Comparison between adenosine triphosphate bioluminescence and aerobic colony count to assess surface sanitation in the hospital environment

Background: Adenosine triphosphate bioluminescence produced by the firefly luciferase has been successfully introduced to verify cleaning procedures in the food industry according to the Hazard Analysis Critical Control Point program. Our aim was to evaluate the reliability of bioluminescence as a tool to monitor the effectiveness of sanitation in healthcare settings, in comparison with the microbiological gold standard. Methods: 614 surfaces of various material were randomly sampled in Policlinico University Hospital units in Palermo, Italy, to detect adenosine triphosphate bioluminescence and aerobic colony count. Linear regression model and Pearson correlation coefficient were used to estimate the relationship between the two variables of the study. Results: Aerobic colony count median was 1.71 colony forming units/cm2 (interquartile range = 3.8), whereas adenosine triphosphate median was 59.9 relative light units/cm2 (interquartile range = 128.3). Pearson coefficient R2 was 0.09. Sensitivity and specificity of bioluminescence test with respect to microbiology were 46% and 71%, whereas positive predictive value and negative predictive value were 53% and 65%, respectively. Conclusion: According to our results, there seemed to be no linear correlation between aerobic colony count and adenosine triphosphate values, suggesting that current bioluminescence technology has not any proportional relationships with culturable microbes contaminating environmental surfaces in health-care settings

Application of minidisk infiltrometer to estimate water repellency in Mediterranean pine forest soils

Assessment of soil water repellency (SWR) was conducted in the decomposed organic floor layer (duff) and in the mineral soil layer of two Mediterranean pine forests, one in Italy and the other in Spain, by the widely-used water drop penetration time (WDPT) test and alternative indices derived from infiltration experiments carried out by the minidisk infiltrometer (MDI). In particular, the repellency index (RI) was calculated as the adjusted ratio between ethanol and water soil sorptivities whereas the water repellency cessation time (WRCT) and the specifically proposed modified repellency index (RIm) were derived from the hydrophobic and wettable stages of a single water infiltration experiment. Time evolution of SWR and vegetation cover influence was also investigated at the Italian site. All indices unanimously detected severe SWR conditions in the duff of the pine forests. The mineral subsoils in the two forests showed different wettability and the clay-loam subsoil at Ciavolo forest was hydrophobic even if characterized by organic matter (OM) content similar to the wettable soil of an adjacent glade. It was therefore assumed that the composition rather than the total amount of OM influenced SWR. The hydraulic conductivity of the duff differed by a factor of 3.8-5.8 between the two forested sites thus influencing the vertical extent of SWR. Indeed, the mineral subsoil of Javea showed wettable or weak hydrophobic conditions probably because leaching of hydrophobic compounds was slowed or prevented at all. Estimations of SWR according to the different indices were in general agreement even if some discrepancies were observed. In particular, at low hydrophobicity levels the SWR indices gathered from the MDI tests were able to signal sub-critical SWR conditions that were not detected by the traditional WDPT index. The WRCT and modified repellency index RIm yielded SWR estimates in reasonable agreement with those obtained with the more cumbersome RI test and, therefore, can be proposed as alternative procedures for SWR assessment

Challenges in the Diagnosis and Management of Bacterial Lung Infections in Solid Organ Recipients: A Narrative Review

Respiratory infections pose a significant threat to the success of solid organ transplantation, and the diagnosis and management of these infections are challenging. The current narrative review addressed some of these challenges, based on evidence from the literature published in the last 20 years. Specifically, we focused our attention on (i) the obstacles to an etiologic diagnosis of respiratory infections among solid organ transplant recipients, (ii) the management of bacterial respiratory infections in an era characterized by increased antimicrobial resistance, and (iii) the development of antimicrobial stewardship programs dedicated to solid organ transplant recipient

Stressed caregivers. An observational study in a rehabilitation care home in western Sicily

