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To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Children are generally at a higher risk of poverty than the population as a whole, although the mechanisms that lead to their socio-economic vulnerability vary widely across European countries. This paper aims to further our understanding of to what extent cross-country variations in child poverty risk are associated with different ways of social transfer targeting: pro-poor versus pro-child targeting. In particular, we address the potential impact on child poverty of countries’ intent to target transfers at lower incomes and children across 30 European countries. Using a multilevel framework, we find that not only the size of the transfer system, but also the form of targeting matters in reducing child poverty. Specifically, the countries’ intent to target children matters even more than their intent to target lower incomes, in terms of reducing child poverty. Moreover, the prevalence of multi-generational households in a country seems to be associated with an attempt to protect against child poverty in countries with lower levels of pro-child targeting.
There is an increasing interest in divesting activities, giving rise to several initiatives both academic and governmental to identify and address one of the problems of health systems. In 2013 the Spanish Atlas of Variability in Clinical Practice (VPM) in collaboration with the Spanish Network of Health Technology Assessment (HTA) Agencies started a project with the purpose of providing elements to support a national strategy aimed at minimizing the use of doubtful procedures in the Spanish National Health System (1).
The identification, selection and definition of low added value procedures and the determination of the most cost-effective alternatives were carried out jointly between the AtlasVPM group and the HTA agencies of Andalusia (AETSA), Catalonia (AQUAS), Galicia (Avalia-t), Basque Country (Osteba), Madrid (UETS) and Aragon (IACS). The process consisted of the following phases: (i) Literature review; (ii) Preliminary list of procedures of dubious value; (iii) Analysis of feasibility and construction of the indicators (variability); and (iv) Empirical validation of the defined indicators. Different lists and sources of evidence were used to identify the procedures and evidence that support their low-value.
The synthesis of the evidence gave rise to an initial list of fifty-nine procedures of doubtful value that could be classified as: obsolete or outdated procedures in comparison to more effective / cost-effective alternatives (n = 31), procedures of doubtful value when used outside their main indication (n = 17) and procedures for which the evidence around effectiveness was still insufficient (n = 11). With the advice of clinical experts and coders, the original list was reduced to seventeen procedures and after some adjustments to thirteen.
Identifying procedures of low-added value is a complex task and is context dependent. Literature could be useful to identify a preliminary list but the analysis of the clinical practice, its variability and reasons that justify it are required to determine which procedures are good candidates for disinvestment.
On 16 June 1936 the young American epigraphist Charles Edson signed an agreement with the Berlin Academy of Sciences for the publication of all Greek inscriptions from Macedonia (Fig. 146) in the prestigious Inscriptiones Graecae series (see the text in Nigdelis 2015b: 10–12), estimating that the whole project could be completed within four years. His estimate proved, as so often in epigraphy, too optimistic. By 2016, only two volumes of inscriptions from ancient Macedonia had appeared in IG: the one Edson managed to complete in 1972 containing the inscriptions of Thessalonike (IG X 2.1) and the 1999 volume covering most of the northwestern border areas prepared by Fanoula Papazoglou and her collaborators (IG X 2.2.1). A further volume, of new material published after or not included in Edson's corpus, has just been published (IG X 2.1, Suppl. 1; most inscriptions have already been published and commented upon in Nigdelis 2006a and 2015a) and another is planned: a supplement to Edson's volume and full photographic documentation (due for publication in 2018).
For a normed infinite-dimensional space, we prove that the family of all locally convex topologies which are compatible with the original norm topology has cardinality greater or equal to
To investigate the association between neighbourhood food availability and the consumption of ready-to-consume products (RCP), either processed or ultra-processed, and unprocessed/minimally processed foods (UF-MPF) by children.
Cross-sectional. 24 h Dietary recalls were collected from children from January 2010 to June 2011. Neighbourhood food availability data were collected from 672 food stores located within 500 m of participants’ homes, using an adapted and validated instrument. Neighbourhood-level socio-economic status (SES) was obtained by calculating the mean years of household head’s education level in each census tract covered by 500 m buffers. Foods that were consumed by children and/or available in the food stores were classified based on their degree of industrial processing. Multilevel random-effect models examined the association between neighbourhood food availability and children’s diets.
Children (n 513) under 10 years old (292 aged <6 years, 221 aged ≥6 years).
The availability of RCP in food stores was associated with increased RCP consumption (P<0·001) and decreased UF-MPF consumption (P<0·001). The consumption of UF-MPF was positively associated with neighbourhood-level SES (P<0·01), but not with the availability of UF-MPF in the neighbourhood.
Results suggest that food policies and interventions that aim to reduce RCP consumption in Santos and similar settings should focus on reducing the availability in food stores. The results also suggest that interventions should not only increase the availability of UF-MPF in lower-SES neighbourhoods, but should strive to make UF-MPF accessible within these environments.
In southern Africa, Middle Stone Age sites with long sequences have been the
focus of intense international and interdisciplinary research over the past
decade (cf. Wadley 2015). Two techno-complexes of the Middle Stone Age—the
Still Bay and Howiesons Poort—have been associated with many technological
and behavioural innovations of Homo sapiens. The classic
model argues that these two techno-complexes are temporally separated
‘horizons’ with homogenous material culture (Jacobs et al.
2008), reflecting demographic pulses and supporting large subcontinental
networks. This model was developed on the basis of evidence from southern
African sites regarded as centres of subcontinental developments.
