Climate change and ocean acidification impacts on lower trophic levels and the export of organic carbon to the deep ocean

Most future projections forecast significant and ongoing climate change during the 21st century, but with the severity of impacts dependent on efforts to restrain or reorganise human activity to limit carbon dioxide (CO2) emissions. A major sink for atmospheric CO2, and a key source of biological resources, the World Ocean is widely anticipated to undergo profound physical and – via ocean acidification – chemical changes as direct and indirect results of these emissions. Given strong biophysical coupling, the marine biota is also expected to experience strong changes in response to this anthropogenic forcing. Here we examine the large-scale response of ocean biogeochemistry to climate and acidification impacts during the 21st century for Representative Concentration Pathways (RCPs) 2.6 and 8.5 using an intermediate complexity global ecosystem model, MEDUSA-2.0. The primary impact of future change lies in stratification-led declines in the availability of key nutrients in surface waters, which in turn leads to a global decrease (1990s vs. 2090s) in ocean productivity (?6.3%). This impact has knock-on consequences for the abundance of the low trophic level biogeochemical actors modelled by MEDUSA-2.0 (?5.8%), and these would be expected to similarly impact higher trophic level elements such as fisheries. Related impacts are found in the flux of organic material to seafloor communities (?40.7% at 1000 m), and in the volume of ocean suboxic zones (+12.5%). A sensitivity analysis removing an acidification feedback on calcification finds that change in this process significantly impacts benthic communities, suggesting that a~better understanding of the OA-sensitivity of calcifying organisms, and their role in ballasting sinking organic carbon, may significantly improve forecasting of these ecosystems. For all processes, there is geographical variability in change – for instance, productivity declines ?21% in the Atlantic and increases +59% in the Arctic – and changes are much more pronounced under RCP 8.5 than the RCP 2.6 scenario

Antimicrobial activity of a continuous visible light disinfection system

We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period

Antimicrobial activity of a continuously active disinfectant against healthcare pathogens

A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae

Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials

Over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, Acinetobacter spp). For example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for acquiring one of these pathogens than a patient admitted to a room whose previous occupant was not colonized or infected. This risk is not surprising because multiple studies have demonstrated that surfaces in hospital rooms are poorly cleaned during terminal cleaning. To reduce surface contamination after terminal cleaning, no touch methods of room disinfection have been developed. This article will review the no touch methods, ultraviolet light devices, and hydrogen peroxide systems, with a focus on clinical trials which have used patient colonization or infection as an outcome. Multiple studies have demonstrated that ultraviolet light devices and hydrogen peroxide systems have been shown to inactivate microbes experimentally plated on carrier materials and placed in hospital rooms and to decontaminate surfaces in hospital rooms naturally contaminated with multidrug-resistant pathogens. A growing number of clinical studies have demonstrated that ultraviolet devices and hydrogen peroxide systems when used for terminal disinfection can reduce colonization or health care-associated infections in patients admitted to these hospital rooms

Patient characteristics and health system factors associated with adjuvant radiation therapy receipt in older women with early-stage endometrial cancer

Introduction: Among women with early-stage endometrial cancer (EC), age, stage, grade, and histology are used to determine fitness for adjuvant radiation therapy (RT) administration. We examined non-cancer factors associated with adjuvant RT receipt in older women with early-stage EC. Materials & methods: Using data from the Surveillance Epidemiology and End Results cancer registry program linked with Medicare claims, we identified 25,654 women (aged ≥66 years) diagnosed with first primary stage I-II EC during 2004–2017 who underwent a hysterectomy. Diagnosis and procedure codes were used to identify adjuvant RT claims filed for the seven-month period post-hysterectomy. Multivariable log-binomial regression was used to estimate adjuvant RT prevalence associated with patient characteristics and health system factors after adjustment for age, frailty, and endometrial factors. Results: Adjuvant RT was less commonly administered to Asian American and Pacific Islander patients than non-Hispanic White patients (Prevalence ratio [PR], 0.84; 95% confidence interval [CI], 0.73 to 0.97). Compared to women treated in the Northeast region, women treated other regions of the US were less likely to undergo adjuvant RT (PR, 0.75; 95% CI, 0.71 to 0.79). Residing in rural or high neighborhood-poverty counties was associated with lower adjuvant RT administration. Higher comorbidity score was not associated with reduced prevalence of adjuvant RT receipt; however, women with high probability of predicted probability of frailty were less likely to undergo adjuvant RT (PR, 0.67; 95% CI, 0.55 to 0.81) compared to women with low probability of frailty. Women who received lymph node assessment were more likely to undergo adjuvant RT compared to women who did not (PR, 1.43; 95% CI, 1.34 to 1.51). Women treated by a gynecologic oncologist were more likely to undergo adjuvant RT compared to women treated by a non-gynecologic oncologist (PR 1.09; 95% CI, 1.04 to 1.14). Adjuvant RT was more commonly administered to women treated in larger academic hospitals. Discussion: Findings suggest that various non-cancer factors affect the delivery of adjuvant RT to older women with early-stage EC in real-world oncology practice. Advancing our understanding of factors associated with adjuvant RT administration may help expand equitable access to RT

