Surface disinfection challenges for Candida auris: an in-vitro study

The emerging pathogenic multidrug-resistant yeast Candida auris is an important source of healthcare-associated infections and of growing global clinical concern. The ability of this organism to survive on surfaces and withstand environmental stressors creates a challenge for eradicating it from hospitals. A panel of C. auris clinical isolates was evaluated on different surface environments against the standard disinfectant sodium hypochlorite and high-level disinfectant peracetic acid. C. auris was shown to selectively tolerate clinically relevant concentrations of sodium hypochlorite and peracetic acid in a surface-dependent manner, which may explain its ability to successfully persist within the hospital environment

The SPADE Symptom Cluster in Primary Care Patients with Chronic Pain

Objectives: Sleep disturbance, pain, anxiety, depression, and low energy/fatigue, the SPADE pentad, are the most prevalent and co-occurring symptoms in the general population and clinical practice. Co-occurrence of SPADE symptoms may produce additive impairment and negatively affect treatment response, potentially undermining patients’ health and functioning. The purpose of this paper is to determine: (1) prevalence and comorbidity (ie, clustering) of SPADE symptoms; (2) internal reliability and construct validity of a composite SPADE symptom score derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) measures; and (3) whether improvement in somatic symptom burden represented by a composite score predicted subsequent measures of functional status at 3 and 12 months follow-up. Methods: Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized trial of a collaborative care intervention for Veterans with chronic pain. Results: Most patients had multiple SPADE symptoms; only 9.6% of patients were monosymptomatic. The composite PROMIS symptom score had good internal reliability (Cronbach’s alpha=0.86) and construct validity and strongly correlated with multiple measures of functional status; improvement in the composite score significantly correlated with higher scores for 5 of 6 functional status outcomes. The standardized error of measurement (SEM) for the composite T-score was 2.84, suggesting a 3-point difference in an individual’s composite score may be clinically meaningful. Discussion: Brief PROMIS measures may be useful in evaluating SPADE symptoms and overall symptom burden. Because symptom burden may predict functional status outcomes, better identification and management of comorbid symptoms may be warranted

Children's Time With Fathers in Intact Families

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73550/1/j.1741-3737.2001.00136.x.pd

A family intervention to reduce delirium in hospitalzed ICU patients: a feasibility randomized controlled trial

Background: Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and accept ability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. Method: A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation, or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and 5 therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective. Results: Recruitment rate was 28% of eligible patients (recruited n=90, attrition n=1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable. Conclusion: The study was able to recruit, randomise, and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection

Longer Lasting Bridge Deck Overlays

The objective of this report is to determine the most effective method for bridge deck overlay construction and repair by assessing current practices; examining new products and technologies; and reviewing NCHRP (National Cooperative Highway Research Program) guidelines, state standard specifications, ASCE (American Society of Civil Engineers) infrastructure ratings, and original bridge core chloride penetration data. Based on the review, this report offers the following conclusions. Latex modified concrete (LMC) overlays perform well, provide a long service life, and are the most commonly used method of bridge deck rehabilitation. Ohio considers microsilica concrete (MSC) overlays as state of the art due to their lower permeability. Superplasticized dense concrete (SDC), fly-ash modified concrete (FAMC), and polymer modified concrete (PMC) are other acceptable choices for bridge deck overlays. Silane or epoxy sealers may be used as a low-cost preventative approach to slow the deterioration of concrete bridge decks. Waterproofing membranes have produced mixed results but have the potential to be an effective system if installed correctly. Rosphalt® can be an expensive material but offers benefits such as minimizing traffic disruption due to shorter installation periods and increased durability. The two most important conclusions drawn from this research are the importance of a comprehensive approach when selecting a bridge deck rehabilitation method, and the importance of properly following instructions when installing overlays or waterproofing membrane systems

Are routinely collected NHS administrative records suitable for endpoint identification in clinical trials? Evidence from the West of Scotland coronary prevention study

Background: Routinely collected electronic patient records are already widely used in epidemiological research. In this work we investigated the potential for using them to identify endpoints in clinical trials.<p></p> Methods: The events recorded in the West of Scotland Coronary Prevention Study (WOSCOPS), a large clinical trial of pravastatin in middle-aged hypercholesterolaemic men in the 1990s, were compared with those in the record-linked deaths and hospitalisations records routinely collected in Scotland.<p></p> Results: We matched 99% of fatal study events by date. We showed excellent matching (97%) of the causes of fatal endpoint events and good matching (.80% for first events) of the causes of nonfatal endpoint events with a slightly lower rate of mismatching of record linkage than study events (19% of first study myocardial infarctions (MI) and 4% of first record linkage MIs not matched as MI). We also investigated the matching of non-endpoint events and showed a good level of matching, with .78% of first stroke/TIA events being matched as stroke/TIA. The primary reasons for mismatches were record linkage data recording readmissions for procedures or previous events, differences between the diagnoses in the routinely collected data and the conclusions of the clinical trial expert adjudication committee, events occurring outside Scotland and therefore being missed by record linkage data, miscoding of cardiac events in hospitalisations data as ‘unspecified chest pain’, some general miscoding in the record linkage data and some record linkage errors.<p></p> Conclusions: We conclude that routinely collected data could be used for recording cardiovascular endpoints in clinical trials and would give very similar results to rigorously collected clinical trial data, in countries with unified health systems such as Scotland. The endpoint types would need to be carefully thought through and an expert endpoint adjudication committee should be involved.<p></p&gt

