did not find significant post-test effects on fatigue or total sleep time.
Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable with those of depression therapy. Clinical trial registration number: NTR6049 (Netherlands Trial Register).
We hypothesized that a computerized clinical decision support tool for Clostridium difficile testing would reduce unnecessary inpatient tests, resulting in fewer laboratory-identified events. Census-adjusted interrupted time-series analyses demonstrated significant reductions of 41% fewer tests and 31% fewer hospital-onset C. difficile infection laboratory-identified events following this intervention.
Recently in vitro and in situ techniques have been used for assessing forage nutritive value for ruminants instead of laborious in vivo trials. Although, Blummel and Ørskov (1993) have shown that an in vitro gas production technique gives reliable estimates of forage nutritive value, whether the estimates could be correlated with in situ degradation are not well established. There is little known about the differences in degradation characteristics of neutral-detergent fibre (NDF) and cellular contents (CC: soluble carbohydrates, lipids and crude protein) in the rumen, and also about the relationships between component degradation rate in the rumen and gas production rate for different forages. This is because most in situ kinetic studies have followed the disappearance of insoluble cell wall constituents and comparative studies of in vitro and in situ estimates was not performed sufficiently.
The objective of this experiment was to investigate the relationship between in situ degradation of forage components and in vitro gas production rate for the three forages.
We describe an outbreak of tuberculosis (TB) in the food preparation area of a hospital, which demonstrates that employees in healthcare settings may serve as potential risks for spread of TB even if they have no direct patient contact.
To identify Choosing Wisely items for the American Board of Internal Medicine Foundation.
The Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA–Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board.
Ninety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don’t perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don’t continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included.
These 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse.
Between 1910 and 1970, millions of southern-born Americans migrated to the northern and western regions of the country in search of better opportunities. Some traveled only short distances, leaving Appalachia for nearby destinations in the southern Midwest. Others made the much longer trek to the West Coast. In this article, we use data from the 1920, 1940, and 1970 Public Use Microdata Samples to investigate the distances traveled by male participants in the Great Migration, with a special focus on differences by race, as well as on changes over time. We find that the average distance traveled increased substantially during the Great Migration for blacks and whites alike. However, throughout this time period, white migrants moved significantly farther than black migrants. The greater propensity for white migrants to move west, rather than north, accounts for a good deal of this overall racial variation. Although the difference in distance traveled between blacks and whites narrowed significantly over time, it remained substantial as the Great Migration came to a close. We conclude by highlighting the impact of these differential migration patterns on the composition and social conditions in northern cities.
An accepted practice for patients colonized with multidrug-resistant organisms is to discontinue contact precautions following 3 consecutive negative surveillance cultures. Our experience with surveillance cultures to detect persistent carbapenemase-producing Enterobacteriaceae (CPE) colonization suggests that extrapolation of this practice to CPE-colonized patients may not be appropriate.
We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).
Before-after intervention study.
Fifteen-bed surgical trauma intensive care unit (ICU).
We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.
The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.
Use of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.
Carbapenemase-producing Enterobacteriaceae (CPE) are of increasing prevalence worldwide, and long-term acute care hospitals (LTACHs) have been implicated in several outbreaks in the United States. This prospective study of routine screening for CPE on admission to a LTACH demonstrates a high prevalence of CPE colonization in central Virginia.
The exceptional electrical, optical, and mechanical properties of graphene make it a promising material for many industrial applications such as solar cells, semiconductor devices, and thermal heat sinks. However, the greatest obstacle in the use of graphene in industry is high-throughput scaling of its production and characterization. Chemical-vapor deposition growth of graphene has allowed for industrial-scale graphene production. In this work we introduce complimentary high-throughput metrology technique for characterization of chemical-vapor deposition-grown graphene. This metrology technique provides quick identification of thickness and uniformity of entire large-area chemical-vapor deposition-grown graphene sheets on a glass substrate and allows for easy identification of folds and cracks in the graphene samples. This metrology technique utilizes fluorescence quenching microscopy, which is based on resonant energy transfer between a dye molecule and graphene, to increase allow graphene visualization on the glass substrate and increase the contrast between graphene layers.
Recently, low-cost processing approaches that produce textured thin bodies have engendered interest as cost-effective approaches for fabrication of magnetostrictive Fe-Ga alloys. In particular, wire-forming methods that strictly control the solidification direction could lead to some measure of crystallographic texture control. This is critical for development of large magnetostriction in polycrystals and for use of the alloys in actuators, sensors, energy harvesters and other systems. Magnetostrictive Fe-Ga wires have been prepared using an innovative cost-effective approach – based on the Taylor wire method – that combines rapid solidification and deformation processes. The procedure for making magnetostrictive wires is discussed and the wires are evaluated in terms of microstructure, crystallographic texture and magnetostriction. Results show that the Taylor-based approach is an effective and versatile means to draw 1-3 mm diameter textured Fe-Ga wire. Experimentation on the influence of drawing technique and quench conditions on texture development resulted with production of a strong <100> fiber texture in the Fe-Ga wire. Magnetostriction measurements, in the absence of prestress, indicated a maximum magnetostriction of ˜165 ppm in a saturation field of less than 200 mTesla. This is considered a significant strain for bulk polycrystalline Fe-Ga alloys without a pre-stress or a stress-annealing treatment. The unique properties of wires made with the Taylor-based approach coupled with the low intrinsic cost make this an attractive approach for production of textured magnetostrictive wire for a variety of applications.