Using a simplified ATP algorithm to improve data reliability and improve cleanliness standards for surface and medical device hygiene

Background: An algorithm has been improved to mitigate variability in cleanliness measurements of various surfaces using rapid Adenosine Triphosphate (ATP) testing. A cleaning intervention step (CIS) verifies the cleanability of those surfaces. Methods: ATP testing was performed on surfaces which were pre-approved as “clean” and ready for re-use. Adjacent (duplicate) ATP sampling was undertaken on 421 environmental surfaces, medical devices and other implements. The CIS was conducted on 270 surfaces using an aseptic technique and disposable cleaning wipes. Results: The two initial ATP results were plotted against each other with a 100 RLU threshold grading the results as clean (2x 100RLU) or equivocal (1x 100RLU). Of the surfaces sampled, 68.5 % were clean (288/421), 13.5 % were dirty (57/421) and 18 % were equivocal (76/421). The duplicate testing demonstrated a false negative rate of 10 % (44/421) where the first swab was 100 RLU. For the equivocal group, the gap between the two swabs was >100 RLU for 7.5 % of surfaces (33/421). The CIS was conducted on 270 of the surfaces tested and showed that cleaning could be improved (P=<0.001) on 88.5 % of surfaces (239/270). Conclusion: The simplified ATP testing algorithm provides real-time discrimination between surface cleanliness levels and improved certainty over surface hygiene. The duplicate swab sampling approach mitigates uncontrolled variability in the results and the CIS provides a nuanced understanding of the measurable cleanliness of any surface

A suggested sampling algorithm for use with ATP testing in cleanliness measurement

Introduction: Rapid Adenosine Triphosphate (ATP) testing is becoming a commonly used method to measure cleanliness on reusable medical devices and healthcare environmental surfaces. Unfortunately, ATP testing devices suffer from inherent variability from a number of sources including imprecision in ATP measurement. Method: This paper proposes a new sampling algorithm which reduces the impact of inherent variability and thus improves decision making when using ATP testing. Conclusion: This algorithm can be applied across a variety of applications to provide more reliable data on measurable cleanliness standards for both medical devices and environmental surfaces. Formal trials using the new ATP sampling algorithm are required

Prevalence and cumulative incidence of food hyper-sensitivity in the first 10 years of life

Background - Prevalence, incidence and natural history of food hypersensitivity (FHS) and its trends in an unselected cohort of older children are unclear.Methods - A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated. At 10 years of age, children were also invited for a blood test.Results - A total of 969 children were recruited at 12 weeks of pregnancy, and 92.9%, 88.5%, 91.6% and 85.3% were assessed at 1, 2, 3 and 10 years. Prevalence of sensitization to any allergen over 10 years was 186 of 969 (19.2%; 95% CI: 16.84–21.8) and 108 of 969 (11.2%; 95% CI: 9.31–13.29) children were sensitized to at least one predefined food allergen. Excluding wheat (due to cross-reactivity with pollen), 40 of 969 (4.1%; 95% CI: 3.19–5.32) children were sensitized to a predefined food allergen. Using food challenges and/or a good clinical history, the cumulative incidence of food hypersensitivity (FHS) in the first decade of life was 64 of 947 (6.8%, 95% CI: 5.2–8.4), while the prevalence of FHS at 10 years was 30 of 827 (3.6%, 95% CI: 2.54–5.15). The vast majority, 25 of 827 (3.0%, 95% CI: 1.8–4.2), suffered from IgE-mediated food allergy, while 5 of 827 (0.6%, 95% CI: 0.07–1.3) had non-IgE-mediated food allergy/food intolerance.Conclusions - By the age of 10 years, 6.8% of children suffered from FHS based on food challenges and a good clinical history. There was a large discrepancy between reported and diagnosed FHS

Association between healthy eating in pregnancy and allergic status of the offspring in childhood

