The revolving door between hospital and community: extended-spectrum beta-lactamase-producing Escherichia coli in Dublin.

BACKGROUND: Escherichia coli that produce extended-spectrum beta-lactamases (ESBLs) are an increasing cause of healthcare-associated infection, and community healthcare facilities may be a reservoir for important epidemic clones. AIM: To characterize retrospectively and investigate the epidemiology of ESBL-producing E. coli collected in a Dublin hospital, during 2009 and 2010, and to investigate the dissemination of specific clones within hospital and community healthcare facilities. METHODS: Pulsed-field gel electrophoresis (PFGE) was used to determine the genetic relatedness of 100 ESBL-producing E. coli isolates. Phylogenetic groups were determined and the O25b-ST131 clone identified in the collection. The genetic data were correlated with antimicrobial susceptibility, clinical and demographic data to explore the epidemiology of specific clones. FINDINGS: Phylogenetic groups B2 (62%) and D (18%) were the most common and were associated with non-urinary isolates (P CONCLUSIONS: E. coli O25b-ST131 is largely responsible for ESBL-producing E. coli in LTCFs in Dublin. The distribution of ESBL-producing E. coli in our hospital and community highlights a \u27revolving door\u27 through which these resistant bacteria spread and disseminate

Exploration of the Physical Activity Guidelines for People with Multiple Sclerosis

Background Despite the numerous benefits of exercise and the publication of the physical activity guidelines (PAG) in 2013, most people with multiple sclerosis (PWMS) remain physically inactive. Appropriately supported opportunities to engage in physical activity in the community remain scarce, so the extent to which the PAGs inform practice is unclear. The overarching aim of the thesis was to explore what helps PWMS engage in exercise in the community, using the physical activity guidelines as a guide. To achieve this, the thesis explored the exercise experiences, preferences, and support needs of PWMS. Methods The research programme included four connected studies using a range of methodologies. Study 1 (Chapter 3) adopted a qualitative approach to explore the thoughts of people with high MS disability. Study 2 (chapter 4) was a mixed-methods feasibility study to explore high-intensity interval training in PWMS. Study 3 (chapter 6) was a qualitative study exploring the opinions of healthcare professionals and PWMS. Study 4 (chapter 8) was a mixed-methods evaluation of a community-based exercise intervention. Additionally, the thesis includes a scoping review (chapter 5) and a systematic intervention development process using the behaviour change wheel (chapter 7). A pragmatic theoretical perspective underpins the research programme as findings were pursued that are applicable in practice and the community. Key Findings The PAGs for PWMS lack inclusivity and provide little detail of exercise prescription and application. High-intensity exercise was safe and feasible for PWMS but with limited long-term appeal. For PWMS and some healthcare professionals, there is a need to change their perception of exercise professionals' competence in working with PWMS. Additionally, healthcare professionals state that discussing exercise with their patients is not a priority. Within the community, interventions are primarily aimed at people with mild MS. Also, PAGs and behaviour change theory are used sporadically in community interventions. Encouragingly, a community-based intervention underpinned by BCT and structured using the PAGs was well attended by participants, improved constructs of the COM-B model, and may improve physical activity levels, fatigue, quality of life, self-efficacy, and physical function. Conclusions The PAGs exist to help support PWMS to exercise in the community. The deep understanding of the exercise experiences, preferences, and needs of PWMS gleaned through this body of work suggests that the PAGs are currently ineffective, as the infrastructure is not in place for PWMS to enact the behaviour. Theory-informed community-based interventions show promise and need to be used to create an ecosystem where PWMS feel capable, and have the opportunities, and motivation to engage in exercise

Search and you will find: detecting extended-spectrum β-lactamase-producing Klebsiella pneumoniae from a patient\u27s immediate environment.

