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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.
Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a clinical phenomenon, that often results from pre or perinatal reduced cerebral blood flow and/or hypoxemia. However, in some cases, neonates present with HIE without significant risk factors or have an unusual clinical course. With the advent of advanced genetic testing, we aimed to explore if such infants had genetic risk factors predisposing them to an HIE-phenotype. Methods: We reviewed 206 charts of infants meeting local protocol criteria for moderate to severe HIE at Level III NICU’s in Calgary, Alberta. Of these, 27 patients had genetic testing such as microarray, whole exome sequencing, or gene panels. Results: Six/twenty-seven patients had genetic mutations; two CDKL5 mutations (protein kinase), one CFTR mutation (cystic fibrosis), one PDH deficiency, one CYP21A2 mutation (congenital adrenal hyperplasia), and one ISY1 (VUS; pre-mRNA splicing). Two patients had noted difficult deliveries and four had minor complications, but all were out of keeping with the severity of presumed HIE. Conclusions: This preliminary study demonstrates a possible association between genetic co-morbidities and predisposition towards HIE in the context of a relatively uneventful pre/perinatal course. Earlier identification of genetic etiology, recognized by a discrepancy between risk factors and clinical presentation, could aid in treatment decisions and outcome prognostication.
In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges.
The presence of 10 virulence genes was examined using polymerase chain reaction (PCR) in 365 European O157 and non-O157 Escherichia coli isolates associated with verotoxin production. Strain-specific PCR data were analysed using hierarchical clustering. The resulting dendrogram clearly separated O157 from non-O157 strains. The former clustered typical high-risk seropathotype (SPT) A strains from all regions, including Sweden and Spain, which were homogenous by Cramer's V statistic, and strains with less typical O157 features mostly from Hungary. The non-O157 strains divided into a high-risk SPTB harbouring O26, O111 and O103 strains, a group pathogenic to pigs, and a group with few virulence genes other than for verotoxin. The data demonstrate SPT designation and selected PCR separated verotoxigenic E. coli of high and low risk to humans; although more virulence genes or pulsed-field gel electrophoresis will need to be included to separate high-risk strains further for epidemiological tracing.
A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.
The mechanical behavior of intermetallic alloys is related to crystal bonding and the influence of bonding on the core structure of dislocations formed in these compounds. These combined effects influence the deformation behavior in an, as yet, undefined manner. However, in a way that gives rise to unusual behavior, such as the anomalous temperature dependence of flow stress observed in TiAl. Recent studies have suggested a particular relationship between the directional bonding in TiAl and dislocation mobility. To better understand the flow behavior of intermetallics, and as a beginning toward bridging the gap between electronic structure and flow behavior, we have calculated the electronic structure of various planar faults in TiAl. The self consistent electronic structure has been determined using the layered Korringa Kohn Rostoker (LKKR) method which embeds the region containing the defect between two semi-infinite perfect crystals. Calculated defect energies agree reasonably well with other theoretical estimates, though overestimating experimental values. The changes in bonding taking place in the vicinity of the planar defect will be discussed and illustrated through the density of states and charge density plots.
The corrosion behavior of TiCode-12 (Ti-0.3 Mo-0.8 Ni) high level nuclear waste container alloy has been studied for a simulated WIPP brine at a temperature of 150°C or below. Crevice corrosion was identified as a potentially important failure mode for this material. Within a mechanical crevice, a thick oxide film was found and shown to be the rutile form of TiO2, with a trace of lower oxide also present. Acidic conditions were found to cause a breakdown of the passive oxide layer. Solution aeration and increased acidity accelerate the corrosion rate. In hydrogen embrittlement studies, it was found that hydrogen causes a significant decrease in the apparent stress intensity level in fracture mechanics samples. Hydride formation is thought to be responsible for crack initiation. Stress corrosion cracking under static loads was not observed. Attention has also been given to methods for extrapolating short term uniform corrosion rate data to extended times.
Crystal damage of GaAs(100) caused by Reactive Ion Etching (RIE) using a mixture of Cl2 and Ar gas has been assessed using Surface Roughness (Ra), Resonant Raman Spectroscopy (RRS), Schottky diodes, and Spectroscopic Ellipsometry (SE). Plasma conditions for minimum induced damage have been determined and compared to optimised RIE processes using plasma gases SiCl4, CH4-H2, CCl2F2 and Ar. The SiCl4 plasma was found to produce the least crystal damage.
Cost effective high volume manufacture (HVM) is a major challenge to the success of solid oxide fuel cells (SOFCs). More than fifteen processing methods have been reported in the literature many of which could be used in various combinations to create the desired product characteristics. Modeling tools are needed to aid in the selection of the appropriate process combination prior to making expensive investment decisions.
This paper describes the development of a multi-process cost model that permits the comparison of manufacturing cost for different processing combinations and various materials. Two specific processing methods are discussed, tape casting and screen printing.