During the past few decades there has been a steady increase in the prevalence of noncommunicable diseases, including allergic disease. Changing lifestyle and subsequent diet may explain this increase seen in the prevalence of atopic disease. Epidemiologic evidence also suggests that diet may be key in the prevention of allergic disease. [1] There are 3 important characteristics in terms of the maternal diet that have been investigated for the prevention of allergic disease: (1) the role of particular nutrients, such as vitamins (A, D, and E), zinc, and fatty acids; (2) the role of particular foods, such as fruits and vegetables and fish; and (3) the total dietary intake, such as a Mediterranean diet or a healthy diet. Research using the healthy eating index tool, specific to the pregnancy diet, found no association between overall healthy eating score and recurrent wheeze in infants at the age of 3 years. [2] However, maternal intake of celery and citrus fruit specifically has been associated with an increased risk of sensitization to food allergens in 2-year-olds. [3] One case-control study found no effect of consumption of fish, butter, and margarine on the development of atopic sensitization in the offspring of allergic mothers; however, a protective effect of fish intake (2–3 times a week or more) was identified in the nonallergic mothers' group with the risk of food sensitization in the offspring reduced by greater than a third. [4] Thus, the question is whether the associations seen are due to the individual nutrients or foods or whether it is part of an overall nutritional composition of the weaning diet. In this study, we aimed to investigate whether maternal diet, specifically seafood intake during pregnancy, is associated with the infant's allergic outcomes in a well-characterized birth cohort with allergy at 3 and 10 years of age

Very low prevalence of IgE mediated wheat allergy and high levels of cross-sensitisation between grass and wheat in a UK birth cohort

BackgroundPatients often report adverse reactions to wheat. Interpretation of sensitization to wheat pollen and flour with/without sensitization to grass pollen is a clinical problem.AimWe set out to determine the prevalence of wheat allergy in a birth cohort (10/11 year olds) and investigate the usefulness of performing skin prick tests (SPT), specific IgE tests and component resolved diagnostics to wheat pollen and flour.MethodsThe Food Allergy and Intolerance Research (FAIR) birth cohort included babies born on the Isle of Wight (UK) between September 2001–August 2002 (n = 969). Children were followed up at 1, 2, 3 and 10/11 years. 588 children had SPTs to wheat pollen and grass during the 10 year follow-up. 294 children underwent further SPT to wheat flour and 246 had specific IgE testing to wheat and grass.ResultsEight children underwent oral food challenges (OFC). We diagnosed 0.48 % (4/827; 95 % CI 0–1 %) children with wheat allergy based on OFC. 16.3 % (96/588) were sensitized to grass pollen, 13.4 % (79/588) to wheat pollen; 78 % (75/96) sensitized to both. Only one child was sensitized to wheat flour and wheat pollen, but not grass pollen. For specific IgE, 15.0 % (37/246) and 36.2 % (89/246) were sensitized to wheat and grass pollen, with 40.5 % (36/89) sensitized to both. Of the 37 children sensitized to wheat, 3 (8.1 %) were sensitized to omega 5 gliadin, 1 (2.7 %) to wheat lipid transfer protein and 1 to wheat gliadin.ConclusionClinicians should be aware of the high level of cross-sensitization when performing tests to wheat and grass pollen i.e. sensitisation to wheat specific IgE and wheat pollen SPT should be assessed in the presence of grass pollen SPT and/or specific IgE

Temporal change in maternal dietary intake during pregnancy and lactation between and within 2 pregnancy cohorts assembled in the United Kingdom

Background: The association between maternal and infant dietary exposures and risk of allergic disease development is an area of considerable scientific uncertainty. Objective: This study aims to compare dietary habits during pregnancy and lactation in two pre-birth cohorts from the same location approximately 10 years apart, a timeframe characterised by changes in government dietary advice. Methods: The FAIR cohort is an unselected birth cohort born between 2001-2002. The 3rd generation cohort was born between 2010-2018. Both cohorts were established on the Isle of Wight (UK) to investigate prevalence of allergic diseases. Nutrition and allergy data was collected prospectively from recruitment and throughout the infant’s early life. Here we present dietary data collected in the third trimester of pregnancy and at three months of age. Differences between cohorts were tested using t-tests, Wilcoxon rank sum tests, chi-squared and Fisher’s exact tests. Results: Data was available for 1331 participants (969 FAIR and 362 3rd generation). The proportion of mothers that reported excluding peanuts during pregnancy was significantly lower for the 3rd generation compared to the FAIR cohort (16.0% vs. 55.6%, p < 0.01). Cohort membership, primiparity, and maternal education were significantly associated with excluding peanuts during pregnancy (p < 0.01). The proportion of mothers who reported excluding any foods during breastfeeding was significantly lower for the 3rd generation compared to the FAIR cohort (22.8% vs. 43.4%, p < 0.01). Conclusion: Maternal exclusion of peanut during pregnancy was lower for mothers giving birth between 2012-2018, compared to mothers giving birth between 2001-2002

Cows’ milk exclusion diet during infancy: is there a long term effect on children's eating behaviour and food preferences?

