The potential of alcohol release doorplates to reduce surface contamination during hand contact

Background: Optimal hand hygiene may be compromised by contact with contaminated environmental surfaces. Aim: To investigate the in-vitro efficacy of a novel alcohol-release doorplate to reduce surface contamination during hand contact. Methods: Prototype, horizontally held, Surfaceskins, alcohol gel-impregnated and control (aluminium) doorplates were challenged (N = 72 per micro-organism) with Staphylococcus aureus-, Eschericia coli-, Enterococcus faecalis-, or Clostridium difficile-contaminated fingers. S. aureus and E. faecalis were used for challenges (90 per micro-organism) of vertical (modified design) doorplates, on days 0, 3, 4, 6, and 7. Surface contamination was measured pre and immediately post challenges using agar contact plates. Findings: Horizontal test, but not control, doorplates demonstrated bacterial killing of S. aureus, E. faecalis and E. coli, but not of C. difficile; hence, only testing of S. aureus and E. faecalis was continued. Vertical Surfaceskins, but not control, doorplates demonstrated rapid killing of S. aureus over seven days. There were significant reductions (>90% up to day 6; P ≤ 0.01) of surface bacterial colony counts compared with controls immediately post challenge. There were also significant reductions in Surfaceskins doorplate enterococcal colony counts compared with controls on every day of testing (P ≤ 0.004). There was no evidence that bacterial recovery was greater from the tops of Surfaceskins doorplates (i.e. due to pooling of contents). Conclusion: Surfaceskins doorplates were efficient at reducing surface contamination by S. aureus, E. faecalis, and E. coli. Reducing microbial contamination of frequently touched door surfaces, and so bacterial transfer via hands, could feasibly reduce the risk of healthcare-associated and other infections

The sedimentology of river confluences

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Channel confluences are key nodes within large river networks, and yet surprisingly little is known about their spatial and temporal evolution. Moreover, because confluences are associated with vertical scour that typically extends to several times the mean channel depth, the deposits associated with such scours should have a high preservation potential within the rock record. Paradoxically, such scours are rarely observed, and their preservation and sedimentological interpretation are poorly understood. The present study details results from a physically‐based morphodynamic model that is applied to simulate the evolution and alluvial architecture of large river junctions. Boundary conditions within the model were defined to approximate the junction of the Ganges and Jamuna rivers, Bangladesh, with the model output being supplemented by geophysical datasets collected at this junction. The numerical simulations reveal several distinct styles of sedimentary fill that are related to the morphodynamic behaviour of bars, confluence scour downstream of braid bars, bend scour and major junction scour. Comparison with existing, largely qualitative, conceptual models reveals that none of these can be applied simply, although elements of each are evident in the deposits generated by the numerical simulation and observed in the geophysical data. The characteristics of the simulated scour deposits are found to vary according to the degree of reworking caused by channel migration, a factor not considered adequately in current conceptual models of confluence sedimentology. The alluvial architecture of major junction scours is thus characterized by the prevalence of erosion surfaces in conjunction with the thickest depositional sets. Confluence scour downstream of braid bar and bend scour sites may preserve some large individual sets, but these locations are typically characterized by lower average set thickness compared to major junction scour and by a lack of large‐scale erosional surfaces. Areas of deposition not related to any of the specific scour types highlighted above record the thinnest depositional sets. This variety in the alluvial architecture of scours may go some way towards explaining the paradox of ancient junction scours, that while abundant large scours are likely in the rock record, they have been reported rarely. The present results outline the likely range of confluence sedimentology and will serve as a new tool for recognizing and interpreting these deposits in the ancient fluvial record.This work was funded by a UK Natural Environment Research Council award to Sambrook Smith (NE/I023228/1), Bull (NE/I023864/1) and Nicholas (NE/I023120/1)

The planform mobility of river channel confluences: Insights from analysis of remotely sensed imagery

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.River channel confluences are widely acknowledged as important geomorphological nodes that control the downstream routing of water and sediment, and which are locations for the preservation of thick fluvial deposits overlying a basal scour. Despite their importance, there has been little study of the stratigraphic characteristics of river junctions, or the role of confluence morphodynamics in influencing stratigraphic character and preservation potential. As a result, although it is known that confluences can migrate through time, models of confluence geomorphology and sedimentology are usually presented from the perspective that the confluence remains at a fixed location. This is problematic for a number of reasons, not least of which is the continuing debate over whether it is possible to discriminate between scour that has been generated by autocyclic processes (such as confluence scour) and that driven by allocyclic controls (such as sea-level change). This paper investigates the spatial mobility of river confluences by using the 40-year record of Landsat Imagery to elucidate the styles, rates of change and areal extent over which large river confluence scours may migrate. On the basis of these observations, a new classification of the types of confluence scour is proposed and applied to the Amazon and Ganges-Brahmaputra-Meghna (GBM) basins. This analysis demonstrates that the drivers of confluence mobility are broadly the same as those that drive channel change more generally. Thus in the GBM basin, a high sediment supply, large variability in monsoonal driven discharge and easily erodible bank materials result in a catchment where over 80% of large confluences are mobile over this 40-year window; conversely this figure is < 40% for the Amazon basin. These results highlight that: i) the potential areal extent of confluence scours is much greater than previously assumed, with the location of some confluences on the Jamuna (Brahmaputra) River migrating over a distance of 20 times the tributary channel width; ii) extensive migration in the confluence location is more common than currently assumed, and iii) confluence mobility is often tied to the lithological and hydrological characteristics of the drainage basins that determine sediment yield.This work was funded by NERC grant NE/I023228/1 to Sambrook Smith, Bull, Nicholas and Best