Introduction: Caregiver is the person who takes care of the patient from the practical point of view, helping him in managing the disease and carrying out daily activities, but also supporting him on an emotional level. Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. The aim of the study was to understand what factors were associated with having panic attacks or crying crises in the caregivers of our study population. Materials and methods: The study design is observational. An anonymous questionnaire was administered to caregivers of the patients of a hospital for the intensive post-acute rehabilitation from April 2016 to December 2018. The statistical significance level chosen for the entire analysis was 0.05. The covariates to be included were selected using a stepwise backward selection process, with a univariate p-value <0.25 as the main criterion. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (CI). Results: The sample consists of 302 caregivers (60.93% was females and 39.07% was males). The mean age of the sample is 53.42 years old (SD ± 12.19). The multivariable logistic regression model shows that the risk to have panic or crying crisis is significantly associated with the following indipendent variables: female gender (aOR 27.06); living with the patient (aOR 4.38); had claimed that the problems related to the illness of their family member is a source of stress (aOR 23.54), smoking cigarettes (aOR 14.68); had claimed that taking care of their client affected their personal financial statement/career (aOR 5.95), having free time (aOR 7.68). Conclusions: In our study we found a greater probability of having panic attacks or crying crises in female subjects, smokers, who think they have sacrificed their careers to take care of the person they follow from a welfare point of view. Certainly in the light of what has emerged it is necessary to dedicate and pay close attention to the psychological and social aspects of the caregiver

Advantages and Challenges of Tailored Regimens for Drug-Resistant Tuberculosis : A {StopTB} Italia Look into the Future

The emerge of drug-resistant tuberculosis (TB) strain in recent decades is hampering the efforts of the international community to eliminate the disease worldwide. The World Health Organization (WHO) has drafted many strategies to achieve this ambitious goal. In the very beginning, the aim was to standardize inadequate regimens used in many countries and, thereafter, evolved to tackle the social determinants which hinder TB elimination. However, following the path of narrowing the clinical vision to deal with TB, there is an increased need to personalize the treatment considering both patients and pathogen unique characteristics. In our narrative review, we report the advantages and the backwards in developing a method to implement the concept of precision medicine to the treatment of TB. In this dissertation, we highlight the importance to address different aspects of the diseases encompassing the host and pathogen features, as well as the needs to further implement an adequate follow-up based on the available resources. Nevertheless, many things may hamper the vision of precision medicine in TB, such as the complexity and the costs to develop novel compounds and the costs related to global-scale implementation of patient-centered follow-up. To achieve the ambitious goal of TB elimination, a radical change in TB treatment is needed in order to give a more comprehensive approach based both on patients\u2019 peculiarities and driven by drug susceptibility tests and whole-genome sequencing

Olive fruits infested with olive fly larvae respond with an ethylene burst and the emission of specific volatiles

Olive fly (Bactrocera oleae R.) is the most harmful insect pest of olive (Olea europaea L.) which strongly affects fruits and oil production. Despite the expanding economic importance of olive cultivation, up to now, only limited information on plant responses to B. oleae is available. Here, we demonstrate that olive fruits respond to B. oleae attack by producing changes in an array of different defensive compounds including phytohormones, volatile organic compounds (VOCs), and defense proteins. Bactrocera oleae-infested fruits induced a strong ethylene burst and transcript levels of several putative ethylene-responsive transcription factors became significantly upregulated. Moreover, infested fruits induced significant changes in the levels of 12-oxo-phytodienoic acid and C12 derivatives of the hydroperoxide lyase. The emission of VOCs was also changed quantitatively and qualitatively in insect-damaged fruits, indicating that B. oleae larval feeding can specifically affect the volatile blend of fruits. Finally, we show that larval infestation maintained high levels of trypsin protease inhibitors in ripe fruits, probably by affecting post-transcriptional mechanisms. Our results provide novel and important information to understand the response of the olive fruit to B. oleae attack; information that can shed light onto potential new strategies to combat this pes

Toward Environmentally Sustainable Digital Preservation

Digital preservation relies on technological infrastructure (information and communication technology, ICT) that has considerable negative environmental impacts, which in turn threaten the very organizations tasked with preserving digital content. While altering technology use can reduce the impact of digital preservation practices, this alone is not a strategy for sustainable practice. Moving toward environmentally sustainable digital preservation requires critically examining the motivations and assumptions that shape current practice. Building on Goldman's challenge to current practices for digital authenticity and using Ehrenfeld's sustainability framework, we propose explicitly integrating environmental sustainability into digital preservation practice by shifting cultural heritage professionals' paradigm of appraisal, permanence, and availability of digital content. The article is organized in four parts. First, we review the literature for differing uses of the term “sustainability” in the cultural heritage field: financial, staffing, and environmental. Second, we examine the negative environmental effects of ICT throughout the full life cycle of its components to fill a gap in the cultural heritage literature, which primarily focuses on the electricity use of ICT. Next, we offer suggestions for reducing digital preservation's negative environmental impacts through altered technology use as a stopgap measure. Finally, we call for a paradigm shift in digital preservation practice in the areas of appraisal, permanence, and availability. For each area, we propose a model for sustainable practice, providing a framework for sustainable choices moving forward

