A Modified Scheme for the Isolation and Enumeration of Bacteria in Municipal Sewage Sludge

Because of the potential health hazards associated with the use of sludge for agricultural purposes, Dudley et al (1980) published a scheme for the routine analysis of bacteria in municipal sewage sludge. In this study, the Dudley et al scheme (1980) was modified by updating some of the procedures. Aerobically digested sludge generated by the Bowling Green Wastewater Treatment Plant, Bowling Green, Kentucky, was analyzed using the modified scheme. Sludge samples were collected once every two months over a one-year period from October 1989 to August 1990. Egg yolk-free tryptose sulfite cycloserine agar in conjunction with the revewrse CAMP test was used to assay for Clostridium perfringens. This procedure improved the one proposed by Dudley et al. (1980) by achieving a higher confirmation rate, reducing testing time, allowing for easier interpretation of results, and increasing accuracy. Selective and differential media by Rippey and Cabelli (1979) were added to the scheme to isolate Aeromonas, Aeroomonas hydrophila and Aeromonas caviae were successfully isolated wand were identified using the system by Cunliffe and Adcock (1989) for speciating aeromonads. Baird-Parker medium was compared to mannitol salt agar for effectiveness in isolating Staphylococcus from sludge. Statistical analysis showed Baird-Parker medium to be significantly more effective than mannitol salt agar. However, neither agar reduced background flora to acceptable levels. Staphylococcus isolates were subject to species identification by the API Staph Ident system (Analytab Products, Plainview, New York). Staphylococcus xylosus, Staphylococcus haemolyticus, and Staphylococcus epidermidis were found to be present in the sludge. A procedure by Ottolenghi and Hamparian (1987) was employed to isolate Salmonella in sludge. No salmonellae were isolated over the one year period. Over the year-long study, bacterial numbers, with the exception of Clostridium perfringens and the total aerobic count, fluctuated with variations in the aerobic digester temperature. Numbers decreased as temperature increased. Clostridium perfringens counts were the most consistent throughout the year and exceeded fecal coliform and fecal streptococci counts in five of the six samplings

The morphology of lath martensite: a new perspective

A mathematical framework is proposed to predict the features of the (5 5 7) lath transformation in low-carbon steels based on energy minimisation. This theory generates a one-parameter family of possible habit plane normals and a selection mechanism then identifies the (5 5 7) normals as those arising from a deformation with small atomic movement and maximal compatibility. While the calculations bear some resemblance to those of double shear theories, the assumptions and conclusions are different. Interestingly, the predicted microstructure morphology resembles that of plate martensite, in the sense that a type of twinning mechanism is involved

Validation of ICD-9-CM diagnosis codes for surgical site infection and noninfectious wound complications after mastectomy

BACKGROUNDFew studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.OBJECTIVESTo determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.METHODSWe reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.RESULTSThe PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).CONCLUSIONSOur results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).Infect Control Hosp Epidemiol 2017;38:334–339</jats:sec

Effectiveness of group-based self-management education for individuals with Type 2 diabetes:A systematic review with meta-analyses and meta-regression

Aims: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self-management behaviours. This systematic review aimed to determine the effectiveness of group-based interventions compared with individual interventions or usual care for improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes. Methods: Six electronic databases were searched. Group-based education programmes for adults with Type 2 diabetes that measured glycated haemoglobin (HbA1c) and followed participants for ≥ 6 months were included. The primary outcome was HbA1c, and secondary outcomes included fasting blood glucose, weight, body mass index, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self-efficacy. Results: Fifty-three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA1c occurred in group-based education compared with controls at 6–10 months [n = 30 studies; mean difference (MD) = 3 mmol/mol (0.3%); 95% confidence interval (CI): −0.48, −0.15; P = 0.0002], 12–14 months [n = 27 studies; MD = 4 mmol/mol (0.3%); 95% CI: −0.49, −0.17; P < 0.0001], 18 months [n = 3 studies; MD = 8 mmol/mol (0.7%); 95% CI: −1.26, −0.18; P = 0.009] and 36–48 months [n = 5 studies; MD = 10 mmol/mol (0.9%); 95% CI: −1.52, −0.34; P = 0.002], but not at 24 months. Outcomes also favoured group-based education for fasting blood glucose, body weight, waist circumference, triglyceride levels and diabetes knowledge, but not at all time points. Interventions facilitated by a single discipline, multidisciplinary teams or health professionals with peer supporters resulted in improved outcomes in HbA1c when compared with peer-led interventions. Conclusions: Group-based education interventions are more effective than usual care, waiting list control and individual education at improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.No Full Tex

