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Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
Background: Patients presenting to the Emergency Department (ED) with unmet palliative care needs are often admitted to hospital and this can be a pivotal point in their subsequent health care journey. Literature from the United States supports the integration of palliative care resources in the ED and to our knowledge, this has yet to be done in a Canadian setting. Aim Statement: To develop, implement, and evaluate a model to support patients presenting to the ED with unmet palliative care needs. Measures & Design: A pilot project was implemented in one campus of the ED at a tertiary care academic center in Ottawa, Ontario. A palliative care nurse specialist was available for consultation with goals to: a) reduce admission to hospital for patients choosing to have a palliative approach to their care; b) increase coordination between ED and community resources; and c) be a resource for ED staff. Referral criteria were developed after systematic review of the literature and in consultation with palliative and emergency medicine experts. Evaluation/Results: Over the course of the study period (9 months), 50 referrals were made. The primary reason for referral was for increased community supports. Patient outcomes: 10 patients were discharged to hospice/palliative care units from the ED, 38 patients were discharged home. Of those discharged home, 66% had no returns to ED within 30 days. Qualitative feedback collected via pre and post survey has been extremely supportive from ED health care practitioners and community palliative care providers. Discussion/Impact: This ongoing project has led to positive, patient centered outcomes and decreased admission to acute care hospital. Ongoing evaluation will include consideration of Ontario Palliative Care Network quality indicators and cost-analysis to determine impact on health care system.
Phase identification by X-ray diffraction techniques in a complex mixture would be greatly simplified if the component phases could be physically separated. As opposed to current computer search-match algorithms for phase identification, which presuppose a single diffraction scan on a carefully prepared sample, we propose multi-scan data-taking on a not-so-carefully prepared sample so as to exploit certain aberrations in the diffracted intensities. The result can effectively be a physical separation by diffraction. Examples include exploitation of samples having a preferentially oriented component as well as samples with components having differing crystallite sizes. The techniques can involve diffractometer as well as film techniques.
During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
Background: Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development. Aims: The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers’ thoughts of infant-related harm. Method: English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood. Results: Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found. Conclusions: Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.
On 27 April 2015, Washington health authorities identified Escherichia coli O157:H7 infections associated with dairy education school field trips held in a barn 20–24 April. Investigation objectives were to determine the magnitude of the outbreak, identify the source of infection, prevent secondary illness transmission and develop recommendations to prevent future outbreaks. Case-finding, hypothesis generating interviews, environmental site visits and a case–control study were conducted. Parents and children were interviewed regarding event activities. Odds ratios (OR) and 95% confidence intervals (CI) were computed. Environmental testing was conducted in the barn; isolates were compared to patient isolates using pulsed-field gel electrophoresis (PFGE). Sixty people were ill, 11 (18%) were hospitalised and six (10%) developed haemolytic uremic syndrome. Ill people ranged in age from <1 year to 47 years (median: 7), and 20 (33%) were female. Twenty-seven case-patients and 88 controls were enrolled in the case–control study. Among first-grade students, handwashing (i.e. soap and water, or hand sanitiser) before lunch was protective (adjusted OR 0.13; 95% CI 0.02–0.88, P = 0.04). Barn samples yielded E. coli O157:H7 with PFGE patterns indistinguishable from patient isolates. This investigation provided epidemiological, laboratory and environmental evidence for a large outbreak of E. coli O157:H7 infections from exposure to a contaminated barn. The investigation highlights the often overlooked risk of infection through exposure to animal environments as well as the importance of handwashing for disease prevention. Increased education and encouragement of infection prevention measures, such as handwashing, can prevent illness.
We investigated the extent to which second-language (L2) learning is influenced by the similarity of grammatical features in one's first language (L1). We used event-related potentials to identify neural signatures of a novel grammatical rule – grammatical gender – in L1 English speakers. Of interest was whether individual differences in L2 proficiency and age of acquisition (AoA) influenced these effects. L2 and native speakers of French read French sentences that were grammatically correct, or contained either a grammatical gender or word order violation. Proficiency and AoA predicted Left Anterior Negativity amplitude, with structure violations driving the proficiency effect and gender violations driving the AoA effect. Proficiency, group, and AoA predicted P600 amplitude for gender violations but not structure violations. Different effects of grammatical gender and structure violations indicate that L2 speakers engage novel grammatical processes differently from L1 speakers and that this varies appreciably based on both AoA and proficiency.