Contamination of inanimate surfaces contribute to the transmission of healthcare-associated infection which is well documented for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci VRE (3, 5, 10). The high rate of skin colonisation with these bacteria among healthcare workers increases the risk of cross-contamination of high-touch surfaces (6). Since Gram-negative bacteria survive poorly on surfaces, their role in transmission of infection has not been as widely investigated. Extended spectrum beta-lactamase-producing enterobacteriaciae (ESBL-PE) are now widespread and endemic in nosocomial settings (2, 4) and given the increasing prevalence of infections involving ESBL-PE, the role of the environment in ESBL-PE transmission should be explored. This study reports the evaluation of two ESBL-PE recovery methods from typical hospital surface materials and their application for recovery of ESBL-PE adjacent to an ESBL-positive patient

Towards more sustainable synthesis of diketopyrrolopyrroles

The alkylation of 1,4-diketo-3,6-arylpyrrolo[3,4-c]pyrroles (ArDPP) is one of the most important steps in the synthesis of soluble materials based on these molecules and the polymers derived from them (that are employed widely in putative organic solar cells). Here we report an improvement in their method of synthesis replacing habitual solvent and base. Compared with more usual conditions, we employed acetonitrile as solvent to give higher or similar yields, with less toxic and hazardous waste, lower reaction time and temperature, and allows recycling of unreacted starting materials. Unlike dimethylformamide and N-methylpyrrolidone, which are the most commonly employed solvents. Our reaction conditions have been tested on three different ArDPPs (Ar = thiophene, phenyl and 4-methoxyphenyl) with a variety of linear and branched alkyl reagents. The results show similar and improved results in comparison with the published reports while reducing the waste and hazard of the reaction, as well as simplifying the purification of the products in many cases. Overall this method has lower environmental impact, is more cost effective and requires neither the use of dry solvent nor inert atmosphere

An integrated model of exercise support for people affected by cancer: consensus through scoping

© 2020 Informa UK Limited, trading as Taylor & Francis Group. Introduction: Exercise support for people with cancer is a national priority. The purpose of this study was to identify the success factors necessary to create a model of exercise support for people affected by cancer in a large city in the north of England. Method: Two groups of participants were recruited; people affected by cancer (n = 26) and professional stakeholders (n = 14) contributing to either focus groups or semi-structured interviews. Data were analysed using framework analysis. Results: Results from this study suggest that the promotion of exercise is not a priority in routine cancer care. Patients identified a lack of support and difficulty attaining information as a barrier to becoming active, emphasising a gulf between the patients’ needs and the health professionals’ priorities. People affected by cancer and professionals agreed that exercise was beneficial to cancer patients both during and after treatment. For an exercise pathway to be successful, key factors were identified including accessibility; tailored support; social interaction; affordability; competence of exercise delivery staff. Conclusions: There was consensus on the importance of exercise and critical factors required to develop a sustainable, accessible and effective service. Evidence to inform the development of an exercise pathway for people affected by cancer is provided.Implications for rehabilitation Exercise should be an included component of a cancer treatment plan, discussed and initiated from diagnosis. Health professionals have a responsibility to provide clear, consistent evidence-based advice on exercise. Exercise professionals must be appropriately trained in cancer rehabilitation according to National Institute for Health and care Excellence (2014). Individual assessments of exercise needs, preferences and cancer limitations will result in a bespoke plan of recommendations and support. The option of group activities has the advantage of increased social interaction, peer support and shared experiences. Available exercise/physical activity services should be accessible and affordable but may involve a modest contribution

Carrier distribution in InGaN/GaN tricolor multiple quantum well light emitting diodes

Carrier transport in InGaN light emitting diodes has been studied by comparing the electroluminescence (EL) from a set of triple quantum well structures with different indium content in each well, leading to multicolor emission. Both the sequence and width of the quantum wells have been varied. Comparison of the EL spectra reveals the current dependent carrier transport between the quantum wells, with a net carrier flow toward the deepest quantum well. (C) 2009 American Institute of Physics. (doi:10.1063/1.3244203

Evaluation of a city-wide physical activity pathway for people affected by cancer: the Active Everyday service

Purpose: The primary goal of this article is to present an evaluation of a UK-based city-wide physical activity pathway for patients with a cancer diagnosis, the Active Everyday service. Active Everyday was a co-produced physical activity service for people affected by cancer. The service was underpinned by a behaviour change care pathway model developed by Macmillan Cancer Support charity. Methods: This was a retrospective evaluation assessing physical activity levels and changes to outcome measures (fatigue, perceived health, and self-efficacy) over 6 months. Each participant self-reported their levels of physical activity for the previous 7 days at three-time points: baseline (T1), at 12-week exit from the scheme (T2), and at 6-month follow-up (T3). Results: The Active Everyday service received 395 referrals, of which 252 attended a baseline assessment. Participants’ fatigue and self-efficacy improved between T1 and T2 and T1 and T3. Perceived health improved across all time points. Participant exercise levels showed significant differences between T1 and T2. Conclusion: The service, provided over 3 years, resulted in positive health and wellbeing outcomes in people affected by cancer who engaged in the service. Future services must routinely include exercise referrals/prescriptions as a standard part of care to help engage inactive individuals. Services should focus on targeted promotion to people from ethnic minority groups, and a wide socioeconomic population

