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Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
Considered as a less hazardous piezoelectric material, potassium sodium niobate (KNN) has been in the fore of the search for replacement of lead (Pb) zirconate titanate for piezoelectrics applications. Here, we challenge the environmental credentials of KNN due to the presence of ~60 wt% Nb2O5, a substance much less toxic to humans than Pb oxide, but whose mining and extraction cause significant environmental damage.
To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.
An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.
An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.
Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.
Hospitals are meant to be places for respite and healing; however, technological advances and reliance on monitoring alarms has led to the environment becoming increasingly noisy. The coronary care unit (CCU), like the emergency department, provides care to ill patients while being vulnerable to noise pollution. The World Health Organization (WHO; Geneva, Switzerland) recommends that for optimum rest and healing, sound levels should average approximately 30 decibels (dB) with maximum readings less than 40 dB.
The purpose of this study was to measure and analyze sound levels in three different locations in the CCU, and to review alarm reports in relation to sound levels.
Over a one-month period, sound recorders (Extech SDL600; Extech Instruments; Nashua, New Hampshire USA) were placed in three separate locations in the CCU at the West Roxbury Veterans’ Administration (VA) Hospital (Roxbury, Massachusetts USA). Sound samples were recorded once per second, stored in Comma Separated Values format for Excel (Microsoft Corporation; Redmond, Washington USA), and then exported to Microsoft Excel. Averages were determined, plotted per hour, and alarm histories were reviewed to determine alarm noise effect on total noise for each location, as well as common alarm occurrences.
Patient Room 1 consistently had the lowest average recordings, though all averages were >40 dB, despite decreases between 10:00 pm and 7:00 am. During daytime hours, recordings maintained levels >50 dB. Overnight noise remained above recommended levels 55.25% of the period in Patient Room 1 and 99.61% of the same time period in Patient Room 7. The nurses’ station remained the loudest location of all three. Alarms per hour ranged from 20-26 during the day. Alarms per day averaged: Patient Room 1-57.17, Patient Room 7-122.03, and the nurses’ station - 562.26. Oxygen saturation alarms accounted for 33.59% of activity, and heart-related (including ST segment and pacemaker) accounted for 49.24% of alarms.
The CCU cares for ill patients requiring constant monitoring. Despite advances in technology, measured noise levels for the hospital studied exceeded WHO standards of 40 dB and peaks of 45 dB, even during night hours when patients require rest. Further work is required to reduce noise levels and examine effects on patient satisfaction, clinical outcomes, and length of stay.
RyanKM, GagnonM, HannaT, MelloB, FofanaM, CiottoneG, MolloyM. Noise Pollution: Do We Need a Solution? An Analysis of Noise in a Cardiac Care Unit. Prehosp Disaster Med. 2016;31(4):432–435.
The efficiency of thin-film solar cells using a-Si:H is limited by the decrease in a-Si:H layer optical path length and its poor light absorption at red and NIR wavelengths. Metal NP such as Au have been shown to increase the absorption in the active material and then cell performances, by exhibiting localized surface plasmon (LSP) resonances. Our work’s goal is to understand NP influence in such cells, to perform an optimal structure by increasing the amount of light absorbed within the cell using NP scattering and luminescence. Modeling based on Mie theory is first carried out using bulk Palik data for Au spheres with various diameters and refractive medium indexes. Using modeling parameters, Au layers were deposited on glass and SnO2 substrates respectively by thermal evaporation in vacuum and sputtering, followed by thermal annealing (200 ∼ 500°C) in order to promote the NP growth. MEB pictures show quasispherical Au NP shape with a mean size of 150nm. This diameter range switches extinction of NP in scattering regime. Annealing temperature (T) strongly affects the NP morphology. Surface coverage decreases and sphericity appears to increase with T. UV-Visible spectroscopy displays distinct LSP resonances around 600nm after annealing with a red shift while T increases.
The manufacture of composite materials can improve the properties of proton-conducting polymers as membranes in PEM fuel cells. We have investigated composite membranes obtained by dispersion of nanodiamond particles in a sulfonated PolyEtherEtherKetone (SPEEK) matrix. SPEEK is a major proton-conducting aromatic polymer. Nanodiamond has been studied for various applications and can be functionalized with different surface groups. For use in proton-conducting membranes, surface functionalization with proton-donating groups is a promising approach. In this preliminary work, we have studied the properties of membranes made using pristine nanodiamond from diverse origins for a first assessment of the potential properties. The composites were analysed by various techniques, including Thermogravimetric Analysis, water vapor uptake and mechanical tensile tests.
Real-time coefficient of friction (COF) analysis is used to determine the extent of normal and shear forces during post-CMP PVA brush scrubbing and identify the tribology of the process. Fluid pH and applied pressure have pronounced effects on process tribology and the magnitude of COF. In cases where brush rotation is the only kinematic attribute of the system, low pH results in ‘mixed lubrication’ where increasing brush velocity causes a dramatic reduction in COF in accordance with classical tribological arguments. At lower pressures the tribological mechanism shifts to ‘hydrodynamic lubrication’ with significantly lower values of COF. Regardless of pressure, increasing the pH to 7 and 10.7 causes the tribology to remain in ‘hydrodynamic lubrication’ and results in even lower values of COF. Trends are explained qualitatively by considering the effect of pH on the solubility and gellation characteristics of silica in the silica-water system. Stribeck curves fail to shed light on the tribology of the system when complex ranges of tool kinematics (i.e. wafer rotation and brush oscillation superimposed on brush rotation) are employed. The results are counter-intuitive since they indicate nearly an order of magnitude increase in COF with increasing brush velocity. Nevertheless, results demonstrate the utility of having complex ranges of motion in PVA brush scrubbing such that very low or very high values of COF can be realized by simply increasing the rotational velocity of the brush while maintaining a constant wafer rotation and brush oscillation.
Cytotaxonomic analysis of the polytene chromosomes from larvae of the Simulium damnosum Theobald complex from the island of Bioko in Equatorial Guinea is reported, and a new endemic cytoform is described. Chromosomally this cytoform is close to both S. squamosum (Enderlein) and S. yahense Vajime & Dunbar, but is not identical to either. However, it is morphologically and enzymatically identical to S. yahense. The Bioko form was also found to differ from other cytoforms of the S. damnosum complex in West Africa in the copy number or RFLP pattern of several different repetitive DNA sequences. It is clear that the Bioko form is genetically distinct from other populations of the S. damnosum complex, and whilst it is closest to S. yahense, it shows features that suggest a high degree of geographical and genetic isolation. Such isolation is an important consideration in the assessment of the potential for onchocerciasis vector eradication on Bioko.
Previous studies have shown that bovine performance can be improved by manipulating photoperiod. This may be an acceptable alternative to the use of exogenous hormones but responses have been inconsistent. The objective of this trial was to determine the response of finishing cattle to extended photoperiod.
Sixty-four Hereford x Friesian steers and 48 Charolais x Friesian heifers were finished in consecutive years over the winter housing period under either natural daylength (Control) or daylength extended to 16 hours (16 hour). Lights were installed to provide 16 hour animals with 400 lux at animal eye level. A photocell and timeswitch combination ensured that lights were switched on if natural light levels were below this level between 04.00 and 20.00 GMT. Animals were penned in groups of eight and silage was weighed in daily to each pen. Animals were weighed fortnightly and feed conversion ratios calculated. Prolactin assays were carried out on blood samples taken monthly from 10 animals per treatment. Steer and heifer behaviour was monitored over 24 hours on three occasions.
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