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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.
Our current global food system – from food production to consumption, including manufacture, packaging, transport, retail and associated businesses – is responsible for extensive negative social and environmental impacts which threaten the long-term well-being of society. This has led to increasing calls from science–policy organizations for major reform and transformation of the global food system. However, our knowledge regarding food system transformations is fragmented and this is hindering the development of co-ordinated solutions. Here, we collate recent research across several academic disciplines and sectors in order to better understand the mechanisms that ‘lock-in’ food systems in unsustainable states.
Anomalous aortic origin of the coronary arteries is associated with exercise-induced ischaemia, leading some physicians to restrict exercise in patients with this condition. We sought to determine whether exercise restriction was associated with increasing body mass index over time. From 1998 to 2015, 440 patients ⩽30 years old were enrolled into an inception cohort. Exercise-restriction status was documented in 143 patients. Using linear mixed model repeated-measures regression, factors associated with increasing body mass index z-score over time, including exercise restriction and surgical intervention as time-varying covariates, were investigated. The 143 patients attended 558 clinic visits for which exercise-restriction status was recorded. The mean number of clinic visits per patient was 4, and the median duration of follow-up was 1.7 years (interquartile range (IQR) 0.5–4.4). The median age at first clinic visit was 10.3 years (IQR 7.1–13.9), and 71% (101/143) were males. All patients were alive at their most recent follow-up. At the first clinic visit, 54% (78/143) were exercise restricted, and restriction status changed in 34% (48/143) during follow-up. The median baseline body mass index z-score was 0.2 (IQR 0.3–0.9). In repeated-measures analysis, neither time-related exercise restriction nor its interaction with time was associated with increasing body mass index z-score. Surgical intervention and its interaction with time were associated with decreasing body mass index z-score. Although exercise restriction was not associated with increasing body mass index over time, surgical intervention was associated with decreasing body mass index z-score over time in patients with anomalous aortic origin of the coronary arteries.
We have measured precise (± 3 km/s) radial velocities for 180 stars in the Fornax dwarf spheroidal galaxy, spanning the region R=0 to just beyond the nominal tidal radius. We perform a “classical” analysis of the resulting velocity dispersion profile. A mass-follows-light King model is ruled out, while a constant velocity dispersion model remains a good fit out to the limits of our dataset. For the constant velocity dispersion case, we calculate a velocity dispersion of 11.1 ± 0.7 km/s, which implies a central M/L/[M/L]⊙ ratio of 7.6 ± 1.0.
The borderline between the periods commonly termed "medieval" and "Renaissance", or "medieval" and "early modern", is one of the most hotly, energetically and productively contested faultlines in literary history studies. The essays presented in this volume both build upon and respond to the work of Professor Helen Cooper, a scholar who has long been committed to exploring the complex connectionsand interactions between medieval and Renaissance literature. The contributors re-examine a range of ideas, authors and genres addressed in her work, including pastoral, chivalric romance, early English drama, and the writings of Chaucer, Langland, Spenser and Shakespeare. As a whole, the volume aims to stimulate active debates on the ways in which Renaissance writers used, adapted, and remembered aspects of the medieval.
Andrew King is Lecturer in Medieval and Renaissance Literature at University College, Cork; Matthew Woodcock is Senior Lecturer in Medieval and Renaissance Literature at the University of East Anglia.
Contributors: Joyce Boro, Aisling Byrne, Nandini Das, Mary C. Flannery, Alexandra Gillespie, Andrew King, Megan G. Leitch, R.W. Maslen, Jason Powell,Helen Vincent, James Wade, Matthew Woodcock
Ediacaran fossils at Mistaken Point, southeastern Newfoundland (terminal Neoproterozoic; 565–575 Ma) represent the oldest known animal communities. In contrast to most Phanerozoic fossil assemblages, in which postmortem transportation, bioturbation, and the accumulation of hardparts obscure community relationships, all fossils in the Mistaken Point assemblages were sessile, soft-bodied organisms that show no evidence of mobility in life or transportation after death. Mistaken Point assemblages are spectacularly preserved on large bedding planes as in situ census populations of hundreds to thousands of fossils, recording the living soft-bodied benthic community at the moment it was smothered by volcanic ash. This unique preservation style allows ecological tests routinely conducted in modern communities (e.g., species richness, abundance, “biomass,” diversity, and evenness, as well as statistical tests of nearest-neighbor interactions) to be applied to the fossil communities. Observed patterns of community variability are consistent with the theory that Mistaken Point fossil surfaces are “snapshots” recording different stages of ecological succession, progressing from communities of low-level feeders (e.g., pectinates and spindles) to frond-dominated communities with complex tiering and spatial structure. The presence of diverse slope communities at Mistaken Point suggests that the deep sea was colonized rapidly during the evolution of complex organisms. Species richness, abundance, and diversity values, as well as levels of intraspecific interaction, all fall within the typical range observed in modern slope communities. These structural similarities imply that ecological processes present in Ediacaran communities at Mistaken Point were strikingly similar to the processes that operate in modern deep-sea animal communities.
Allotment food gardens represent important sources of food security for urban residents. Since urban gardeners rarely receive formal agricultural education and have extremely limited space, they may be relying on readily available gardening advice (e.g., seed packet instructions), inventing cultural strategies that consider inter-specific competitive dynamics, or making poor planting decisions. Knowledge of garden crop diversity and planting arrangements can aid in designing strategies for productive urban gardens and food systems. We surveyed 96 individual plots in 10 allotment gardens in the Toronto region, assessed crop diversity within gardens and recorded planting practices used by urban gardeners by measuring the proximity of individual plants relative to similar or different crop species. We also compared planting densities used by urban gardeners with those recommended by major seed distributers. Collectively, Toronto urban agriculture contributes substantially to urban plant diversity (108 crops), but each plot tends to be relatively depauperate. Carrots and lettuce were three to five times more likely to be planted in clusters than intermingled with other crops (P < 0.05); whereas gardeners did not appear to use consistent planting arrangements for tomatoes or zucchini. Gardeners tended to plant tomatoes and zucchini 56–62.5% more densely than recommended by seed distributers (P < 0.001), whereas they planted 147 times fewer carrots in a given area than recommended (P < 0.05). Furthermore, neither crop planting density nor crop diversity changed with plot size. The planting arrangements we have documented suggest gardeners using allotment plots attempt plant densely in extremely limited space, and are employing cultural strategies that intensify competitive dynamics within gardens. Future research should assess the absolute and relative effect of altered cultural practices on yield, such that any modifications can be prioritized by their impact on yield.