Adjuvant radiation therapy and health-related quality of life among older women with early-stage endometrial cancer: an analysis using the SEER-MHOS linkage

Purpose: Radiation therapy (RT) has been associated with decreased health-related quality of life (HRQOL) in clinical trials of early-stage endometrial cancer (EC), but few studies have examined the association in real-world settings. We assessed HRQOL associated with adjuvant RT for older women with early-stage EC within a large U.S. population-based registry resource. Methods: The Surveillance Epidemiology and End Results and the Medicare Health Outcomes Survey linkage (1998–2017) was used to identify women with early-stage EC aged ≥ 65 years at survey who received surgery and were diagnosed ≥ 1-year prior (n = 1,140). HRQOL was evaluated with the 36-item Short-Form Health Survey (SF-36) until 2006 and the Veterans RAND 12-Item Health Survey (VR-12) post 2006. Ordinary least squares regression was used to estimate mean difference (MD) in T scores and 95% confidence intervals (CIs) comparing treatment groups (surgery alone, adjuvant external beam radiation therapy [EBRT], or adjuvant vaginal brachytherapy [VBT]) after accounting for confounders using propensity score weighting. Results: Overall, RT was not associated with physical health (MD = 0.97; 95% CI = − 1.13, 3.07) or mental health (MD = − 0.78; 95% CI = − 2.60, 1.05) relative to surgery alone. In analyses by RT type, adjuvant VBT was associated with better general health on the SF-36/VR-12 subscale (MD = 3.59; 95% CI = 0.56, 6.62) relative to surgery alone. No statistically significant associations were observed for adjuvant VBT and physical or mental health, or for adjuvant EBRT and any HRQOL domain. Conclusion: Older women with early-stage EC treated with adjuvant RT did not report worse physical and mental HRQOL scores compared to those treated with surgery alone, though relevant symptoms should be evaluated further to fully understand the disease and treatment specific aspects of the HRQOL

Unravelling social constructionism

Social constructionist research is an area of rapidly expanding influence that has brought together theorists from a range of different disciplines. At the same time, however, it has fuelled the development of a new set of divisions. There would appear to be an increasing uneasiness about the implications of a thoroughgoing constructionism, with some regarding it as both theoretically parasitic and politically paralysing. In this paper I review these debates and clarify some of the issues involved. My main argument is that social constructionism is not best understood as a unitary paradigm and that one very important difference is between what Edwards (1997) calls its ontological and epistemic forms. I argue that an appreciation of this distinction not only exhausts many of the disputes that currently divide the constructionist community, but also takes away from the apparent radicalism of much of this work

Continuous room decontamination technologies

The contaminated surface environment in the rooms of hospitalized patients is an important risk factor for the colonization and infection of patients with multidrug-resistant pathogens. Improved terminal cleaning and disinfection have been demonstrated to reduce the incidence of health care–associated infections. In the United States, hospitals generally perform daily cleaning and disinfection of patient rooms. However, cleaning and disinfection are limited by the presence of the patient in room (eg, current ultraviolet devices and hydrogen peroxide systems cannot be used) and the fact that after disinfection pathogenic bacteria rapidly recolonize surfaces and medical devices/equipment. For this reason, there has been great interest in developing methods of continuous room disinfection and/or “self-disinfecting” surfaces. This study will review the research on self-disinfecting surfaces (eg, copper-coated surfaces and persistent chemical disinfectants) and potential new room disinfection methods (eg, “blue light” and diluted hydrogen peroxide systems)

Assessment of self-contamination during removal of personal protective equipment for Ebola patient care

OBJECTIVE Ebola virus disease (EVD) places healthcare personnel (HCP) at high risk for infection during patient care, and personal protective equipment (PPE) is critical. Protocols for EVD PPE doffing have not been validated for prevention of viral self-contamination. Using surrogate viruses (non-enveloped MS2 and enveloped Φ6), we assessed self-contamination of skin and clothes when trained HCP doffed EVD PPE using a standardized protocol. METHODS A total of 15 HCP donned EVD PPE for this study. Virus was applied to PPE, and a trained monitor guided them through the doffing protocol. Of the 15 participants, 10 used alcohol-based hand rub (ABHR) for glove and hand hygiene and 5 used hypochlorite for glove hygiene and ABHR for hand hygiene. Inner gloves, hands, face, and scrubs were sampled after doffing. RESULTS After doffing, MS2 virus was detected on the inner glove worn on the dominant hand for 8 of 15 participants, on the non-dominant inner glove for 6 of 15 participants, and on scrubs for 2 of 15 participants. All MS2 on inner gloves was observed when ABHR was used for glove hygiene; none was observed when hypochlorite was used. When using hypochlorite for glove hygiene, 1 participant had MS2 on hands, and 1 had MS2 on scrubs. CONCLUSIONS A structured doffing protocol using a trained monitor and ABHR protects against enveloped virus self-contamination. Non-enveloped virus (MS2) contamination was detected on inner gloves, possibly due to higher resistance to ABHR. Doffing protocols protective against all viruses need to incorporate highly effective glove and hand hygiene agents