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Background: Alcohol-based hand rubs (ABHRs) are the primary form of hand hygiene in healthcare settings globally. Many developed countries, and most US hospitals utilize wall-mounted ABHR dispensers throughout the facility. The adoption of automated touch-free dispensers is increasing. However, data on the efficacy of ABHRs when used at dispensed amounts are limited. The evidence is strong, showing that formulation matters (not just alcohol concentration) and that agent volume impacts efficacy. Objective: We evaluated the efficacy of ABHR foams on human hands using 2 controlled test methods at variable volumes (ie, typical doses and realistic volumes that healthcare personnel could use in patient care practice). Methods: We tested 8 commercially available ABHR products, the WHO hand-rub formulation, (P1–P9) and a nonantibacterial foam handwash control (P10) on human participants at 2 different application frequencies (“1 application” and “10 applications”) using 2 different ASTM test methods (E1174 and E2755). Studies using ASTM-E1174 evaluated 3 different application volumes (0.7 mL, 1.1 mL, and 2.0 mL) of the 10 products, each tested on 12–13 subjects. Studies using ASTM-E2755 evaluated a single 1.1 mL volume for the 9 ABHR products (P1–P9), each on 2–12 subjects. A linear mixed-effects model was fit separately to log reductions with random effects for subject and date, and a fixed effect for product. Results: Four different foam formulations (P1–P4) consistently outperformed all other formulations by the E1174 method, especially with increasing volumes and after 10 product applications (Fig. 1). When tested with E2755, all formulations performed similarly, with only P1 and P2 differentiating after 10 applications (Fig. 2). ABHR efficacy consistently increased with larger application volumes, whereas the handwash control (P10) achieved a similar efficacy (∼2 log reduction) at all volumes. Efficacy for some ABHR formulations increased, whereas others decreased with repeated applications. Alcohol concentration did not correlate with log reduction. Conclusions: Formulation and the product application volume affect the antimicrobial efficacy of ABHR; therefore, those data should be critically assessed by healthcare personnel assessing ABHR product performance. Test methods matter: when E1174 was used, greater differentiation between formulations was observed. This may be due to the larger contamination volume and greater soil load used in E1174.
Funding: GOJO Industries, Inc., provided Funding: for this study.
Disclosures: James W. Arbogast and David R. Macinga report salary from GOJO Industries.
To develop and evaluate a program to presvent hospital-acquired pneumonia (HAP).
Prospective, observational, surveillance program to identify HAP before and after 7 interventions. An order set automatically triggered in programmatically identified high-risk patients.
All 21 hospitals of an integrated healthcare system with 4.4 million members.
All hospitalized patients.
Interventions for high-risk patients included mobilization, upright feeding, swallowing evaluation, sedation restrictions, elevated head of bed, oral care and tube care.
HAP rates decreased between 2012 and 2018: from 5.92 to 1.79 per 1,000 admissions (P = .0031) and from 24.57 to 6.49 per 100,000 members (P = .0014). HAP mortality decreased from 1.05 to 0.34 per 1,000 admissions and from 4.37 to 1.24 per 100,000 members. Concomitant antibiotic utilization demonstrated reductions of broad-spectrum antibiotics. Antibiotic therapy per 100,000 members was measured as follows: carbapenem days (694 to 463; P = .0020), aminoglycoside days (154 to 61; P = .0165), vancomycin days (2,087 to 1,783; P = .002), and quinolone days (2,162 to 1,287; P < .0001). Only cephalosporin use increased, driven by ceftriaxone days (264 to 460; P = .0009). Benzodiazepine use decreased between 2014 to 2016: 10.4% to 8.8% of inpatient days. Mortality for patients with HAP was 18% in 2012% and 19% in 2016 (P = .439).
HAP rates, mortality, and broad-spectrum antibiotic use were all reduced significantly following these interventions, despite the absence of strong supportive literature for guidance. Most interventions augmented basic nursing care. None had risks of adverse consequences. These results support the need to examine practices to improve care despite limited literature and the need to further study these difficult areas of care.
Comparing parasitic infection among individuals of wildlife populations can provide insight into factors that influence wildlife disease ecology. Strongylids are parasitic worms that infect the intestinal tract of vertebrates, and infection with strongylids can be approximated by counting strongylid eggs in dung samples. Here we tested for correlations between strongylid egg counts and 18 different individual characteristics, environmental and social factors in individually known wild African elephants. We counted more eggs in the dung samples of younger elephants and females relative to mature elephants and males. We also found that elephants spending more time outside reserves shed more strongylid eggs than elephants that were more often within reserves. Elephants that were less socially integrated, as measured by how much aggression they received from other elephants, shed fewer strongylid eggs; relatedly, socially isolated orphan elephants that had left their family shed fewer strongylid eggs than elephants that remained with their family. Our results suggest that landscapes altered by livestock grazing and social disruption caused by humans may impact parasitic infection in wildlife.