In the late fourth and early fifth centuries Augustine of Hippo preached a number of sermons at the annual celebrations of martyr festivals. These festivals commemorated the martyr’s ‘birthday’: the day of the martyr’s death on earth and entrance into the eternal life of heaven. They were popular occasions, drawing in larger and more diverse crowds than ordinary services, and attracting a certain air of festivity and merriment in North Africa. Martyr festivals provided the ideal location for the discussion of the afterlife: eschatological hopes had long given meaning to martyrdom, exposing the order permeating chaos, pointing towards beauty amid human suffering, and revealing death as the gateway to true life.
Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.
Comets are probably the best archives of the nascent solar system, 4.5 Gyr ago, and their compositions reveal crucial clues on the structure and dynamics of the early protoplanetary disk. Anhydrous minerals (olivine and pyroxene) have been identified in cometary dust for a few decades. Surprisingly, samples from comet Wild2 returned by the Stardust mission in 2006 also contain high temperature mineral assemblages like chondrules and refractory inclusions, which are typical components of primitive meteorites (carbonaceous chondrites - CCs). A few Stardust samples have also preserved some organic matter of comet Wild 2 that share some similarities with CCs. Interplanetary dust falling on Earth originate from comets and asteroids in proportions to be further constrained. These cosmic dust particles mostly show similarities with CCs, which in turn only represent a few percent of meteorites recovered on Earth. At least two (rare) families of cosmic dust particles have shown strong evidences for a cometary origin: the chondritic porous interplanetary dust particles (CP-IDPs) collected in the terrestrial stratosphere by NASA, and the ultracarbonaceous Antarctic Micrometeorites (UCAMMs) collected from polar snow and ice by French and Japanese teams. Analyses of dust particles from the Jupiter family comet 67P/Churyumov-Gerasimenko by the dust analyzers on Rosetta orbiter (COSIMA, GIADA, MIDAS) suggest a relationship to interplanetary dust/micrometeorites. A growing number of evidences highlights the existence of a continuum between asteroids and comets, already in the early history of the solar system.
The Civil War was one of the most significant events in the history of contemporary Spain. The war lasted nearly three years, from July 1936, when a military coup attempted to overthrow the government of the Second Republic, to March 1939, when General Franco's Army claimed total victory over a demoralized Republican Army. The sorry legacy of this tragic episode were the 300,000 lives lost, the 300,000 exiled, the 300,000 political prisoners, and the ensuing dictatorship endured by the country for forty years until the death of Franco.
This chapter addresses the ‘financing of the civil war’, a subject that until very recently has received little attention in the literature, although it is widely accepted that once a war begins it is economics as much as military strategy that decides the outcome. This neglect of the general financial aspects of the war is partly due to the lack of reliable data, with most studies relying on a handful of reports that the victorious Francoist authorities produced after the conflict was over, especially the so-called Larraz report published in August 1940. However there are exceptions that have advanced our knowledge of the financial aspects Spanish Civil War. Building on this research and using new quantitative information, we revise the established view of how the war was financed and the amount of resources available to each of the contenders. Section 1 introduces the economic context of the war, section 2 examines how the Republican Treasury met the cost of the conflict, while section 3 does the same for the so-called ‘national Treasury’. We conclude with a reassessment of Spain's war finances and some conclusions.
Spain at War
Historians and political scientists have viewed the civil war as a major turning point in Spanish history. It was not only a military conflict but also a political, social, ideological and religious confrontation. From its onset the Spanish conflict became an international affair.
Acetyl-coenzyme A carboxylase (ACCase)–resistant Italian ryegrass is one of the most difficult-to-control weeds in United States wheat-production systems. Seed was collected from a suspected ACCase-resistant Italian ryegrass population in a winter wheat field with a history of ACCase-inhibitor herbicide use. This study investigated cross-resistance patterns in this Italian ryegrass population. Resistance was identified to the commercial dose of the ACCase herbicides pinoxaden, clethodim, sethoxydim, and clodinafop. Partial chloroplastic ACCase sequences revealed aspartate-to-glycine or isoleucine-to-asparagine substitutions at positions 2078 or 2041 in individuals of the resistant population. This is the first report, to our knowledge, of Asp-2078-Gly and Ile-2041-Asn substitutions in ACCase-resistant Italian ryegrass in the United States. Associating the occurrence of resistance alleles with resistance to specific active ingredients provides a better understanding of ACCase cross-resistance in Italian ryegrass and possibly options for its control.
The purpose of this work was to analyse the influence of rennet from different Cynara cardunculus plants, selected for its clotting and proteolytic activity on caseins, on the characteristics of manufactured ‘Torta del Casar’ cheeses. After classifying the cardoon according to proteolytic activity into five groups of greater or lesser activity, 16 batches of cheeses were made with rennet derived from different wild cardoon plants. We observed a major development of the proteolysis during ripening leading to the generation of non-protein nitrogen compounds. Especially noteworthy was the relationship of amino acid nitrogen (AN) generation with rennet clotting activity after 24 h of maceration, and the fact that the production of biogenic amines was not related to the proteolytic activity of the rennet. The activities of the rennet observed ‘in vitro’ were also developed ‘in vivo’ in the cheeses, with the different rennets used affecting the final sensory characteristics of cheeses. The rennet with high clotting activity after 24 h of maceration was positively correlated with the creaminess, viscosity, and acceptability of the cheese. However, the high proteolytic activity rennet negatively influenced the acidity, bitterness, and creaminess parameters. Therefore the most appropriate cardoons for making this cheese are those with higher clotting activities and moderate proteolytic activities especially on β-casein. The use of controlled and characterised cardoons in the manufacturing process of Torta del Casar is fundamental to obtaining the homogeneous product demanded by the Torta del Casar Registry of the Protected Designation of Origin.