Background: Dietary restriction during infancy may influence later eating behaviour. The aim of this study was to determine if consuming a cows’ milk exclusion (CME) diet during infancy affects eating habits in later childhood, once cows’ milk has been reintroduced into the diet. Methods: Children were recruited from two large birth cohort studies in the UK. A small number of participants were recruited from allergy clinic. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group, who had consumed an unrestricted diet during infancy. Parents and children completed questionnaires regarding eating behaviour and food preferences. Results: 101 children of mean age 11.5 years were recruited (28 CME and 73 control). The CME group scored significantly higher on “slowness of eating” and on the combined “avoidant eating behaviour” construct (p < 0.01). The number of foods avoided and symptoms were associated with higher levels of avoidant eating behaviour (p < 0.05). The CME group rated liking for several dairy foods (butter, cream, chocolate, full fat milk and ice cream) significantly lower than the control group (p < 0.05), although there were no significant differences seen for any other category of food. Conclusion: This study demonstrated that consuming a CME diet during infancy has persistent and long-term effects on eating habits and food preferences. To reduce future negative eating behaviours, children’s exclusion diets need to be as varied as possible and reintroduction of cows’ milk products closely monitored

Conditions under which glutathione disrupts the biofilms and improves antibiotic efficacy of both ESKAPE and NON-ESKAPE species

Bacterial antibiotic resistance has increased in recent decades, raising concerns in hospital and community settings. Novel, innovative strategies are needed to eradicate bacteria, particularly within biofilms, and diminish the likelihood of recurrence. In this study, we investigated whether glutathione (GSH) can act as a biofilm disruptor, and enhance antibiotic effectiveness against various bacterial pathogens. Biological levels (10 mM) of GSH did not have a significant effect in inhibiting growth or disrupting the biofilm in four out of six species tested. However, exposure to 30 mM GSH showed >50% decrease in growth for all bacterial species, with almost 100% inhibition of Streptococcus pyogenes and an average of 94–52% inhibition for Escherichia coli, Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive S. aureus (MSSA) and multi-drug resistant Acinetobacter baumannii (MRAB) isolates, respectively. Klebsiella pneumoniae and Enterobacter sp. isolates were however, highly resistant to 30 mM GSH. With respect to biofilm viability, all species exhibited a >50% decrease in viability with 30 mM GSH, with confocal imaging showing considerable change in the biofilm architecture of MRAB isolates. The mechanism of GSH-mediated biofilm disruption is possibly due to a concentration-dependent increase in GSH acidity that triggers cleaving of the matrix components. Enzymatic treatment of MRAB revealed that eDNA and polysaccharides are essential for biofilm stability and eDNA removal enhanced amikacin efficiency. Combination of GSH, amikacin and DNase-I showed the greatest reduction in MRAB biofilm viability. Additionally, GSH alone and in combination with amikacin fostered human fibroblast cell (HFF-1) growth and confluence while inhibiting MRAB adhesion and colonization

Statistical M-Estimation and Consistency in Large Deformable Models for Image Warping

The problem of defining appropriate distances between shapes or images and modeling the variability of natural images by group transformations is at the heart of modern image analysis. A current trend is the study of probabilistic and statistical aspects of deformation models, and the development of consistent statistical procedure for the estimation of template images. In this paper, we consider a set of images randomly warped from a mean template which has to be recovered. For this, we define an appropriate statistical parametric model to generate random diffeomorphic deformations in two-dimensions. Then, we focus on the problem of estimating the mean pattern when the images are observed with noise. This problem is challenging both from a theoretical and a practical point of view. M-estimation theory enables us to build an estimator defined as a minimizer of a well-tailored empirical criterion. We prove the convergence of this estimator and propose a gradient descent algorithm to compute this M-estimator in practice. Simulations of template extraction and an application to image clustering and classification are also provided