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Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain.
To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning.
A prospective survey study.
An academic medical center.
The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison.
According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2).
The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.
Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.
A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.
A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).
A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.
Hypoxia is the primary stimulus for the production of erythropoietin (EPO) in both fetal and adult life. Here, we investigated fetal plasma EPO concentrations in monochorionic (MC) twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery (UA) Doppler. We diagnosed sIUGR in presence of (1) birth-weight discordance >20% and (2) either twin with a birth weight <10th percentile. An abnormal UA Doppler was defined as a persistent absent-reverse end diastolic flow (AREDF). The intertwin EPO ratio was calculated as the plasma EPO level of the smaller (or small-for-gestational-age) twin divided by the EPO concentration of the larger (or appropriate-for-gestational-age (AGA)) twin. Thirty-two MC twin pairs were included. Of these, 17 pairs were normal twins (Group 1), seven pairs were twins with sIUGR without UA Doppler abnormalities (Group 2), and eight pairs were twins with sIUGR and UA Doppler abnormalities (Group 3). The highest EPO ratio was identified in Group 3 (p < .001) but no significant differences were observed between Groups 1 and 2. Fetal hemoglobin levels did not differ significantly in the three groups, and fetal EPO concentration did not correlate with gestational age at birth. We conclude that fetal plasma EPO concentrations are selectively increased in MC twin pregnancies with sIUGR and abnormal UA Doppler, possibly as a result of uncompensated hypoxia.
Fe is an essential element for erythropoiesis and Hb synthesis. High Hb levels affect the blood’s viscosity and are associated with cardiovascular dysfunction. The aim of the present study was to examine relationships of Hb and cardiometabolic abnormalities with the risk of alanine aminotransferase (ALT) elevation in adolescents.
A population-based, cross-sectional study.
National Nutrition and Health Survey in Taiwan (2010–2011, adolescents).
Healthy adolescents aged 13–18 years.
In total, 1941 adolescents (963 boys and 978 girls) were entered in the study. The mean age was 15·3 (sd 0·1) years (boys, 15·3 (sd 0·1) years; girls, 15·2 (sd 0·1) years). ALT tertile cut-off points for boys were 11 and 16 U/l, and for girls were 9 and 12 U/l. Girls without dyslipidaemia and presenting in the highest quartile (Q1) of Hb (>13·6 g/dl) were 1·89 and 3·76 times more likely to have raised serum ALT (9 and >12 U/l, respectively) than the reference (lowest quartile of Hb (Q1), <12·4 g/dl). Moreover, for those girls with dyslipidaemia, serum ALT seemed to increase with an increase in Hb levels. Specifically, girls with dyslipidaemia and Hb levels of 12·4, 13·1 and 13·6 g/dl were, respectively, 2·86, 3·53 and 5·64 times more likely to have elevated serum ALT levels (>12 U/l) than the reference (Q1 of Hb, <12·4 g/dl). The only effect found in boys was for those who had dyslipidaemia and presenting in Q4 of Hb (>15·4 g/dl), who were 7·40 times more likely to have elevated serum ALT of >16 U/l than the reference (Q1 of Hb, <14·1 g/dl).
Our findings suggest that an increased Hb level is a predictor of elevated serum ALT in adolescent girls with dyslipidaemia. Our study also highlights the importance of further research to establish cut-off points for Hb and its utility in diagnosing and preventing the onset of dyslipidaemia in adolescents.
This study investigates whether the existence or strength of any misreaction in the options market is affected by investor sophistication and investor sentiment. Based on a unique data set of the complete history of all transactions in the Taiwan options market, we find that individual investors exhibit significant misreaction to information and that this misreaction becomes stronger during periods of high investor sentiment. In addition, more active or aggressive individual investors always exhibit misreaction and do not learn from their past mistakes. Our empirical results are robust to alternative measures of investor sentiment and definitions of long- and short-term horizons.
