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Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Objectives: The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. Method: In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40–80 years). Results: The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Conclusions: Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520–529)
This paper reports a previously unidentified paleoenvironmental record found in sand dunes of the Atacama Desert, Chile. Long-term aeolian deflation by prevailing onshore winds has resulted in the deposition of sand on the irregular surface of a Miocene-aged anhydrite outcrop. Two deposits ~25 km apart, along the prevailing wind trajectory, were hand excavated then analyzed for vertical (and temporal) changes in physical and chemical composition. Radiocarbon ages of organic matter embedded within the deposits show that rapid accumulation of sediment began at the last glacial maximum and slowed considerably after the Pacific Ocean attained its present post-glacial level. Over this time period, grain sizes are seen to increase while accumulation rates simultaneously decrease, suggesting greater wind speeds and/or a change or decrease in sediment supply. Changes in δ34S values of sulfate in the sediment beginning ~10 ka indicate an increase in marine sources. Similarly, δ2H values from palmitic acid show a steady increase at ~10 ka, likely resulting from aridification of the region during the Holocene. Due to the extreme aridity in the region, these sand dunes retain a well-preserved chemical record that reflects changes in elevation and coastal proximity after the last glacial maximum.
Pb-based organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). However, the main issues hampering commercialization are toxic Pb contained in these cells and their instability in ambient air. Therefore, great attention is devoted to replace Pb by Sn or Bi, which are less harmful and - in the case of Bi - also expected to yield enhanced stability. In literature, the most efficient hybrid organic-inorganic methylammonium bismuth iodide (MBI) perovskite solar cells reach PCE up to 0.2 %. In this work, we present spin-coated MBI perovskite solar cells and highlight the impact of the concentration of the perovskite solution on the layer morphology and photovoltaic (PV) characteristics. The solar cells exhibit open-circuit voltages of 0.73 V, which is the highest value published for this type of solar cell. The PCE increases from 0.004 % directly after processing to 0.17 % after 48 h of storage in air. 300 h after exposure to air, the cells still yield 56 % of their peak PCE and 84 % of their maximum open-circuit voltage.
Major depression and anxiety disorders are known to negatively influence cognitive performance. Moreover, there is evidence for greater cognitive decline in older adults with generalized anxiety disorder. Except for clinical studies, complex executive planning functions and subclinical levels of anxiety have not been examined in a population-based sample with a broad age range.
Planning performance was assessed using the Tower of London task in a population-based sample of 4240 participants aged 40–80 years from the Gutenberg Health Study (GHS) and related to self-reported anxiety and depression by means of multiple linear regression analysis.
Higher anxiety ratings were associated with lower planning performance (β = −0.20; p < 0.0001) independent of age (β = 0.03; p = 0.47). When directly comparing the predictive value of depression and anxiety on cognition, only anxiety attained significance (β = −0.19; p = 0.0047), whereas depression did not (β = −0.01; p = 0.71).
Subclinical levels of anxiety but not of depression showed negative associations with cognitive functioning independent of age. Our results demonstrate that associations observed in clinical groups might differ from those in population-based samples, also with regard to the trajectory across the life span. Further studies are needed to uncover causal interrelations of anxiety and cognition, which have been proposed in the literature, in order to develop interventions aimed at reducing this negative affective state and to improve executive functioning.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
We have investigated organic light emitting diode (OLED) backside contacting for the enhancement of luminance uniformity as a superior alternative to gridlines. In this approach, the low-conductivity OLED anode is supported by a high-conductivity auxiliary electrode and vertically contacted through via holes. Electrical simulations of large-area OLEDs have predicted that this method allows comparable luminance uniformity while sacrificing significantly less active area compared to the common gridline approach.
The method for fabricating backside contacts is comprised of five steps: (1) Thin-film encapsulation of the OLED, (2) Patterning of the OLED surface with lithography (resist mask defining via hole positions), (3) Via hole formation to the bottom anode by a plasma etching process, (4) Organic residues removal and sidewall insulation. (5) Contacting of the anode with a high-conductivity auxiliary electrode.
Backside-contacted OLEDs processed by organic vapor phase deposition show high luminance uniformity. Scanning electron microscopy pictures and electrical breakthrough measurements confirm efficient sidewall insulation.
