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To determine infection prevention and control (IPAC) practices for carbapenemase-producing Enterobacteriaceae (CPE), an emerging threat, at acute-care hospitals in Ontario, Canada.
A descriptive cross-sectional survey.
We surveyed IPAC directors and managers at all acute-care hospitals in Ontario, Canada, to gather information on IPAC practices related to CPE, including admission screening, other patient screening, environmental testing, use of precautions to prevent transmission, and outbreak management.
Of 116 acute-care hospitals, 105 (91%) responded. Admission screening included patients previously colonized or infected with CPE (n = 64, 61%), patients recently hospitalized outside of Canada (Indian subcontinent, n = 62, 59%; other countries, n = 56, 53%), and patients recently hospitalized in Canada (n = 22, 21%). Fifty-one hospitals (49%) screened patients for colonization during an outbreak. Almost all hospitals (n = 101, 96%) used precautions to prevent transmission from patients with CPE colonization or infection; most hospitals (n = 54, 53%) continued precautions indefinitely. Few hospitals (n = 19, 18%) performed environmental cultures. Eight hospitals (8%) reported at least 1 outbreak, and 6 hospitals (6%) reported transmission from sink or shower drains to patients.
Variability in practices may result from lack of evidence and challenges in updating guidelines as evidence emerges. A coordinated approach to slow the emergence of CPE should be considered in our population.
Healthcare workers (HCWs) are at risk of acquiring and transmitting respiratory viruses while working in healthcare settings.
To investigate the incidence of and factors associated with HCWs working during an acute respiratory illness (ARI).
HCWs from 9 Canadian hospitals were prospectively enrolled in active surveillance for ARI during the 2010–2011 to 2013–2014 influenza seasons. Daily illness diaries during ARI episodes collected information on symptoms and work attendance.
At least 1 ARI episode was reported by 50.4% of participants each study season. Overall, 94.6% of ill individuals reported working at least 1 day while symptomatic, resulting in an estimated 1.9 days of working while symptomatic and 0.5 days of absence during an ARI per participant season. In multivariable analysis, the adjusted relative risk of working while symptomatic was higher for physicians and lower for nurses relative to other HCWs. Participants were more likely to work if symptoms were less severe and on the illness onset date compared to subsequent days. The most cited reason for working while symptomatic was that symptoms were mild and the HCW felt well enough to work (67%). Participants were more likely to state that they could not afford to stay home if they did not have paid sick leave and were younger.
HCWs worked during most episodes of ARI, most often because their symptoms were mild. Further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.
To measure transmission frequencies and risk factors for household acquisition of community-associated and healthcare-associated (HA-) methicillin-resistant Staphylococcus aureus (MRSA).
Prospective cohort study from October 4, 2008, through December 3, 2012.
Seven acute care hospitals in or near Toronto, Canada.
Total of 99 MRSA-colonized or MRSA-infected case patients and 183 household contacts.
Baseline interviews were conducted, and surveillance cultures were collected monthly for 3 months from household members, pets, and 8 prespecified high-use environmental locations. Isolates underwent pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec typing.
Overall, of 183 household contacts 89 (49%) were MRSA colonized, with 56 (31%) detected at baseline. MRSA transmission from index case to contacts negative at baseline occurred in 27 (40%) of 68 followed-up households. Strains were identical within households. The transmission risk for HA-MRSA was 39% compared with 40% (P=.95) for community-associated MRSA. HA-MRSA index cases were more likely to be older and not practice infection control measures (P=.002–.03). Household acquisition risk factors included requiring assistance and sharing bath towels (P=.001–.03). Environmental contamination was identified in 78 (79%) of 99 households and was more common in HA-MRSA households.
Household transmission of community-associated and HA-MRSA strains was common and the difference in transmission risk was not statistically significant.
In an effort to better constrain the relevant physical processes dictating the co-evolution of supermassive black holes and the galaxies in which they reside we turn to local Seyfert AGN. It is only with these local AGN that we can reach the spatial resolution needed to adequately characterize the inflow and outflow mechanisms thought to be the driving forces in establishing the relationship between black holes and their host galaxies at higher redshift. We present the first results from the KONA (Keck OSIRIS Nearby AGN) survey, which takes advantage of the integral field unit OSIRIS plus laser and natural guide star adaptive optics to probe down to scales of 5-30 parsecs in a sample of 40 local Seyfert galaxies. With these K-band data we measure the two-dimensional distribution and kinematics of the nuclear stars, molecular gas, and ionized gas within the central few hundred parsecs.