Asians and Pacific Islanders have higher circulating serum ferritin (SF) compared with Caucasians but the clinical significance of this is unclear. There is a higher prevalence of metabolic syndrome (MetS) in Taiwanese Indigenous than Han Chinese. Genetically, Indigenous are related to Austronesians and account for 2 % of Taiwan's population. We tested the hypothesis that accumulation of Fe in the body contributes to the ethnic/racial disparities in MetS in Taiwan.
A population-based, cross-sectional study.
National Nutrition and Health Survey in Taiwan and Penghu Island.
A total of 2638 healthy adults aged ≥19 years. Three ethnic groups were included.
Han Chinese and Indigenous people had comparable levels of SF. Austronesia origin was independently associated with MetS (OR = 2·61, 95 % CI 2·02, 3·36). After multiple adjustments, the odds for MetS (OR = 2·49, 95 % CI 1·15, 5·28) was significantly higher among Indigenous people in the highest SF tertile compared with those in the lowest tertile. Hakka and Penghu Islanders yielded the lowest risks (OR = 1·08, 95 % CI 0·44, 2·65 and OR = 1·21, 95 % CI 0·52, 2·78, respectively). Indigenous people in the highest SF tertile had increased risk for abnormal levels of fasting glucose (OR = 2·34, 95 % CI 1·27, 4·29), TAG (OR = 1·94, 95 % CI 1·11, 3·39) and HDL-cholesterol (OR = 2·10, 95 % CI 1·18, 3·73) than those in the lowest SF tertile.
Our results raise the possibility that ethnic/racial differences in body Fe store susceptibility may contribute to racial and geographic disparities in MetS.
The crystal structure of a-plane GaN/ZnO heterostructures on r-plane sapphire was investigated by using the XRD and TEM measurment. It was found the formation of (220) ZnGa2O4 and crystal orientation of semipolar (10
3) GaN at GaN/ZnO interface. The epitaxial relation of normal surface direction are the sapphire (1
02) // a-GaN (11
0) and ZnGa2O4 (220) // semi-polar GaN (10
). Beside, the emission peak energy of ZnO appears shift about 60 meV in the GaN/ZnO/GaN heterostructures due to the re-crystallization of ZnO layer with Ga or N atom and the formation of the localized state.
We studied the polarization-dependent photoluminescence (PL) of a-plane GaN /AlGaN multiple quantum wells (MQWs) grown on r-plane sapphire substrate with the various well width from 1.5 to 7.33 nm. To clarify the reasons of light emission polarization properties, we applied the 6×6 k‧p model to simulate the E-k dispersion relation and the wave functions to obtain the polarization optical transitions. According to the experimental result, the PL emission peak position exhibits a red-shifted with increasing well width, due to the reduction of the quantum confinement effect. The polarization ratio of a-plane GaN/AlGaN MQWs increased from 0.236 to 0.274 with increasing the quantum well width. This phenomenon is believed to be that y-polarized light emission gradually dominates the PL spectrum and thus enhances the polarization ratio.
We report on the direct observation of optical near-field enhancement around metallic nanoparticles. We used an easy to set up approach which consists in irradiating a photosensitive azo-dye polymer film spin-coated on metallic nanostructures. Photoinduced topographical modifications of the polymer film surface are characterized after irradiation by atomic force microscopy (AFM). Comparisons between AFM images and numerical simulations show that these photo-induced topography agrees with the near-field intensity distribution around the nano-structures. The possibility of generating complex structures is demonstrated.
In this study, the theory of micropolar fluids is employed to study the stability problem of flow between two concentric rotating cylinders. The field equations subject to no-slip conditions (non-zero velocity and microrotation velocity components) at the wall surfaces are solved. The analytical solutions of the velocity and microrotation velocity fields as well as the shear stress difference, couple stress and strain rate for basic flow are obtained. The equations with respect to non-axisymmetric disturbances are derived and solved by a direct numerical procedure. It is found that non-zero wall-surface microrotation velocity makes the flow faster and more unstable. Moreover, it tends to reduce the limits of critical non-axisymmetric disturbances. The effect on the stability characteristics can be magnified by increasing the microstructure or couple-stress parameter or the microinertia parameter for the cases of corotating cylinders and a stationary outer cylinder or by decreasing the radius ratio or the microinertia parameter for the case of counterrotating cylinders.