Recently, organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). While such PCE values of perovskite solar cells are already competitive to those of other photovoltaic technologies, processing of large-area devices is still a challenge. Most of the devices reported in literature are prepared by small-scale solution-based processing techniques (e.g. spin-coating). Perovskite solar cells processed by vacuum thermal evaporation (VTE), which show uniform layers and achieve higher PCE and better reproducibility, have also been presented. Regarding the co-evaporation of the perovskite constituents, this technology suffers from large differences in the thermodynamic characteristics of the two species. While the organic components evaporate instantaneously at room temperature at pressures in the range of 10−6 hPa, significantly higher temperatures are needed for reasonable deposition rates of the metal halide compound. In addition, hybrid vapor phase deposition techniques have been developed employing a carrier gas to deposit the organic compound on the previously solution-processed metal halide compound. Generally, vapor phase processes have proven to be a desirable choice for industrial large-area production. In this work, we present a setup for the direct chemical vapor phase deposition (CVD) of methylammonium lead iodide (MAPbI3) employing nitrogen as carrier gas. X-ray diffraction (XRD) and scanning electron microscopy (SEM) measurements are carried out to investigate the crystal quality and structural properties of the resulting perovskite. By optimizing the deposition parameters, we have produced perovskite films with a deposition rate of 30 nm/h which are comparable to those fabricated by solution processing. Furthermore, the developed CVD process can be easily scaled up to higher deposition rates and larger substrates sizes, thus rendering this technique a promising candidate for manufacturing large-area devices. Moreover, CVD of perovskite solar cells can overcome most of the limitations of liquid processing, e.g. the need for appropriate and orthogonal solvents.
Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.
Cover crop-based reduced tillage (CCBRT) has achieved positive impacts in organic row crop systems, contributing to the conservation of soil resources and the facilitation of weed management. This technique, which uses cover crop residues as mulches to suppress weeds, has shown more variable success in organic vegetable production systems. This experiment examined CCBRT for small-scale organic vegetable production in the upper Midwestern USA, specifically evaluating weed suppression, labor inputs and crop yields. Cereal rye (Secale cereale L.) and winter wheat (Triticum aestivum L.) were fall-sown in 2012 and 2013 in a strip-plot design, including control treatments with no cover crop and spring-applied oat straw mulch. Cover crop plots were strip-tilled in mid-April to establish a planting zone, with cover crops terminated in late May at anthesis with a hand-tractor mounted sickle-bar mower. Bell peppers (Capsicum annuum L. var. ‘Revolution’), snap beans (Phaseolus vulgaris L. var. ‘Tavera’), and potatoes (Solanum tuberosum L. var. ‘Red La Soda’) were hand-planted either as transplants or seed in each treatment immediately following cover crop termination. During each summer growing season, weeds were completely eliminated from each plot by hand approximately every 10–14 days, with time for manual weeding recorded for each treatment. Vegetable crop yields and quality were measured at harvest during 2013 and 2014. Cereal rye and winter wheat produced similar biomass at the time of termination. Greater weed biomass was collected in the wheat treatment as compared with the cereal rye, increasing the in-season labor required for manual weeding. Bean yields were decreased in the all CCBRT treatments compared with control treatments in both years of the study. Pepper yields did not differ in CCBRT treatments as compared with the control in both 2012 and 2013, although the CCBRT treatments did yield lower marketable peppers compared with the straw mulch plots. Potato tuber yields were not different in the CCBRT treatments as compared with the control in 2012, but were lower in 2013. These data indicate that, if CCBRT is to be more widely adopted in small-scale vegetable production, further optimization of the system must be achieved to ensure consistent and adequate weed suppression while maintaining crop yield and quality.
We demonstrate Ag-free transparent OLED (TOLED) fabricated by organic vapor phase
deposition (OVPD) using thin Au contacts. Three types of TOLED devices have been
studied. The first one has been deposited on ITO substrates to compare thin Ag
and Au films as top cathodes. A 6-fold increase in operational lifetime
(LT50, 4 mA/cm2) from 27 h to 172 h can be observed
when replacing Ag by Au while maintaining similar electro-optical
characteristics. Furthermore, a second type of TOLED on thin Au films, replacing
ITO and suppressing laterally guided modes , has been studied. TOLED on ITO
substrates and on thin Au films exhibit very low onset voltages of 2.2 V. Both
types show about 30% transparency in the VIS light region and emit orange light
with a peak wavelength of 608 nm from either side with a total EQE of about 9%
(measured at 1000 cd/m2 in sum). The third type of TOLED was
fabricated with an inverted structure, with the aim to further increase
operational lifetime by burying the reactive LiF/Al electron injection layer
(EIL). This will make the EIL less accessible for oxygen and moisture. Our
results show difficulties in electron injection when depositing the organic
stack on Al/LiF, which may be attributed to an insufficient thermal activation
of the EIL.