There has been a tendency in scholarship on premodern women and the law to see married women as hidden from view, obscured by their husbands in legal records. This volume provides a corrective view, arguing that the extent to which the legal principle of 'coverture' applied has been over-emphasized. In particular, it points up differences between the English common law position, which gave husbands guardianship over their wives and their wives' property, and the position elsewhere in northwest Europe, where wives' property became part of a community of property. Detailed studies of legal material from medieval and early modern England, Wales, Scotland, Ireland, Ghent, Sweden, Norway and Germany enable a better sense of how, when, and where the legal principle of 'coverture' was applied and what effect this had on the lives of married women. Key threads running through the book are married women's rights regarding the possession of moveable and immovable property, marital property at the dissolution of marriage, married women's capacity to act as agents of their husbands and households in transacting business, and married women's interactions with the courts. Cordelia Beattie is Senior Lecturer in Medieval History at the University of Edinburgh; Matthew Frank Stevens is Lecturer in Medieval History at Swansea University. Contributors: Lars Ivar Hansen, Shennan Hutton, Lizabeth Johnson, Gillian Kenny, Mia Korpiola, Miriam Muller, S. C. Ogilvie, Alexandra Shepard, Cathryn Spence.
Electron-optical aberration correction has recently progressed from a promising concept to a powerful research tool. 100–120 kV scanning transmission electron microscopes (STEMs) equipped with spherical aberration (Cs) correctors now achieve sub-Å resolution in high-angle annular dark field (HAADF) imaging, and a 300 kV Cs-corrected STEM has reached 0.6 Å HAADF resolution. Moreover, the current available in an atom-sized probe has grown by about 10x, allowing electron energy loss spectroscopy (EELS) to detect single atoms. We summarize the factors that have made this possible, and outline likely future progress.
We use electron energy-loss spectroscopy (EELS) in the cryo-STEM to determine the spatial distribution of water in a model frozen-hydrated two-phase polymer blend composed of hydrophilic poly(vinylpyrrolidone) (PVP) and hydrophobic poly(styrene) (PS). We demonstrate that it is possible to directly correlate the water spatial distribution with variations in the underlying polymer morphology. HAADF-STEM imaging of both dry and frozen-hydrated specimens shows weak contrast between the polymer phases but gives no information regarding the composition of these phases and no indication of where water might be localized. Spatially-resolved EELS spectra collected at 100 nm pixel size show that this system is composed of discrete PVP-rich domains dispersed in a continuous PS-rich matrix. The PVP-rich domains were found to be hydrated up to a level of ∼ 23 wt%. We have made our compositional maps fully quantitative, given as mass-fraction maps, by measuring the total inelastic scattering cross-sections per unit mass of water, PVP and PS. This is an important quantity which we have determined for an incident beam energy of 200 keV. Hydrated PVP gives rise to hydrogen evolution when irradiated above an electron dose of 1500 e/nm2 as evidenced from changes in the 13 eV region, and this effect gives rise to dose-limited resolution in these experiments.
To assess the impact of an institution-wide infection control education program on the rate of transmission of methicillin-resistant Staphylococcus aureus (MRSA).
A 472-bed, urban, university-affiliated hospital.
During the period March-May 2004, all hospital staff completed a mandatory infection control education program, including the receipt of hospital-specific MRSA data and case-based practice with additional precautions.
The rate of nosocomial MRSA acquisition was calculated as the number of cases of nosocomial MRSA acquisition per 100 days that a person with MRSA colonization or infection detected at admission is present in the hospital (“admission MRSA” exposure-days) for 3 time periods: June 2002-February 2003 (before the Toronto outbreak of severe acute respiratory syndrome [SARS]), June 2003-February 2004 (after the outbreak of SARS), and June 2004-February 2005 (after education). A case of nosocomial acquisition of MRSA colonization or infection represented a patient first identified as colonized or infected more than 72 hours after admission or at admission after a previous hospitalization.
The rate of nosocomial acquisition of MRSA colonization or infection was 8.8 cases per 100 admission MRSA exposure-days for the period before SARS, 3.8 cases per 100 admission MRSA exposure-days for the period after SARS (P < .001 for before SARS vs after SARS), and 1.9 cases per 100 admission MRSA exposure-days for the period after education (P = .02 for after education vs before education). The volume of alcohol-based handrub purchased was apparently stable, with 4,010 L during fiscal year 2003-2004 (April 2003-March 2004) compared with 3,780 L during fiscal year 2004—2005. The observed rate of compliance with hand washing did not change significantly (40.9% during education vs 44.2% after education; P = .23). The total number of patients screened for MRSA colonization was not different in the 3 periods.
The rate of nosocomial acquisition of MRSA colonization or infection decreased after SARS and was further reduced in association with a hospital-wide education program.
Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.
An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.
The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (⩾50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%).
VNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.
Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.