To evaluate the effect on decrease in blood pressure of modifying risk factors for stroke, such as blood lipid profiles, diet habits and indices of body weight, through a family-based nutrition health education programme among hypertensive patients and pre-hypertensive subjects without taking any antihypertensive drugs.
Design and setting
This was a community-based prospective study. The study population was randomly selected from communities in Taipei; potential subjects were invited by telephone to participate.
After excluding subjects whose blood pressure was normal and those using antihypertensive drugs, there were 390 participants included in the study. Subjects in the intervention group (n 293) received nutrition health education on blood pressure control and stroke-related risk factor modification at each visit. Non-intervention subjects (n 97) only acquired a general education sheet available in clinics. The blood pressure of study subjects was measured at baseline and 6-month follow-up to evaluate the intervention’s effect on decrease in blood pressure.
Significant decreases of 2·0 mmHg and 5·9 mmHg in systolic blood pressure were observed both in pre-hypertensive and hypertensive subjects in the intervention group. Additionally, intervention subjects with improvement of total cholesterol and LDL cholesterol, decrease in indices of body weight and increase in consumption of fruit and vegetables also had significant lowering of blood pressure.
The present study provided evidence that the blood pressure of pre-hypertensive and hypertensive subjects could decrease significantly, without taking antihypertensive drugs, after modifying blood lipid profiles and waist by dietary habits changed through a family-based nutrition heath education programme, resulting in a significant effect on stroke risk reduction.
This study investigated the effects of β-carotene and canthaxanthin on lipid peroxidation and antioxidative enzyme activities in rats fed a high-cholesterol, high-fat diet. Wistar rats were divided into six groups. Negative control group (group NC) received a high-fat (150 g/kg) diet; cholesterol control group (group CC) received a high-cholesterol (10 g/kg), high-fat diet. The other four groups were fed a high-cholesterol, high-fat diet supplemented with crystal β-carotene (group BC), β-carotene beadlet (group BB), canthaxanthin beadlet (group CX) or α-tocopherol (group AT). Blood and livers were collected for analysis after 6 weeks of feeding. Group BB had significantly lower hepatic thiobarbituric acid reactive substance (TBARS) and conjugated diene concentrations, whereas group CX had a significantly lower plasma TBARS concentration than did group CC. In erythrocytes, glutathione peroxidase activities were significantly greater in groups BC, BB and CX than in group CC. Moreover, compared with group CC, catalase activities were significantly greater in groups BB and CX, and superoxide dismutase (SOD) activity was significantly greater in group BB. In livers, SOD activities were significantly greater in groups BC, BB and CX, and glutathione reductase activities were significantly greater in groups BB and CX than in group CC. Compared with group CC, hepatic retinol and α-tocopherol concentrations were significantly greater in groups BC, BB and CX, whereas plasma and hepatic cholesterol concentrations were significantly lower in group BC. These findings suggest that β-carotene and canthaxanthin altered the pro-oxidation and antioxidation balance and suppressed cholesterol-induced oxidative stress via modulation of antioxidant system and cholesterol metabolism.
Laryngeal photographs from 165 Taiwanese subjects were taken during microlaryngoscopy. Photographs of the vocal fold during the open phase were chosen. For measuring the vocal fold length, both the photograph of a ruler and the larynx were taken under the operating microscope, thus forming a ‘new scale’. Photographs of the vocal fold and the ruler were then processed at the same power of magnification. The length of the vocal folds was measured with the ‘new scale’. In 100 patients receivingdirect laryngoscopy under neuroleptic anaesthesia, the vocal fold length was 14.6 ± 1.2 mm (n = 35) for males and 11.1 ± 1.0 mm (n = 65) for females. In 65 patients under general anaesthesia, the vocal fold length was 15.3 ± 1.6 mm (n = 23) for males and 13.5 ± 1.3 mm (n = 42) for females. Statistical analysis revealed a significant difference between both groups and both sexes. Elongation of the vocal fold under general rather than neuroleptic anaesthesia may be important when performing functional surgery of the vocal fold.