Serum and erythrocyte (RBC) total folate are indicators of folate status. No nationally representative population data exist for folate forms. We measured the serum folate forms (5-methyltetrahydrofolate (5-methylTHF), unmetabolised folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate (THF), 5-formyltetrahydrofolate (5-formylTHF), 5,10-methenyltetrahydrofolate (5,10-methenylTHF)) and MeFox (5-methylTHF oxidation product)) by HPLC–MS/MS and RBC total folate by microbiologic assay in US population ≥ 1 year (n approximately 7500) participating in the National Health and Nutrition Examination Survey 2011–2. Data analysis for serum total folate was conducted including and excluding MeFox. Concentrations (geometric mean; detection rate) of 5-methylTHF (37·5 nmol/l; 100 %), UMFA (1·21 nmol/l; 99·9 %), MeFox (1·53 nmol/l; 98·8 %), and THF (1·01 nmol/l; 85·2 %) were mostly detectable. 5-FormylTHF (3·6 %) and 5,10-methenylTHF (4·4 %) were rarely detected. The biggest contributor to serum total folate was 5-methylTHF (86·7 %); UMFA (4·0 %), non-methyl folate (4·7 %) and MeFox (4·5 %) contributed smaller amounts. Age was positively related to MeFox, but showed a U-shaped pattern for other folates. We generally noted sex and race/ethnic biomarker differences and weak (Spearman's r< 0·4) but significant (P< 0·05) correlations with physiological and lifestyle variables. Fasting, kidney function, smoking and alcohol intake showed negative associations. BMI and body surface area showed positive associations with MeFox but negative associations with other folates. All biomarkers showed significantly higher concentrations with recent folic acid-containing dietary supplement use. These first-time population data for serum folate forms generally show similar associations with demographic, physiological and lifestyle variables as serum total folate. Patterns observed for MeFox may suggest altered folate metabolism dependent on biological characteristics.
In this work, Na- and K-doped β-Li5AlO4 samples were synthesized, characterized and analyzed thermogravimetrically (dynamically and isothermally), under different CO2 conditions. Additionally, chemisorption/desorption cycles were performed for the best chemical compositions and thermal conditions determined. While the CO2 chemisorption of the Na- and K-doped β-Li5AlO4 samples was improved at high temperatures (450 -700 °C), the opposite effect was observed at lower temperatures as well as in the presence of water vapor.
Consumption of carbohydrate-containing foods leads to transient postprandial rises in blood glucose concentrations that vary between food types. Higher postprandial glycaemic exposures have particularly been implicated in the development of chronic cardiometabolic diseases. Reducing such diet-related exposures may be beneficial not only for diabetic patients but also for the general population. A variety of markers have been used to track different aspects of glycaemic exposures, with most of the relevant knowledge derived from diabetic patients. The assessment of glycaemic exposures among the non-diabetic population may require other, more sensitive markers. The present report summarises key messages of presentations and related discussions from a workshop organised by Unilever intended to consider currently applied markers of glycaemic exposure. The particular focus of the meeting was to identify the potential applicability of glycaemic exposure markers for studying dietary effects in the non-diabetic population. Workshop participants concluded that markers of glycaemic exposures are sparsely used in intervention studies among non-diabetic populations. Continuous glucose monitoring remains the optimal approach to directly assess glycaemic exposure. Markers of glycaemic exposure such as glycated Hb, fructosamine, glycated albumin, 1,5-anhydroglucitol and advanced glycation end products can be preferred dependent on the aspect of interest (period of exposure and glucose variability). For all the markers of glycaemia, the responsiveness to interventions will probably be smaller among the non-diabetic than among the diabetic population. Further validation and acceptance of existing glycaemic exposure markers applied among the non-diabetic population would aid food innovation and better design of dietary interventions targeting glycaemic exposure.