The Effects of Cold and Lower Body Negative Pressure on Cardiovascular Effects

Purpose. The purpose of this study is to determine how cold exposure and lower body negative pressure effected cardiovascular variables. Methods. Eleven males (20.3 years ± 2.7) underwent two 20-minute exposures to LBNP. During the 2 trials, the subjects were exposed to cold air (10°C) (COLD) and to ambient temperature (23°C) (AMB). The trials consisted of a 100-minute pre-LBNP period followed by a 20-minute exposure to LBNP and then a 15-minute recovery period. Cardiovascular variables were recorded every 30 minutes using bioimpedance. Results. When LBNP was applied during the AMB trials, stroke volume immediately decreased. During the COLD trial, there was a five-minute delay before the decrease in stroke volume. Heart rate increased immediately after LBNP initiation during the AMB trials but there was a delay in the increase during the COLD trials. That same pattern was followed with mean arterial blood pressures. Cerebral oxygenation was significantly lower throughout the COLD trial as compared to the AMB trials. Six subjects reported symptoms of syncope or presyncope during the AMB trials but there were no reports of symptoms during the COLD trials. Conclusion. From analysis of this data, cold improved the subject’s tolerance to LBNP

Candida albicans as an essential "keystone" component within polymicrobial oral biofilm models?

Background: Existing standardized biofilm assays focus on simple mono-species or bacterial-only models. Incorporating Candida albicans into complex biofilm models can offer a more appropriate and relevant polymicrobial biofilm for the development of oral health products. Aims: This study aimed to assess the importance of interkingdom interactions in polymicrobial oral biofilm systems with or without C. albicans, and test how these models respond to oral therapeutic challenges in vitro. Materials and Methods: Polymicrobial biofilms (two models containing 5 and 10 bacterial species, respectively) were created in parallel in the presence and absence of C. albicans and challenged using clinically relevant antimicrobials. The metabolic profiles and biomasses of these complex biofilms were estimated using resazurin dye and crystal violet stain, respectively. Quantitative PCR was utilized to assess compositional changes in microbial load. Additional assays, for measurements of pH and lactate, were included to monitor fluctuations in virulence “biomarkers.” Results: An increased level of metabolic activity and biomass in the presence of C. albicans was observed. Bacterial load was increased by more than a factor of 10 in the presence of C. albicans. Assays showed inclusion of C. albicans impacted the biofilm virulence profiles. C. albicans did not affect the biofilms’ responses to the short-term incubations with different treatments. Conclusions: The interkingdom biofilms described herein are structurally robust and exhibit all the hallmarks of a reproducible model. To our knowledge, these data are the first to test the hypothesis that yeasts may act as potential “keystone” components of oral biofilms. © 2020 by the authors. Licensee MDPI, Basel, Switzerland

Filling the void: an optimized polymicrobial interkingdom biofilm model for assessing novel antimicrobial agents in endodontic infection

There is a growing realization that endodontic infections are often polymicrobial, and may contain Candida spp. Despite this understanding, the development of new endodontic irrigants and models of pathogenesis remains limited to mono-species biofilm models and is bacterially focused. The purpose of this study was to develop and optimize an interkingdom biofilm model of endodontic infection and use this to test suitable anti-biofilm actives. Biofilms containing Streptococcus gordonii, Fusobacterium nucleatum, Porphyromonas gingivalis, and Candida albicans were established from ontological analysis. Biofilms were optimized in different media and atmospheric conditions, prior to quantification and imaging, and subsequently treated with chlorhexidine, EDTA, and chitosan. These studies demonstrated that either media supplemented with serum were equally optimal for biofilm growth, which were dominated by S. gordonii, followed by C. albicans. Assessment of antimicrobial activity showed significant effectiveness of each antimicrobial, irrespective of serum. Chitosan was most effective (3 log reduction), and preferentially targeted C. albicans in both biofilm treatment and inhibition models. Chitosan was similarly effective at preventing biofilm growth on a dentine substrate. This study has shown that a reproducible and robust complex interkingdom model, which when tested with the antifungal chitosan, supports the notion of C. albicans as a key structural component