Establishing Innovative Complex Services: Learning from the Active Together Cancer Prehabilitation and Rehabilitation Service

Prehabilitation and rehabilitation will be essential services in an ageing population to support patients with cancer to live well through their life spans. Active Together is a novel evidence-based service embedded within existing healthcare pathways in an innovative collaboration between health, academic, and charity organisations. Designed to improve outcomes for cancer patients and reduce the demand on healthcare resources, it offers physical, nutritional, and psychological prehabilitation and rehabilitation support to patients undergoing cancer treatment. The service is underpinned by behaviour change theories and an individualised and personalised approach to care, addressing the health inequalities that might come about through age, poverty, ethnicity, or culture. Meeting the challenge of delivering high-quality services across multiple stakeholders, while addressing the complexity of patient need, has required skilled leadership, flexibility, and innovation. To support patients equally, regardless of geography or demographics, future services will need to be scaled regionally and be available in locations amenable to the populations they serve. To deliver these services across wide geographic regions, involving multiple providers and complex patient pathways, will require a systems approach. This means embracing and addressing the complexity of the contexts within which these services are delivered, to ensure efficient, high-quality provision of care, while supporting staff well-being and meeting the needs of patients

A randomised controlled trial and cost-effectiveness evaluation of 'booster' interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: More evidence is needed on the potential role of 'booster' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary populations. Objectives: To determine whether objectively measured physical activity, 6 months after a brief intervention, is increased in those receiving physical activity 'booster' consultations delivered in a motivational interviewing (MI) style, either face to face or by telephone. Design: Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with nested qualitative research fidelity and geographical information systems and health economic substudies. Treatment allocation was carried out using a web-based simple randomisation procedure with equal allocation probabilities. Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only. Setting: Deprived areas of Sheffield, UK. Participants: Previously sedentary people, aged 40-64 years, living in deprived areas of Sheffield, UK, who had increased their physical activity levels after receiving a brief intervention. Interventions: Participants were randomised to the control group (no further intervention) or to two sessions of MI, either face to face ('full booster') or by telephone ('mini booster'). Sessions were delivered 1 and 2 months post-randomisation. Main outcome measures: The primary outcome was total energy expenditure (TEE) per day in kcal from 7-day accelerometry, measured using an Actiheart device (CamNtech Ltd, Cambridge, UK). Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment. An estimate of the per-participant intervention costs, resource use data collected by questionnaire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective. An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness. Results: In total, 282 people were randomised (control = 96; mini booster = 92, full booster = 94) of whom 160 had a minimum of 4 out of 7 days' accelerometry data at 3 months (control = 61, mini booster = 47, full booster = 52). The mean difference in TEE per day between baseline and 3 months favoured the control arm over the combined booster arm but this was not statistically significant (-39 kcal, 95% confidence interval -173 to 95, p = 0.57). The autonomy-enabled MI communication style was generally acceptable, although some participants wanted a more paternalistic approach and most expressed enthusiasm for monitoring and feedback components of the intervention and research. Full boosters were more popular than mini boosters. Practitioners achieved and maintained a consistent level of MI competence. Walking distance to the nearest municipal green space or leisure facilities was not associated with physical activity levels. Two alternative modelling approaches both suggested that neither intervention was likely to be cost-effective. Conclusions: Although some individuals do find a community-based, brief MI 'booster' intervention supportive, the low levels of recruitment and retention and the lack of impact on objectively measured physical activity levels in those with adequate outcome data suggest that it is unlikely to represent a clinically effective or cost-effective intervention for the maintenance of recently acquired physical activity increases in deprived middle-aged urban populations. Future research with middle-aged and relatively deprived populations should explore interventions to promote physical activity that require less proactive engagement from individuals, including environmental interventions