Limitations of access have long restricted exploration and investigation of the cavities beneath ice shelves to a small number of drillholes. Studies of sea-ice underwater morphology are limited largely to scientific utilization of submarines. Remotely operated vehicles, tethered to a mother ship by umbilical cable, have been deployed to investigate tidewater-glacier and ice-shelf margins, but their range is often restricted. The development of free-flying autonomous underwater vehicles (AUVs) with ranges of tens to hundreds of kilometres enables extensive missions to take place beneath sea ice and floating ice shelves. Autosub2 is a 3600 kg, 6.7 m long AUV, with a 1600 m operating depth and range of 400 km, based on the earlier Autosub1 which had a 500 m depth limit. A single direct-drive d.c. motor and five-bladed propeller produce speeds of 1–2 m s−1. Rear-mounted rudder and stern-plane control yaw, pitch and depth. The vehicle has three sections. The front and rear sections are free-flooding, built around aluminium extrusion space-frames covered with glass-fibre reinforced plastic panels. The central section has a set of carbon-fibre reinforced plastic pressure vessels. Four tubes contain batteries powering the vehicle. The other three house vehicle-control systems and sensors. The rear section houses subsystems for navigation, control actuation and propulsion and scientific sensors (e.g. digital camera, upward-looking 300 kHz acoustic Doppler current profiler, 200 kHz multibeam receiver). The front section contains forward-looking collision sensor, emergency abort, the homing systems, Argos satellite data and location transmitters and flashing lights for relocation as well as science sensors (e.g. twin conductivity–temperature–depth instruments, multibeam transmitter, sub-bottom profiler, AquaLab water sampler). Payload restrictions mean that a subset of scientific instruments is actually in place on any given dive. The scientific instruments carried on Autosub are described and examples of observational data collected from each sensor in Arctic or Antarctic waters are given (e.g. of roughness at the underside of floating ice shelves and sea ice).
Multi-wavelength investigations of the interstellar environment around WR stars using IUE, IRAS, and optical data have led to the discovery of extended shells of gas and dust 50-100 pc in diameter in the lines of sight to the WR stars HD 50896, HD 96548, and HD 192163. These three stars share several common characteristics: (1) associated N- and He-enriched ring nebula, (2) spectral class WN5-8, and (3) spectral and photometric variability. Surveys of IUE spectra and IRAS images reveal a few additional candidates for such extended shells. Although positional coincidences cannot be excluded, possible origins of these extended shells include interstellar bubbles formed by stellar winds, non-conservative mass loss from binary systems, and supernova remnants. Current data suggest these three stars may be in a post X-ray binary stage, representing the second WR phase of massive binary star evolution. The discovery of extended shells of gas and dust possibly related to WR stars is important because the search for stars in the second WR phase, after the supernova of the primary, has been quite elusive. However, the observational evidence and available theoretical models for post-supernova massive binary star evolution and subsequent non-conservative mass transfer are not yet sufficient to firmly identify the origins of these extended shells.
Field experiments were conducted to evaluate the integration of cover crops and POST herbicides to control glyphosate-resistant Palmer amaranth in cotton. The winter-annual grasses accumulated the greatest amount of biomass and provided the most Palmer amaranth control. The estimates for the logistic regression would indicate that 1540 kg ha−1 would delay Palmer amaranth emerging and growing to 10 cm by an estimated 16.5 days. The Palmer amaranth that emerged in the cereal rye and wheat cover crop treatments took a longer time to reach 10 cm compared to the hairy vetch and crimson clover treatments. POST herbicides were needed for adequate control of Palmer amaranth. The glufosinate-based weed control system provided greater control (75% vs 31%) of Palmer amaranth than did the glyphosate system. These results indicate that a POST only herbicide weed management system did not provide sufficient control of Palmer amaranth, even when used in conjunction with cover crops that produced a moderate level of biomass. Therefore, future recommendations for GR Palmer amaranth control will include integrating cover crops with PRE herbicides, overlaying residual herbicides in-season, timely POST herbicide applications, and hand weeding in order to achieve season-long control of this pest.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
The government publishes 3 different public report surgical site infection (SSI) metrics, all called standardized infection ratios (SIRs), that impact perceived hospital quality. We conducted a non-random cross-sectional observational pilot study of 20 California hospitals that voluntarily submitted colon surgery and SSI data. Discordant SIR values, leading to contradictory conclusions, occurred in 35% of these hospitals.
Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.
Dialysis is the process by which an artificial kidney device removes waste and excess water from a patient. An outstanding problem with dialysis is that the body has a remarkable immune function where proteins and antigens mark foreign objects as possible threats despite the biocompatibility of the material. Upon adhesion to polymeric materials used currently in dialysis, proteins are lost. In this study, polytetrafluoroethylene (PTFE) is investigated as a potential replacement material for dialysis tubing because of its unreactive nature. The focus is to determine if PTFE will prove a viable material in minimizing protein adhesion and further reducing antibody loss of the patient. Protein loss as a function of filtration time was measured. PVC and PTFE materials were investigated following the same battery of testing where the protein concentrations in the blood were characterized using UV Visible spectrophotometry. Results demonstrate a loss of nearly 12 percent of blood proteins to the PVC material over the course of a typical dialysis treatment. Conversely, the protein loss due to adhesion to PTFE was less than two percent.
The NEWSIPS-reprocessing of IUE data permits the extraction of spectra to wavelengths as short as 1150 Å. We present representative well-exposed IUE spectra of Wolf-Rayet stars covering the 1150–1220 Å region with a resolution of 0.1 Å. The C III 1175 Å line in WC and some WN stars typically shows a P-Cygni profile, with dacs apparent in time series spectra. Superimposed on the stellar spectra are many strong interstellar absorption lines of N I, Si II and other species. These spectra are a guide to a portion of the wavelength region to be covered by FUSE, and an indication of the new information that will be available in the far-UV range with FUSE.