The results are compared with data and experience from the fuel cell and electronic packaging industries. Initial comparisons show good agreement with this experience base. Sensitivity of manufacturing costs to SOFC performance requirements such as maximum power density and operation temperature is investigated.
Ba0.7Sr0.3TiO3 (BST) single and quadruple layer capacitors with Pt electrodes were fabricated together on polycrystalline alumina substrates with a SiO2-based multicomponent amorphous buffer layer (SiO2/Al2O3). This paper presents the results of the characterization of these capacitors, to demonstrate their suitability for application as decoupling (high value) capacitors and as components in tunable RF applications (e.g., phase shifters and filters). BST films of different compositions, (Ba0.7Sr0.3)TiO3 and (Ba0.5Sr0.5)TiO3, were grown by metal-organic decomposition (MOD) and RF magnetron reactive sputtering. The capacitance density of 90–140 nm thick BST films was in the range of 20 to 70 fF/μm 2. Parallel plate capacitors with areas from 16 μm2 to 2.25 mm2 were fabricated using photolithography and ion milling techniques. For large capacitors (0.125 to 2.25 mm2), capacitance and tanδ were measured at low frequencies (1 KHz - 1 MHz) using an LCR meter. Smaller capacitors (16 μm2 to 3600 μm2) were additionally characterized in the frequency range of 50 MHz - 20 GHz. In such case, capacitance, tanδ and equivalent series resistance (ESR) were extracted from two port scattering parameters obtained using a vector network analyzer (VNA). The relationship between dielectric loss, tunability and calculated figure of merit vs. BST composition and deposition temperature was outlined. In addition, loss and ESR at high frequencies was investigated. The typical achieved leakage current density of sputtered BST films for 2.25 mm2 capacitors fabricated on SiO2/Al2O3 was 7.3×10-9 A/cm2 at 300 kV/cm (65 fF/μm2), about 2 times lower than for (Ba0.7Sr0.3)TiO3 films deposited by MOD (1.4×10-8 A/cm2 at 300 kV/cm, 34.5 fF/μm2). Furthermore, the tunability of (Ba0.7Sr0.3)TiO3 deposited by both methods on SiO2/Al2O3 was ∼60% at 350 kV/cm.
Infections involving Salmonella enterica subsp. enterica serovars have serious animal and human health implications; causing gastroenteritis in humans and clinical symptoms, such as diarrhoea and abortion, in livestock. In this study an optical genetic mapping technique was used to screen 20 field isolate strains from four serovars implicated in disease outbreaks. The technique was able to distinguish between the serovars and the available sequenced strains and group them in agreement with similar data from microarrays and PFGE. The optical maps revealed variation in genome maps associated with antimicrobial resistance and prophage content in S. Typhimurium, and separated the S. Newport strains into two clear geographical lineages defined by the presence of prophage sequences. The technique was also able to detect novel insertions that may have had effects on the central metabolism of some strains. Overall optical mapping allowed a greater level of differentiation of genomic content and spatial information than more traditional typing methods.
The two methods for measuring the haemagglutinin content of an influenza virus suspension are the haemagglutinating (HA) and chick cell agglutinating (CCA) techniques and both measure the same biological activity. With the establishment of an international reference preparation for influenza virus haemagglutinin (type A), however, it seems logical to express the haemagglutinin content of influenza vaccines in international units. Accordingly a collaborative study was arranged in order to obtain agreement on the number of units to be assigned to a British reference preparation for influenza haemagglutinin. It was agreed that the preparation contains 190 i.u. per ampoule and 1 i.u. is contained in 0·0622 mg. of the dried material.
Fourier analysis is used to consider the characteristics of linear magnetosonic N waves propagating through a uniform background medium at rest, with constant uniform magnetic field В0. The disturbance is driven by an initial compressed and localized gas pressure perturbation, represented by a Dirac delta distribution. The solutions for the perturbed gas and magnetic field variables are expressed as second derivatives of appropriate wave potentials. The wave potentials split naturally into fast and slow magnetosonic components. The fast- and slow-mode wave potentials reduce to onedimensional integrals over the wave normal angle θ between the wave vector k and B0. Alternatively, the fast-mode wave potentials can be written as Abelian integrals over the slow-mode phase speed cs, whereas the slow-mode potentials reduce to Abelian integrals over the fast-mode phase speed cf. The structure of the integrals depends on the location of the observation point relative to the fast and slow magnetosonic eikonal or group velocity surfaces. Calculations of the time evolution of the magnetic field of the N wave show a family of magnetic field lines connecting the cusps of the slow magnetosonic group velocity surface, plus a further family of field lines not connected with the cusps. The wave disturbance is confined on and within the fast magnetosonic group velocity surface. The gas pressure perturbation shows singular N wave type disturbances on the fast- and slow-mode eikonal surfaces. The Green's function for the magneto-acoustic wave operator for a uniform background medium initially at rest is also obtained. Generalization of the N wave solutions for non-singular distributions of the initial gas pressure perturbation are also obtained.