A central line care maintenance bundle for the prevention of central line–associated bloodstream infection in non–intensive care unit settings

OBJECTIVE: To evaluate a central line care maintenance bundle to reduce central line-associated bloodstream infection (CLABSI) in non-ICU settings. DESIGN: Before-after trial with 12 month follow-up period. SETTING: 1250-bed teaching hospital. PARTICIPANTS: Patients with central lines on eight general medicine wards. Four wards received the intervention and four served as controls. INTERVENTION: A multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance. RESULTS: Data were collected for 25,542 catheter-days including 43 CLABSI (rate = 1.68 per 1,000 CL-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors, but this was not statistically significant (95% confidence interval (CI); −5.3 – 0.4). On control floors, there was a smaller, but marginally significant decrease in CLABSI incidence during the study (change in monthly rate = −1.1%; 95% CI, −2.1 - −0.1). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance pre-intervention vs. 87.9% during intervention/follow-up; p<0.001) but improvement was also observed on control wards (84.9% compliance pre-intervention vs. 90.9% during intervention/follow-up; P = .001). CONCLUSIONS: A multi-faceted program to improve catheter care was associated with improvement in catheter dressing care, but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non-ICU patients

Building skills, knowledge and confidence in eating and exercise behavior change: Brief motivational interviewing training for healthcare providers

Objective: Obesity related health problems affect individuals, families, communities and the broader health care system, however few healthcare providers (e.g., doctors, nurses, social workers, psychologists, counselors) receive formal training in obesity prevention interventions. We examined the effectiveness of training healthcare providers in brief motivational interviewing (brief MI) targeting eating and exercise behavior change. Methods: 163 healthcare providers participated. 128 participants completed a one-day experiential brief MI training workshop followed by electronic peer-support and a further 35 matched controls did not receive the training. Results: Participant's knowledge of brief MI and confidence in their ability to counsel patients using brief MI significantly improved following training (p< 0.05) and remained at 3 and 6-month follow-up (p< 0.05). Brief MI skills assessed during the simulated patient interactions indicated a significant improvement across two practical training blocks (p< 0.05). Conclusion: Healthcare providers can learn brief MI skills and knowledge quickly and confidence in their counseling abilities improves and is sustained. Practice implications: Healthcare providers may consider brief MI as an obesity prevention intervention

Soft clustering analysis of galaxy morphologies: A worked example with SDSS

Context: The huge and still rapidly growing amount of galaxies in modern sky surveys raises the need of an automated and objective classification method. Unsupervised learning algorithms are of particular interest, since they discover classes automatically. Aims: We briefly discuss the pitfalls of oversimplified classification methods and outline an alternative approach called "clustering analysis". Methods: We categorise different classification methods according to their capabilities. Based on this categorisation, we present a probabilistic classification algorithm that automatically detects the optimal classes preferred by the data. We explore the reliability of this algorithm in systematic tests. Using a small sample of bright galaxies from the SDSS, we demonstrate the performance of this algorithm in practice. We are able to disentangle the problems of classification and parametrisation of galaxy morphologies in this case. Results: We give physical arguments that a probabilistic classification scheme is necessary. The algorithm we present produces reasonable morphological classes and object-to-class assignments without any prior assumptions. Conclusions: There are sophisticated automated classification algorithms that meet all necessary requirements, but a lot of work is still needed on the interpretation of the results.Comment: 18 pages, 19 figures, 2 tables, submitted to A

Distribution of the birds of the Philippines: biogeography and conservation priorities

The Philippine islands hold a concentration of species diversity and endemism of global importance, yet few studies have analyzed biogeographic patterns or attempted to prioritize areas for conservation within the archipelago. We analyzed distributions of 386 species on 28 Philippine islands and island groups, documenting intense concentration of species richness, especially of endemic species, on the two largest islands, Mindanao and Luzon. Factors identified as influencing species richness included island area, maximum elevation, and Pleistocene patterns of connection and isolation. Reserve systems were developed based on heuristic complementarity algorithms, and compared with the existing Integrated Protected Areas (IPAS) system in the country, showing that IPAS is an impressive first step towards protecting avian diversity in the country. Addition of presently proposed reserves on Palawan and Mindoro would make IPAS a near-optimal reserve design, at least at the level of island representation. Important challenges remain, however, with regard to design of reserve systems within islands to represent complete island avifaunas