Recontamination of Healthcare Surfaces by Repeated Wiping with Biocide-Loaded Wipes: “One Wipe, One Surface, One Direction, Dispose” as Best Practice in the Clinical Environment

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 μm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a “One wipe, One surface, One direction, Dispose” policy should be implemented and rigorously enforced

Estimation of a probability in inverse binomial sampling under normalized linear-linear and inverse-linear loss

Sequential estimation of the success probability $p$ in inverse binomial sampling is considered in this paper. For any estimator $\hat p$, its quality is measured by the risk associated with normalized loss functions of linear-linear or inverse-linear form. These functions are possibly asymmetric, with arbitrary slope parameters $a$ and $b$ for $\hat pp$ respectively. Interest in these functions is motivated by their significance and potential uses, which are briefly discussed. Estimators are given for which the risk has an asymptotic value as $p$ tends to $0$, and which guarantee that, for any $p$ in $(0,1)$, the risk is lower than its asymptotic value. This allows selecting the required number of successes, $r$, to meet a prescribed quality irrespective of the unknown $p$. In addition, the proposed estimators are shown to be approximately minimax when $a/b$ does not deviate too much from $1$, and asymptotically minimax as $r$ tends to infinity when $a=b$.Comment: 4 figure

Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: a randomised controlled trial

Background and aims Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC). Design, setting and participants This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum. Interventions Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence (‘3-month incentives’); or (iii) UC plus ‘3-month incentives’ plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence (‘12-month incentives’). Measurements Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. Secondary outcomes: self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum. Findings Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46−3.96), P = 0.001; 12 months versus UC 1.67 (1.04−2.70), P = 0.035; 3 months versus UC 0.69 (0.41−1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis. Conclusions This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care

Global parameter search reveals design principles of the mammalian circadian clock

Background: Virtually all living organisms have evolved a circadian (~24 hour) clock that controls physiological and behavioural processes with exquisite precision throughout the day/night cycle. The suprachiasmatic nucleus (SCN), which generates these ~24 h rhythms in mammals, consists of several thousand neurons. Each neuron contains a gene-regulatory network generating molecular oscillations, and the individual neuron oscillations are synchronised by intercellular coupling, presumably via neurotransmitters. Although this basic mechanism is currently accepted and has been recapitulated in mathematical models, several fundamental questions about the design principles of the SCN remain little understood. For example, a remarkable property of the SCN is that the phase of the SCN rhythm resets rapidly after a 'jet lag' type experiment, i.e. when the light/ dark (LD) cycle is abruptly advanced or delayed by several hours. Results: Here, we describe an extensive parameter optimization of a previously constructed simplified model of the SCN in order to further understand its design principles. By examining the top 50 solutions from the parameter optimization, we show that the neurotransmitters' role in generating the molecular circadian rhythms is extremely important. In addition, we show that when a neurotransmitter drives the rhythm of a system of coupled damped oscillators, it exhibits very robust synchronization and is much more easily entrained to light/dark cycles. We were also able to recreate in our simulations the fast rhythm resetting seen after a 'jet lag' type experiment. Conclusion: Our work shows that a careful exploration of parameter space for even an extremely simplified model of the mammalian clock can reveal unexpected behaviours and non-trivial predictions. Our results suggest that the neurotransmitter feedback loop plays a crucial role in the robustness and phase resetting properties of the mammalian clock, even at the single neuron level

Factors affecting Removal of Bacterial Pathogens from Healthcare Surfaces during Dynamic Wiping

Wiping of surfaces contaminated with pathogenic bacteria is a key strategy for combatting transmission of healthcare associated infections. It is essential to understand the extent to which removal of bacteria is modulated by fibre properties, biocidal liquid impregnation and applied hand pressure. The influence of intrinsic and extrinsic factors on the removal efficiencies of pathogenic bacteria was studied. Nonwoven wipes made of either hydrophobic (polypropylene) or hygroscopic (lyocell) fibres were manufactured and dynamic removal efficiency of bacteria studied. The single most important parameter affecting bacterial removal efficiency was impregnation with biocidal liquid (p <0.05). For inherently hygroscopic 100% regenerated cellulose (lyocell) wipes impregnated with biocidal liquid, removal of E. coli, S. aureus and E. faecalis improved by increasing the fabric surface density and wiping pressure to their maximal values - 150 g.m-2 and 13.80 kN.m-2 respectively. For inherently hydrophobic 100% polypropylene nonwoven wipes, the same conditions maximised the removal efficiency of S. aureus, but for E. coli and E. faecalis a reduction in the wiping pressure to 4.68 kN.m-2 was required. Best practice involves the use of higher surface density wipes (150 g m-2) containing regenerated cellulose fibres loaded with liquid biocide, and applied with the greatest possible wiping pressure