Zinc Oxide (ZnO) has been shown to exhibit semiconducting and piezoelectric dual properties. This has led to a large commercial demand on ZnO for optoelectronics that operate at the blue-ultraviolet regions. Consequently, varying techniques have been devised to create different nanostructures of ZnO. Here, the single step synthesis of ZnO nanostructures was performed on Si(100) substrates with a thin ZnO seed-layer. A modified chemical vapor deposition (CVD) method was developed to accomplish the structure formation. Sb doping of the structures in the gas phase was performed to study its effects on structure and optoelectronic properties. Different structures were realized including nanofilaments, nanoparticles, microflowers, nanorods, nanotubes, and nanocolumns. Only nanorods/columns, and nanotubes are shown in this work. Morphology was examined using scanning electron microscopy (SEM). Energy-dispersive X-ray spectroscopy (EDS) and X-ray powder diffraction (XRD) were used for structural studies. Optoelectronic properties were explored using room-temperature photoluminescence (PL) spectroscopy. PL data show the relative decrease in the number of defects and increase in crystal quality upon increasing reaction time. Significant structural effects were also observed upon doping. Some structural defects might be attributed to the diffusion of Sb ions into the lattices of ZnO, replacement of Zn by Sb, and ionic radii difference. These stacking faults are most likely the reason behind the dominance and broadening of DLE peak.
We compared systematic and random survey techniques to estimate breeding population sizes of burrow-nesting petrel species on Marion Island. White-chinned (Procellaria aequinoctialis) and blue (Halobaena caerulea) petrel population sizes were estimated in systematic surveys (which attempt to count every colony) in 2009 and 2012, respectively. In 2015, we counted burrows of white-chinned, blue and great-winged (Pterodroma macroptera) petrels within 52 randomized strip transects (25 m wide, total 144 km). Burrow densities were extrapolated by Geographic Information System-derived habitat attributes (geology, vegetation, slope, elevation, aspect) to generate island-wide burrow estimates. Great-winged petrel burrows were found singly or in small groups at low densities (2 burrows ha−1); white-chinned petrel burrows were in loose clusters at moderate densities (3 burrows ha−1); and blue petrel burrows were in tight clusters at high densities (13 burrows ha−1). The random survey estimated 58% more white-chinned petrels but 42% fewer blue petrels than the systematic surveys. The results suggest that random transects are best suited for species that are widely distributed at low densities, but become increasingly poor for estimating population sizes of species with clustered distributions. Repeated fixed transects provide a robust way to monitor changes in colony density and area, but might fail to detect the formation/disappearance of new colonies.
A survey of Antarctic toothfish (Dissostichus mawsoni) was conducted in the northern Ross Sea region during the winter of 2016 to document the timing and location of spawning activity, to collect biological information about reproductive status during the spawning season and to look for temporal signals in biological data from D. mawsoni that may indicate a spawning migration of mature toothfish from the continental slope region to the northern Ross Sea region. The 58 day survey showed that spawning of D. mawsoni began on some seamounts by early July. No changes were detected between winter and summer in length, age, sex ratio or condition factor distributions for D. mawsoni in the northern Ross Sea as hypothesized following a spawning migration from the slope to the northern Ross Sea region. These results suggest that the distribution of D. mawsoni in the Ross Sea is mainly accomplished through ontogenetic migration and not annual return spawning migrations.
We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.
A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.
A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.
This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
The Orion facility at the Atomic Weapons Establishment in the United Kingdom has the capability to operate one of its two 500 J, 500 fs short-pulse petawatt beams at the second harmonic, the principal reason being to increase the temporal contrast of the pulse on target. This is achieved post-compression, using 3 mm thick type-1 potassium dihydrogen phosphate crystals. Since the beam diameter of the compressed pulse is
mm, it is impractical to achieve this over the full aperture due to the unavailability of the large aperture crystals. Frequency doubling was originally achieved on Orion using a circular sub-aperture of 300 mm diameter. The reduction in aperture limited the output energy to 100 J. The second-harmonic capability has been upgraded by taking two square 300 mm
300 mm sub-apertures from the beam and combining them at focus using a single paraboloidal mirror, thus creating a 200 J, 500 fs, i.e., 400 TW facility at the second harmonic.
