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

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

Advances in Ecohydrology for Water Resources Optimization in Arid and Semi-Arid Areas

Conserving water resources is a current challenge that will become increasingly urgent in future due to climate change. The arid and semi-arid areas of the globe are expected to be particularly affected by changes in water availability. Consequently, advances in ecohydrology sciences, i.e., the interplay between ecological and hydrological processes, are necessary to enhance the understanding of the critical zone, optimize water resources’ usage in arid and semi-arid areas, and mitigate climate change. This Special Issue (SI) collected 10 original contributions on sustainable land management and the optimization of water resources in fragile environments that are at elevated risk due to climate change. In this context, the topics mainly concern transpiration, evapotranspiration, groundwater recharge, deep percolation, and related issues. The collection of manuscripts presented in this SI represents knowledge of ecohydrology. It is expected that ecohydrology will have increasing applications in the future. Therefore, it is realistic to assume that efforts to increase environmental sustainability and socio-economic development, with water as a central theme, will have a greater chance of success

Contraceptive methods and knowledge of sexually transmitted diseases in nursing students. Results from a survey conducted at the University of Palermo

Background: The main purpose of the study was to evaluatesexual habits, sexual relations and knowledge of sexually transmitted infections (STIs) among the students in the nursing science course of University of Palermo, and to evaluate the use of contraceptive methods.Methods: In April 2019, a survey was provided to students who attend daily lessons in the nursing science course of University of Palermo, that investigate primarily about sexual habits, sexual relations and knowledge of sexually transmitted diseases. A multivariable logistic regression was performed.Results: The sample size consists of 405 students. The average age of the sample is 21.65 years, 69.63% of the interviewees are women. In relation to the question "Do you think you are sufficiently informed to be able to avoid risks of infection from sexually transmitted diseases? No", the analysis shows that this independent variable is significantly associated with the following independent variables: female gender (aOR 3.11, 95% CI 1.01 - 9.65); "how would you define your knowledge about contraceptive methods? - Poor" (aOR 5.38, 95% CI 1.79 - 16.20); "have you ever received information on sex education and/or sexually transmitted diseases? - No" (aOR 11.59, 95% CI 2.26 - 59.42); "do you know the human papillomavirus (HPV) vaccination? - yes, but I'm not vaccinated" (aOR 3.09, 95% CI 1.12 - 8.51); "do you know that men can also undergo HPV vaccination? - No" (aOR 2.67, 95% CI 1.01 - 7.04).Conclusion: Based on our findings, it is necessary to implement sexual education programs for the improvement of knowledge in terms of STIs and the promotion of health. Improving sexual health outcomes for young people is a priority for the public health

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

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

Combination Antifungal Therapy for Invasive Mold Infections Among Pediatric Patients with Hematological Malignancies : Data from A Real-Life Case-Series

Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited. Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients' characteristics. Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial response). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects. Conclusions: In our experience, combination antifungal therapy seems to be a safe option in immunocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting

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