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Background: Contaminated healthcare facility plumbing is increasingly recognized as a source of carbapenemase-producing organisms (CPOs). In August 2019, the Tennessee State Public Health Laboratory identified Tennessee’s twelfth VIM-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA), from a patient in a long-term acute-care hospital. To determine a potential reservoir, the Tennessee Department of Health (TDH) reviewed healthcare exposures for all cases. Four cases (33%), including the most recent case and earliest from March 2018, had a history of admission to intensive care unit (ICU) room X at acute-care hospital A (ACH A), but the specimens were collected at other facilities. The Public Health Laboratory collaborated with ACH A to assess exposures, perform environmental sampling, and implement control measures. Methods: TDH conducted in-person infection prevention assessments with ACH A, including a review of the water management program. Initial recommendations included placing all patients admitted to room X on contact precautions, screening for CPO on room discharge, daily sink basin and counter cleaning, and other sink hygiene measures. TDH collected environmental and water samples from 5 ICU sinks (ie, the handwashing and bathroom sinks in room X and neighboring room Y [control] and 1 hallway sink) and assessed the presence of VIM-CRPA. Moreover, 5 patients and 4 environmental VIM-CRPA underwent whole-genome sequencing (WGS). Results: From February to June 2020, of 21 patients admitted to room X, 9 (43%) underwent discharge screening and 4 (44%) were colonized with VIM-CRPA. Average room X length of stay was longer for colonized patients (11.3 vs 4.8 days). Drain swabs from room X’s bathroom and handwashing sinks grew VIM-CRPA; VIM-CRPA was not detected in tap water or other swab samples. VIM-CRPA from the environment and patients were sequence type 253 and varied by 0–13 single-nucleotide variants. ACH A replaced room X’s sinks and external plumbing in July. Discharge screening and contact precautions for all patients were discontinued in November, 5 months following the last case and 12 consecutive negative patient discharge screens. Improved sink hygiene and mechanism testing for CRPA from clinical cultures continued, with no new cases identified. Conclusions: An ICU room with a persistently contaminated sink drain was a persistent reservoir of VIM-CRPA. The room X attack rate was high, with VIM-CRPA acquisition occurring in >40% of patients screened. The use of contaminated plumbing fixtures in ACH have the potential to facilitate transmission to patients but may be challenging to identify and remediate. All healthcare facilities should follow sink hygiene best practices.
The study of aphrodisiacs is an overlooked area of global history which this article seeks to remedy by considering how such substances were commercially traded and how medical knowledge of them was exchanged globally between 1600 and 1920. We show that the concept of ‘aphrodisiacs’ as a new nominal category of pharmacological substances came to be valued and defined in early modern Latin, English, Dutch, Swiss, and French medical sources in relation to concepts transformed from their origin in both the ancient Mediterranean world and in medieval Islamicate medicine. We then consider how the general idea of aphrodisiacs became widely discredited in mid-nineteenth-century scientific medicine until after the First World War in France and in the US, alongside their commercial proliferation in the context of new colonial trade exchanges between Europe, the US, Southeast Asia, Africa, India, and South America. In both examples, we propose that global entanglements played a significant role in both the cohesion and the discreditation of the medical category of aphrodisiacs.
Physiological regulation may interact with early experiences such as maltreatment to increase risk for behavior problems. In the current study, we investigate the role of parasympathetic nervous system regulation (respiratory sinus arrhythmia [RSA] at rest and in response to a frustration task) as a moderator of the association between early risk for maltreatment (i.e., involvement with Child Protective Services; CPS) and externalizing behavior problems in middle childhood. CPS involvement was associated with elevated externalizing problems, but only among children with average to high RSA at rest and average to high RSA withdrawal in response to frustration. Effects appeared to be specific to CPS involvement as the association between cumulative risk (i.e., nonmaltreatment experiences of early adversity) and externalizing problems was not significantly moderated by RSA activity. These findings are consistent with the theoretical idea that the consequences of early maltreatment for later externalizing behavior problems depend on children's biological regulation abilities.