OBJECTIVES/SPECIFIC AIMS: (1) Evaluate safety of a novel influenza vaccination strategy in patients with plasma cell disorders. (2) Measure laboratory-confirmed influenza infection rates following a novel influenza vaccination strategy in patients with plasma cell disorders. (3) Evaluate clinical correlates of response following a novel influenza vaccination strategy in patients with plasma cell disorders. METHODS/STUDY POPULATION: We conducted a double-blind, randomized study over the 2015–16 flu season, comparing 2 doses of Fluzone® High-Dose influenza vaccination (separated by 30 d) to the current standard of care influenza vaccination. Patients were allocated to the experimental arm in 2:1 ratio compared with standard of care arm. Standard of care influenza vaccination was considered single age-based vaccination (standard dose for those <65 y and high dosefor those ≥65 y) and patients in this arm received a saline placebo injection at 30 days to assist in blinding. Eligibility criteria allowed any patient with a PCD and no contraindication to trivalent inactivated influenza vaccine. The primary endpoint was laboratory-confirmed flu infection rate. Protocol-driven surveillance screened patients for flu-like illnesses and performed laboratory testing for influenza until the end of the flu season in May 2016. Secondary endpoints include HAI titer serologic response rates, clinical correlates of protection from influenza infection, and exploratory studies of cell-mediated immunity through characterization of T cell subpopulations, cytokine profiles, and flu-specific T-cell responsiveness. RESULTS/ANTICIPATED RESULTS: In total, 122 plasma cell disorder patients were enrolled (97 with disease requiring therapy and 25 with asymptomatic gammopathy). Of those 48 patients received a single standard of care influenza vaccination and 74 patients received 2 doses of Fluzone® high-dose vaccine. Median age was 67 years (range 42–90). This 2-dose vaccination strategy was safely tolerated in all patients with no grade 2 adverse events attributed to vaccine. With close clinical follow-up, only 4% of patients receiving 2 vaccine doses developed laboratory confirmed influenza Versus 8.3% of those receiving single vaccine. When compared to the expected CDC influenza infection rate of 10%–15%, 1 sample, 2-tailed binomial testing revealed patients receiving 2 vaccines experienced a significantly lower rate of infection than the expected rate (p<0.05) whereas those receiving single vaccine showed no significant difference (p=0.38). DISCUSSION/SIGNIFICANCE OF IMPACT: This randomized study demonstrates that the 2 dose strategy of Fluzone® high-dose influenza vaccine is safely tolerated in patients with plasma cell disorders and associated with significantly less than expected laboratory-confirmed influenza infections. The results suggest that this novel vaccination strategy may have a clinical benefit in reducing influenza infections in plasma cell disorder patients and thus may have practice changing implications. Final analyses of serologic responses, clinical correlates of response, and cell-mediated immune correlates may provide valuable insights into in vivo “immune-competence” in patients with plasma cell disorders.
Populations of grey petrels have declined globally due to both incidental capture in commercial fisheries and predation by introduced mammals at breeding sites. In the New Zealand region, grey petrels only breed on Campbell and Antipodes islands. Rats were successfully eradicated from Campbell Island in 2001. We assessed the spatial extent and conducted the first quantitative population estimate of the grey petrel population on Campbell Island and surrounding islets. There was an estimated c. 96 pairs (95% CI: 83, 109) of breeding grey petrels from the four colonies. Since work was conducted during the middle of the chick-rearing stage, this is an underestimate of the breeding population. The Campbell Island grey petrel breeding population remains small. Our study provides a baseline for future population estimates of grey petrels on Campbell Island.
The HASH (Hong Kong/ AAO/ Strasbourg/ Hα) planetary nebula research platform is a unique data repository with a graphical interface and SQL capability that offers the community powerful, new ways to undertake Galactic PN studies. HASH currently contains multi-wavelength images, spectra, positions, sizes, morphologies and other data whenever available for 2401 true, 447 likely, and 692 possible Galactic PNe, for a total of 3540 objects. An additional 620 Galactic post-AGB stars, pre-PNe, and PPN candidates are included. All objects were classified and evaluated following the precepts and procedures established and developed by our group over the last 15 years. The complete database contains over 6,700 Galactic objects including the many mimics and related phenomena previously mistaken or confused with PNe. Curation and updating currently occurs on a weekly basis to keep the repository as up to date as possible until the official release of HASH v1 planned in the near future.