Fortification of select grain products with folic acid and periconceptional supplementation recommendations in Canada and the USA have improved folate status, and have been associated with a reduced risk of neural tube defects. In the present study, we aimed to conduct a comparison of erythrocyte folate concentrations from the 2007–9 Canadian Health Measures Survey (CHMS) and the 2007–8 US National Health and Nutrition Examination Survey (NHANES). Erythrocyte folate concentration was assessed in participants aged 6–79 years (CHMS, n 5248; NHANES, n 7070). To account for different folate assays employed – Immulite 2000 immunoassay (CHMS) and microbiological assay (NHANES) – a conversion equation was generated (n 152 adults) to adjust the CHMS data. t Tests were used to examine country differences. Median Canadian erythrocyte folate concentrations (method-adjusted) were lower than those of Americans (988 and 1100 nmol/l, respectively), but unadjusted median Canadian erythrocyte folate concentrations were higher (1250 nmol/l). The upper 95 % CI boundary of the method-adjusted Canadian erythrocyte folate distribution overlapped that of the American erythrocyte folate concentrations, while the lower 95 % CI boundary of the method-adjusted Canadian erythrocyte folate data was below the American distribution. In summary, the fact that erythrocyte folate concentrations were either higher or lower in Canadians compared with Americans, depending on whether an adjustment was made to account for assay differences, suggests that caution must be exercised in evaluating erythrocyte folate data from different countries because analytical methods are not readily comparable. Furthermore, we cannot unequivocally conclude that there are true differences in erythrocyte folate concentrations between the Canadian and American populations in the post-fortification era.
In this globalized world, the spread of new, exotic and re-emerging diseases has become one of the most important threats to animal production and public health. This systematic review analyses conventional and novel early detection methods applied to surveillance. In all, 125 scientific documents were considered for this study. Exotic (n = 49) and re-emerging (n = 27) diseases constituted the most frequently represented health threats. In addition, the majority of studies were related to zoonoses (n = 66). The approaches found in the review could be divided in surveillance modalities, both active (n = 23) and passive (n = 5); and tools and methodologies that support surveillance activities (n = 57). Combinations of surveillance modalities and tools (n = 40) were also found. Risk-based approaches were very common (n = 60), especially in the papers describing tools and methodologies (n = 50). The main applications, benefits and limitations of each approach were extracted from the papers. This information will be very useful for informing the development of tools to facilitate the design of cost-effective surveillance strategies. Thus, the current literature review provides key information about the advantages, disadvantages, limitations and potential application of methodologies for the early detection of new, exotic and re-emerging diseases.
Welfare concerns for intensive beef production have often been raised, but on-farm welfare assessment studies are rare. The aim of this study was to apply the Welfare Quality® (WQ) welfare assessment system for fattening cattle on beef bull farms to evaluate the state of welfare at the level of WQ measures and of aggregated scores, as well as overall classification. In addition, the purpose was to evaluate two ways of providing feedback information to the farmers with regard to possible welfare improvements on the farms. The study was conducted in Austria, Germany and Italy on a total of 63 beef bull farms with deep litter or cubicle-housing systems. Assessments were carried out 3 times (1 month and 7 months apart from the initial visit). In every country, farmers were assigned to two treatment groups (feedback from initial visit as written report, F, written feedback plus oral advice, FA) and a control group (C), which did not receive any feedback. At the criterion level, the highest average welfare scores were obtained from ‘Absence of prolonged hunger’ (94/100 points) followed by ‘Absence of pain induced by management procedures’ (88/100) and ‘Comfort around resting’ (77/100). Most welfare concerns related to the criteria ‘Absence of disease’ (40/100), ‘Expression of social behaviour’ (44/100) and ‘Positive emotional state’ (48/100), thus indicating room for improvements. Two-thirds of the farms achieved the ‘Enhanced’ level, about one-third was judged ‘Acceptable’ and only one farm ‘Excellent’. After 6 months of monitoring period, there was no significant welfare improvement in both the treatment groups as compared with the control group. Reasons for the lack of effect may mainly be seen in the short monitoring period and a lack of external incentives. In conclusion, the WQ assessment system revealed areas for improvement, but longer term studies and investigations on alternative ways of transferring outcomes from on-farm welfare assessments to farmers should be carried out in future.
To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.
Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.
Setting and Participants.
Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.
The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.
Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.
A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.