Analysis of Geometrical Relationships and Friction Losses in Small-Diameter Lay-Flat Polyethylene Pipes

[EN] The use of lay-flat polyethylene pipes to irrigate horticultural crops has been receiving widespread attention in the last decade, due to the significant improvements in their hydraulic performance, their potentially high application efficiency, and their limited installation costs. However, even if hydraulic design procedures for conventional microirrigation systems are fairly well established, there is still the need to know how different pipe-wall thicknesses of lay-flat pipes can affect the pipe geometry under different operating pressures as well as the related consequences on friction losses. This paper, after comparing two different procedures (caliper and photographic) to assess the geometry of lay-flat polyethylene pipes under different operating pressures, analyzes the friction losses per unit of pipe length, J, in order to identify and to assess a procedure for their evaluation. Hydrostatic tests, initially carried out on pipes with wall thicknesses of 6, 8, and 10 thousandth of an inch (mil), evidenced that the pipe dimensions measured with both methods are quite similar, despite the generally higher standard deviations characterizing caliper measurements when compared to photographic method. Tests allowed to verify that most of the changes in pipe dimensions occur within a range of pressure from 0 kPa to about 30 kPa, with pipe horizontal width and vertical height quite similar at higher pressures and pipes have a tendency to become circular. Additionally, due to the elasticity of the material, over a certain limit of water pressure, both the pipe dimensions tend to rise, with a trend depending on pipe thickness. According to the experimental data, the relationships between pipe effective diameter and water pressure were then determined for the three considered pipes. Moreover, based on measured friction losses and pipe effective diameters, it was confirmed that the relationship between the Darcy-Weisbach friction factor, f, and the Reynolds number, R, can be described by a power equation in which, by assuming a value of -0.25 for the exponent, it results a coefficient c = 0.285, lower than the theoretical. For the three investigated pipes the errors associated to estimated J were finally evaluated by considering (1) the experimental relationships between friction factor and Reynolds number as well as between pipe diameter and operating pressure (Case A); (2) the same value of c, but pipe effective diameters of 16.20, 16.10, and 15.85 mm corresponding to p = p(lim) (Case B); (3) the standard procedure, with a value of c = 0.302 and the pipe diameter equal to 16.10 mm, as suggested by the manufacturer. The results evidenced that suitable estimations of J need to account for the variations of the pipe effective diameter with water pressure. On the other hand, incorrect values of pipe diameter combined with inexact values of the friction factor generate inaccurate estimations of friction losses, with unavoidable consequences in pipe design. (C) 2015 American Society of Civil Engineers.The research was cofinanced by Universita di Palermo (FFR 2011) and Ministero dell'Istruzione, dell'Universita e della Ricerca (PRIN 2010). All the authors setup the research and discussed the results. V. Alagna and D. Autovino carried out the experimental measurements and G. Provenzano wrote the paper. A special thank to the Committee for International Relations Office (CORI) of University of Palermo to support the research cooperation with the University of Valencia.Provenzano, G.; Alagna, V.; Autovino, D.; Manzano Juarez, J.; Rallo, G. (2016). Analysis of Geometrical Relationships and Friction Losses in Small-Diameter Lay-Flat Polyethylene Pipes. Journal of Irrigation and Drainage Engineering. 142(2):1-9. https://doi.org/10.1061/(ASCE)IR.1943-4774.0000958S19142

Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome

Background: In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G 12) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G 12 bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods: This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G 12 bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G 12 bacteria were analyzed. Results: Ninety-one included patients [48.5 (37\u201356) years old, 63% male, simplified acute physiology score II 37 (32\u201347)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G 12 bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11). Conclusions: In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G 12 bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death