The Hong Kong/AAO/Strasbourg Hα (HASH) planetary nebula database is an online research platform providing free and easy access to the largest and most comprehensive catalogue of known Galactic PNe and a repository of observational data (imaging and spectroscopy) for these and related astronomical objects. The main motivation for creating this system is resolving some of long standing problems in the field e.g. problems with mimics and dubious and/or misidentifications, errors in observational data and consolidation of the widely scattered data-sets. This facility allows researchers quick and easy access to the archived and new observational data and creating and sharing of non-redundant PN samples and catalogues.
A detailed examination of new high quality radio catalogues (e.g. Cornish) in combination with available mid-infrared (MIR) satellite imagery (e.g. Glimpse) has allowed us to find 70 new planetary nebula (PN) candidates based on existing knowledge of their typical colors and fluxes. To further examine the nature of these sources, multiple diagnostic tools have been applied to these candidates based on published data and on available imagery in the HASH (Hong Kong/ AAO/ Strasbourg Hα planetary nebula) research platform. Some candidates have previously-missed optical counterparts allowing for spectroscopic follow-up. Indeed, the single object spectroscopically observed so far has turned out to be a bona fide PN.
A subset of Post-AGB (PAGB) objects are the highly luminous RV Tauri variables that show similarities to Type-II Cepheids. By using a sample of known RV Tauri stars from the Magellanic Clouds we are able to determine period luminosity relationships (PLRs) in various bands that have been used to determine the luminosities of their Galactic counterparts. We have gathered all available photometry in order to generate an SED for each object and determine the total integrated flux. This total flux combined with a calculated or inferred intrinsic luminosity leads to a distance (Vickers et al. 2015). This distance catalogue has allowed us to begin to constrain the physical parameters of this poorly understood evolutionary phase and to determine links between these physical characteristics as a function of their stellar population.
Background: The UK Department of Health Improving Access to Psychological Therapies (IAPT) initiative set out to train a large number of therapists in cognitive behaviour therapies (CBT) for depression and anxiety disorders. Little is currently known about the retention of IAPT CBT trainees, or the use of CBT skills acquired on the course in the workplace after training has finished. Aims: This study set out to conduct a follow-up survey of past CBT trainees on the IAPT High Intensity CBT Course at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), one of the largest IAPT High Intensity courses in the UK. Method: Past trainees (n = 212) across 6 cohorts (2008-2014 intakes) were contacted and invited to participate in a follow-up survey. A response rate of 92.5% (n = 196) was achieved. Results: The vast majority of IAPT trainees continue to work in IAPT services posttraining (79%) and to practise CBT as their main therapy modality (94%); 61% have become CBT supervisors. A minority (23%) have progressed to other senior roles in the services. Shortcomings are reported in the use of out-of-office CBT interventions, the use of disorder-specific outcome measures and therapy recordings to inform therapy and supervision. Conclusions: Past trainees stay working in IAPT services and continue to use CBT methods taught on the course. Some NICE recommended treatment procedures that are likely to facilitate patients’ recovery are not being routinely implemented across IAPT services. The results have implications for the continued roll out of the IAPT programme, and other future large scale training initiatives.
Stonehenge is a site that continues to yield surprises. Excavation in 2009 added a new and unexpected feature: a smaller, dismantled stone circle on the banks of the River Avon, connected to Stonehenge itself by the Avenue. This new structure has been labelled ‘Bluestonehenge’ from the evidence that it once held a circle of bluestones that were later removed to Stonehenge. Investigation of the Avenue closer to Stonehenge revealed deep periglacial fissures within it. Their alignment on Stonehenge's solstitial axis (midwinter sunset–midsummer sunrise) raises questions about the early origins of this ritual landscape.
We sought to determine the frequency with which hospice and palliative social workers encounter patients, family caregivers, and other clients at risk of suicide, and to discover the extent to which hospice and palliative social workers feel prepared to address issues related to suicide in their professional practice.
We conducted a cross-sectional survey of hospice and palliative social workers, recruiting a convenience sample of volunteer respondents through advertisements at professional conferences and listservs, and via social media accounts associated with national organizations, state hospice and palliative care associations, and individual healthcare professionals.
Most respondents reported having worked with patients, family caregivers, or other clients who had exhibited warning signs of suicide during the previous year. Fewer respondents indicated that they had worked with patients and family members who had attempted or died by suicide. While the majority of respondents believed they possessed sufficient knowledge and skills to intervene effectively with individuals at risk of suicide, they indicated that additional education on this topic would be valuable for their professional practice.
Significance of results:
These study results suggest that suicide-related competencies are important in the practice of hospice and palliative social work. Future education and training efforts should include skill development in addition to knowledge building.