From the very moment the concept of sexuality emerged in nineteenth-century European medical and psychiatric thought, it became a topic of historicization. This historicization formed a consistent habit of thought in many of the medical and psychiatric texts that first enunciated sexuality as a distinct field of meaning. Dialogue between doctors and the first historians of sexuality informed the emergence of both sexology and of the historiography of sexuality. This dialogue suggests a need to rethink the origins of sexual historiography, situating current historians within a continuous genealogy, rather than as transcendental observers marked by epistemological rupture from earlier biological theories of sexual evolution.
This chapter profiles the contribution of Systemic Functional Linguistics to the study of language and medicine from early in the history of SFL to the present. It outlines the health problems and settings on which such studies have focused, summarizes pertinent findings, reviews the theoretical and descriptive tools used, and considers how the role of language in healthcare has been conceptualised. A brief research example is given, from a study of genetic counselling for women with a family history of breast cancer, which combines contextual, semantic, and multimodal text analysis to account for unexpected overestimation of cancer risk among women who were provided with expert counselling. The chapter argues that SFL has generated a significant body of work around language and medicine, with some important impacts on theory and practice, but there is scope for this field to develop into a more prominent and strategic application of Systemic Functional Linguistics that makes a substantial contribution to improving health and healthcare. Crucial to such a goal are enhanced co-ordination between research groups and a broader conception of how discourse and health are related.
To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions.
Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011–2013).
Nationally representative survey in Australia.
Male and female Australians aged 18–84 years (n 7818).
Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes.
Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.
To analyze influential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers
World wide web
We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.
A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they (1) focused on infectious diseases, antimicrobial stewardship, infection control, or medical microbiology; (2) were intended for health professionals; and (3) were written in English and (4) were updated regularly. We mapped blog and blogger characteristics and used an innovative tool to assess the architecture and content of the included blogs. The motivations and perceptions of bloggers and readers were also assessed.
A total of 88 blogs were identified. Moreover, 28 blogs (32%) focused on infectious diseases, 46 (52%) focused on medical microbiology, and 14 (16%) focused on infection control or antimicrobial stewardship. Bloggers were mainly male with medical doctorates and/or PhDs; 32 bloggers (36%) posted at least weekly; and 51 (58%) had a research purpose. The aims were considered clear for 23 blogs (26%), and the field covered was considered broad for 25 blogs (28%). Presentation was considered good for 22 blogs (25%), 51 blogs (58%) were easy to read, and 46 blogs (52%) included expert interpretation. Among the top 10 blogs, 3 focused on infectious diseases, 6 focused on medical microbiology, and 2 focused on infection control (2 were equally ranked). The bloggers we questioned were motivated to share their independent expertise and opinions. Readers appreciated the concise messages on scientific topics and practical updates.
This study describes high-level blogs in the fields of infectious diseases, infection control, and medical microbiology. Our findings suggest ways in which bloggers should build/orientate blogs for readers, and we have highlighted current gaps in blog topics such as antimicrobial stewardship.
Patients who experience Transient Ischaemic Attack (TIA) should be assessed and treated in a specialist clinic to reduce risk of further TIA or stroke. But referrals are often delayed. We aimed to identify published studies describing pathways for emergency assessment and referral of patients with suspected TIA at first medical contact: primary care; ambulance services; and emergency department.
We conducted a scoping literature review. We searched four databases (PubMed, CINAHL, Web of Science, Scopus). We screened studies for eligibility. We extracted and analysed data to describe setting, assessment and referral processes reported in primary research on referral of suspected TIA patients directly to specialist outpatient services.
We identified eight studies in nine papers from five countries: 1/9 randomized trial; 6/9 before-and-after designs; 2/9 descriptive account. Five pathways were used by family doctors and three by Emergency Department (ED) physicians. None were used by paramedics. Clinicians identified TIA patients using a checklist incorporating the ABCD2 tool to describe risk of further stroke, online decision support tool or clinical judgement. They referred to a specialist clinic, either directly or via a telephone helpline. Anti-platelet medication was often given, usually aspirin unless contraindicated. Some patients underwent neurological and blood tests before referral and discharge. Five studies reported reduced incident of stroke at 90 days, from 6–10 percent predicted rate to 1.2-2.1 percent actual rate. Between 44 percent and 83 percent of suspected TIA cases in these studies were directly referred to stroke clinics through the pathways.
Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalization of TIA patients. No pathways for paramedic use were reported. Since many suspected TIA patients present to ambulance services, effective pre-hospital assessment and referral pathways are needed. We will use review results to develop a paramedic referral pathway to test in a feasibility trial.
Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).
We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.
We conducted three interrelated activities to produce the TIER intervention:
• Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use
• Scoping review of literature describing prehospital care of patients with TIA
• Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.
The panel used results to define the TIER intervention, to include:
1. Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic
2. Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic
3. Referral process via ambulance control room
4. Training package for paramedics
5. Agreement with TIA clinic service provider including rapid review of referred patients
We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
Older adults are a fast growing population, and the emerging cohort comprises older adults from the baby boomer generation who engage in unhealthy use of substances at higher rates than earlier cohorts. Though older adults use alcohol and illicit drugs at lower rates than younger adults, the sheer numbers of the older adult population and the aging of the baby boomers are expected to drive up the prevalence rates of substance use disorders among older adults. Thus, health care professionals need to know how to identify, assess, and intervene in substance use disorders among aging adults, which may involve unhealthy use of alcohol, tobacco, and illicit and non-medical prescription drugs.
Mental health services are increasingly expected to engage in a process of cultural change to fulfil guiding values and hopes for choice, personalisation, self-determination, social inclusion and personal recovery. It is unclear how this will be achieved. This transformational agenda also engages with an ambition for progressive change in practice across mental health professions to support people in self-care and self-management, based on a new relationship between practitioners and users of mental health services. There is little consistent guidance on the content of recovery-oriented and socially inclusive practice and what may be the new competencies and skills that would most effectively support recovery outcomes. Life coaching to support recovery for people with mental health needs is emerging as a creative possibility with considerable potential to support this ambition. This is an exploratory article which offers an overview of experience so far, suggests further routes for development and, in line with the College's Fair Deal campaign, underlines the need for evaluation.
The Nature Conservancy takes a strategic and systematic approach to conservation planning. Ecoregional assessments are used to set goals and identify geographical priorities, and Conservation Action Planning is used to develop strategic plans for conservation areas. This study demonstrates how these planning processes were applied at the seascape scale based on a case study of Kimbe Bay, Papua New Guinea. Conservation Action Planning was used to identify key threats and strategies, and systematic conservation planning (similar to that used for ecoregional assessments) was used to design a network of marine protected areas to be resilient to the threat of climate change. The design was based on an assessment of biodiversity and socio-economic values, and identified 14 Areas of Interest that meet specific conservation goals. A detailed community-based planning process is now underway with local communities that own and manage these areas to refine and implement the marine protected area network.
We have characterized the surface charge on a variety of GaN samples using two surface potential techniques, conventional Kelvin probe and scanning Kelvin probe microscope (SKPM). Kelvin probe was primarily used to measure the change in surface potential under UV illumination, otherwise known as the surface photovoltage (SPV). Due to band bending near the semiconductor surface of about 1 eV in dark conditions, the SPV signal for n-type GaN typically reaches 0.5 to 0.6 eV upon switching on UV light. This value can slowly decrease by up to 0.3 eV during UV illumination in air ambient for 2-3 hours. We report that samples with many hours of ambient UV exposure do not show this slow decrease during SPV measurements, consistent with the UV-induced growth of a thicker surface oxide that limits charge transfer. In addition to prolonged UV exposure, the surface contact potential was also manipulated by local charge injection. In this procedure, the surface is charged using a metallized atomic force microscope tip which is scanned in contact with the sample. Subsequent SKPM measurements indicate an increase or decrease in the surface contact potential for the charged region, depending on the applied voltage polarity. Measurements of the discharge behavior in dark for these regions show a logarithmic time behavior, similar to the decay behavior during our observations of SPV transients after switching off the light. As expected, illumination of the surface increases the discharge rate and restores the charged area to its original state.