Clostridium botulinum causes infant botulism by colonising the intestines and producing botulinum neurotoxin in situ. Previous reports have linked infant botulism cases to C. botulinum spores in household dust, yet the baseline incidence of C. botulinum spores in residential households is currently unknown. Vacuum cleaner dust from 963 households in 13 major Canadian cities was tested for C. botulinum using a novel real-time PCR assay directed against all known subtypes of the botulinum neurotoxin gene. None of the samples tested positive for C. botulinum. Analysis of a random subset of samples by MALDI Biotyper revealed that the most common anaerobic bacterial isolates were of the genus Clostridium and the most common species recovered overall was Clostridium perfringens. Dust that was spiked with C. botulinum spores of each toxin type successfully produced positive real-time PCR reactions. These control experiments indicate that this is a viable method for the detection of C. botulinum spores in household dust. We make several recommendations for future work that may help discover a common environmental source of C. botulinum spores that could lead to effective preventative measures for this rare but deadly childhood disease.

Housing figures prominently during economic crises, a notable example being the Great Depression. Because housing is immobile, its market is very localized. In each city, the main agents are closely interconnected. Lenders depend on mortgaged homeowners and landlords to maintain payments; landlords rely on tenants; municipalities need all property owners to pay taxes. The Depression experiences of tenants, homeowners, and federal housing programs are well-appreciated; those of landlords and private lenders much less so. Considering the role of all agents, this case study of Hamilton, Ontario, focuses on owners and private lenders and asks who lost property, to whom, and how. Drawing on land registry and property tax records, city directories, and newspaper accounts, it documents the pattern and trajectory of defaults experienced by homeowners, landlords, and private lenders. Contemporaries and historians have used foreclosures as a measure of distress, but many borrowers defaulted voluntarily. The experience of Hamilton’s homeowners was similar to those in U.S. cities. Local landlords experienced higher rates of defaults than homeowners; private lenders foreclosed less often than lending institutions. Along with municipalities, both learned to be flexible in demanding payments. The high incidence of private mortgages, the stability of lending institutions, and the marginal role of the federal government were distinctively Canadian, but in general Hamilton’s experience is more broadly indicative.

The Depression housing crisis caused enormous distress, with social, economic and political implications. The roles and experiences of some major players are well established. Tenants were evicted. National statistics on foreclosures show that many property owners lost their homes. Lending institutions went under. Municipalities struggled when property tax receipts fell. The federal government stepped in, establishing new programs and agencies, with long-term consequences.

Other parts of the story have been neglected. Many borrowers surrendered their properties voluntarily, rather than await foreclosure. As vacancies rose and rents fell, landlords, many owning only one or two properties and/or renting part of their own homes, struggled. Neglected sources show they defaulted at a higher rate than homeowners. Among lenders, private individuals held more mortgages than any type of institution. Relying on investment income, many had a hard time. Both landlords and private lenders made concessions to avoid having to evict or foreclose, mitigating the effects of the Depression on tenants and borrowers. Sources exist to document local variations in the role of landlords and private lenders. These can give us a fuller picture of the Depression, one that still has relevance today.

Excavated over two centuries ago, the Upton Lovell G2a ‘Wessex Culture’ burial has held a prominent place in research on Bronze Age Britain. In particular, was it the grave of a ‘shaman’ or a metalworker? We take a new approach to the grave goods, employing microwear analysis and scanning electron microscopy to map a history of interactions between people and materials, identifying evidence for the presence of Bronze Age gold on five artefacts, four for the first time. Advancing a new materialist approach, we identify a goldworking toolkit, linking gold, stone and copper objects within a chaîne opératoire, concluding that modern categorisations of these materials miss much of their complexity.

The feasibility of non-pharmacological public health interventions (NPIs) such as physical distancing or isolation at home to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in low-resource countries is unknown. Household survey data from 54 African countries were used to investigate the feasibility of SARS-CoV-2 NPIs in low-resource settings. Across the 54 countries, approximately 718 million people lived in households with ⩾6 individuals at home (median percentage of at-risk households 56% (95% confidence interval (CI), 51% to 60%)). Approximately 283 million people lived in households where ⩾3 people slept in a single room (median percentage of at-risk households 15% (95% CI, 13% to 19%)). An estimated 890 million Africans lack on-site water (71% (95% CI, 62% to 80%)), while 700 million people lacked in-home soap/washing facilities (56% (95% CI, 42% to 73%)). The median percentage of people without a refrigerator in the home was 79% (95% CI, 67% to 88%), while 45% (95% CI, 39% to 52%) shared toilet facilities with other households. Individuals in low-resource settings have substantial obstacles to implementing NPIs for mitigating SARS-CoV-2 transmission. These populations urgently need to be prioritised for coronavirus disease 2019 vaccination to prevent disease and to contain the global pandemic.

The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.

Background: In 2018, the Maryland Department of Health, in collaboration with the University of Maryland and Johns Hopkins University, created the Statewide Prevention and Reduction of Clostridioides difficile (SPARC) collaborative to reduce C. difficile as specified in Healthy People 2020. Methods: The SPARC collaborative recruited hospitals contributing most cases to statewide C. difficile standardized infection ratio (SIR), according to data reported to the National Healthcare Safety Network (NHSN). SPARC developed intervention bundles around 4 domains: infection prevention, environmental cleaning, and diagnostic and antimicrobial stewardship. Each facility completed a self-assessment followed by an on-site, day-long, peer-to-peer (P2P) evaluation with 8–12 SPARC subject matter experts (SMEs) representing each domain. The SMEs met with hospital executive leadership and then led 4 domain-based group discussions with relevant hospital team leaders. To identify policy and practice gaps, SMEs visited hospital inpatient units for informal interviews with frontline staff. In a closing session, SPARC SMEs, hospital executives, and team leaders reconvened to discuss preliminary findings. This included review of covert observation data (hand hygiene, personal protective equipment compliance, environmental cleaning) obtained by SPARC team 1–2 weeks prior. Final SPARC P2P written recommendations guided development of customized interventions at each hospital. SPARC provided continuous support (follow up phone calls, educational webinars, technical support, didactic training for antimicrobial stewardship pharmacists) to enhance facility-specific implementation. For every quarter, we categorized C. difficile NHSN data for each Maryland hospital into “SPARC” or “non-SPARC” based on participation status. Using negative binomial mixed models, we analyzed difference-in-difference of pre- and postincidence rate ratios (IRRs) for SPARC and non-SPARC hospitals, which allowed estimation of change attributable to SPARC participation independent of other time-varying factors. Results: Overall, 13 of 48 (27%) hospitals in Maryland participated in the intervention. The baseline SIR for all Maryland hospitals was 0.92, and the post-SPARC SIR was 0.67. The SPARC hospitals had a greater reduction in hospital-onset C. difficile incidence; 8.6 and 4.3 events per 10,000 patient days for baseline and most recent quarter, respectively. For non-SPARC hospitals, these hospital-onset C. difficile incidences were 5.1 preintervention and 4.3 postintervention. We found a statistically significant difference-in-difference between SPARC and non-SPARC hospital C. difficile reduction rates (ratio of IRR, 0.63; 95% CI, 0.44−0.89; P = .01). Conclusions: The Maryland SPARC collaborative, a public health-academic partnership, was associated with a 25% reduction in the Maryland C. difficile SIR. Hospitals participating in SPARC demonstrated significantly reduced C. difficile incidences to match that of high-performing hospitals in Maryland.

Funding: None

Disclosure: Aaron Milstone, BD – consulting.