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In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
Learners preferentially interpret novel nouns at the basic level (‘dog’) rather than at a more narrow level (‘Labrador’). This ‘basic-level bias’ is mitigated by statistics: children and adults are more likely to interpret a novel noun at a more narrow label if they witness ‘a suspicious coincidence’ – the word applied to three exemplars of the same narrow category. Independent work has found that exemplar typicality influences learners’ inferences and category learning. We bring these lines of work together to investigate whether the content (typicality) of a single exemplar affects the level of interpretation of words and whether an atypicality effect interacts with input statistics. Results demonstrate that both four- to five-year-olds and adults tend to assign a narrower interpretation to a word if it is exemplified by an atypical category member. This atypicality effect is roughly as strong as, and independent of, the suspicious coincidence effect, which is replicated.
A small pragmatic non-randomised controlled study investigated the feasibility and acceptability of a novel theory-informed community-based self-management programme targeting the biopsychosocial factors associated with chronic low back pain disability in a rural Nigerian primary care centre. Participants either received the programme, once weekly for 6 weeks, or usual care. The programme combined group exercise sessions with group/individual discussion sessions, informed by cognitive behavioural therapy and motivational interviewing. Recruitment rate, intervention delivery, proportion of planned treatment attended, retention/dropout rate, adherence to recommended self-management strategies and biopsychosocial outcomes were used to determine feasibility. Structured qualitative exit feedback interviews ascertained acceptability. Recruitment rate was 100%, treatment uptake was 83% and loss to follow-up was 8%. Greater benefits for the self-management group compared with control were observed for primary and secondary biopsychosocial outcomes. Although the programme appears promising, the exploratory design of this study warrants more rigorous intervention testing following suggested programme improvement.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events
Retrospective chart review
A convenience sample of 8 acute-care hospitals in Pennsylvania
All patients hospitalized during 2011–2012
Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.
We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.
We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).
One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (pdiscovery = 3.82 × 10−8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (pdiscovery+replication = 1.10 × 10−6) with evidence of heterogeneity.
Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
We present an analysis of changes of state, pressures and conservation responses over 20 years in the Tanzanian portion of the Coastal Forests of Eastern Africa biodiversity hotspot. Baseline data collected during 1989–1995 are compared with data from a synthesis of recently published papers and reports and new field work carried out across the region during 2010–2014. We show that biodiversity endemism values are largely unchanged, although two new species (amphibian and mammal) have been named and two extremely rare tree species have been relocated. However, forest habitat continues to be lost and degraded, largely as a result of agricultural expansion, charcoal production to supply cities with cooking fuel, logging for timber and cutting of wood for firewood and building poles. Habitat loss is linked to an increase in the number of species threatened over time. The government-managed forest reserve network has expanded slightly but has low effectiveness. Three forest reserves have been upgraded to National Parks and Nature Reserves, which have stricter protection and more effective enforcement. There has also been rapid development of village-owned forest reserves, with more than 140 now existing; although usually small, they are an important addition to the areas being managed for sustainable resource use, and also provide tangible benefits to local people. Human-use pressures remain intense in many areas, and combined with emerging pressures from mining, gas and oil exploration, many endemic species remain threatened with extinction.
The patterns of parasite sharing among hosts have important implications for ecosystem structure and functioning, and are influenced by several ecological and evolutionary factors associated with both hosts and parasites. Here we evaluated the influence of fish diet and phylogenetic relatedness on the pattern of infection by parasites with contrasting life history strategies in a freshwater ecosystem of key ecological importance in South America. The studied network of interactions included 52 fish species, which consumed 58 food types and were infected with 303 parasite taxa. Our results show that both diet and evolutionary history of hosts significantly explained parasite sharing; phylogenetically close fish species and/or species sharing food types tend to share more parasites. However, the effect of diet was observed only for endoparasites in contrast to ectoparasites. These results are consistent with the different life history strategies and selective pressures imposed on these groups: endoparasites are in general acquired via ingestion by their intermediate hosts, whereas ectoparasites actively seek and attach to the gills, body surface or nostrils of its sole host, thus not depending directly on its feeding habits.
Investigation of an outbreak of Clostridium difficile infection (CDI) at a hemodialysis facility revealed evidence that limited intrafacility transmission occurred despite adherence to published infection control standards for dialysis clinics. Outpatient dialysis facilities should consider CDI prevention, including environmental disinfection for C. difficile, when formulating their infection control plans.
Infect. Control Hosp. Epidemiol. 2015;36(8):972–974
We present a simple construction of spherical wavelets for the unit ball, which we label Radial 3D Needlets. We envisage an experimental framework where data are collected on concentric spheres with the same pixelization at different radial distances from the origin. The unit ball is hence viewed as a tensor product of the unit interval with the unit sphere: a set of eigenfunctions is therefore defined on the corresponding Laplacian operator. Wavelets are then constructed by a smooth convolution of the projectors defined by these eigenfunctions. Localization properties may be rigorously shown to hold in the real and harmonic domain, and an exact reconstruction formula holds; the system allows a very convenient computational implementation.
High speed photometry of several accreting binaries was obtained using the McDonald Observatory 2.1m telescope and ARGOS CCD photometer. A broad-band filter (BVR) was used in order to maximize flux and maintain a short (1-10s) integration time on faint targets. Such observations obtained over several years allow for variability study over time scales covering many orders of magnitude. Observations and analysis for several binaries are summarized.
Fluorescence Quenching Microscopy has been shown to be an effective means of characterizing graphene on the macroscale. Centimeter-scale CVD-grown pristine and doped graphene were manufactured in a high temperature (1000°C) furnace on pristine copper substrates. The copper was then etched away in a FeCl3solution and the graphene was coated with DCM-based fluorescent dye before being imaged in a fluorescence microscope. The fluorescence image was then image-processed using modified Matlab software. The resulting image showed clear contrast between the pristine graphene sheet and defects on the graphene surface, which revealed that fluorescence microscopy could determine the quality of a large region of graphene. Also, significant contrast was identified between single-layer and multi-layer regions, showing that this technique is also effective at determining the degree of uniformity within a graphene sample. Lastly, the fluorescence images showed contrast between doped and undoped regions of graphene.