The impact of an ambulance vehicle preparation service on the presence of bacteria: a service evaluation.

Introduction: Around 300,000 patients a year in England acquire a healthcare-associated infection (HAI) while being cared for by the NHS. The contribution from NHS Ambulance Services is not known, but previous studies have identified the presence of pathogenic bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus, including resistant strains in some cases, inside ambulances. To improve ambulance cleanliness, Yorkshire Ambulance Service NHS Trust (YAS) piloted an Ambulance Vehicle Preparation Service (AVPS) at two ambulance stations, where staff were tasked with ensuring every ambulance at these stations was cleaned every 24 hours. Methods: Adenosine triphosphate (ATP) bioluminescence testing was conducted on 16 ambulances at the two pilot AVPS stations and on 18 ambulances at four 'business as usual' (BAU) ambulance stations using a Hygiena SystemSURE luminometer. Swabs were obtained from 10 pre-selected locations inside each ambulance. Results: Between November 2016 and August 2018, a total of 690 swabs were obtained and recorded from 34 ambulances. Overall, median relative light unit (RLU) values for both groups were 100. However, when stratified by swabbing area, three areas had a median RLU of > 100 in the BAU group: suction unit handle, steering wheel and airway seat shelf. In addition, the upper quartile RLU values for the grab rail above the stretcher and the passenger seat in the BAU group were also > 100. No swab areas had a median RLU > 100 in the AVPS group. Conclusion: A dedicated AVPS results in better cleaning of ambulance vehicles than the existing cleaning system utilising operational crews. The areas most likely to be contaminated are the suction unit handle, steering wheel, airway seat shelf and grab rails. The position of equipment and the materials that equipment are constructed from should have infection prevention and control (IPC) as a consideration

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination

Heavy Quarkonium Physics

This report is the result of the collaboration and research effort of the Quarkonium Working Group over the last three years. It provides a comprehensive overview of the state of the art in heavy-quarkonium theory and experiment, covering quarkonium spectroscopy, decay, and production, the determination of QCD parameters from quarkonium observables, quarkonia in media, and the effects on quarkonia of physics beyond the Standard Model. An introduction to common theoretical and experimental tools is included. Future opportunities for research in quarkonium physics are also discussed.Comment: xviii + 487 pages, 260 figures. The full text is also available at the Quarkonium Working Group web page: http://www.qwg.to.infn.i

Genome-wide analysis of ivermectin response by Onchocerca volvulus reveals that genetic drift and soft selective sweeps contribute to loss of drug sensitivity

Treatment of onchocerciasis using mass ivermectin administration has reduced morbidity and transmission throughout Africa and Central/South America. Mass drug administration is likely to exert selection pressure on parasites, and phenotypic and genetic changes in several Onchocerca volvulus populations from Cameroon and Ghana-exposed to more than a decade of regular ivermectin treatment-have raised concern that sub-optimal responses to ivermectin's anti-fecundity effect are becoming more frequent and may spread.Pooled next generation sequencing (Pool-seq) was used to characterise genetic diversity within and between 108 adult female worms differing in ivermectin treatment history and response. Genome-wide analyses revealed genetic variation that significantly differentiated good responder (GR) and sub-optimal responder (SOR) parasites. These variants were not randomly distributed but clustered in ~31 quantitative trait loci (QTLs), with little overlap in putative QTL position and gene content between the two countries. Published candidate ivermectin SOR genes were largely absent in these regions; QTLs differentiating GR and SOR worms were enriched for genes in molecular pathways associated with neurotransmission, development, and stress responses. Finally, single worm genotyping demonstrated that geographic isolation and genetic change over time (in the presence of drug exposure) had a significantly greater role in shaping genetic diversity than the evolution of SOR.This study is one of the first genome-wide association analyses in a parasitic nematode, and provides insight into the genomics of ivermectin response and population structure of O. volvulus. We argue that ivermectin response is a polygenically-determined quantitative trait (QT) whereby identical or related molecular pathways but not necessarily individual genes are likely to determine the extent of ivermectin response in different parasite populations. Furthermore, we propose that genetic drift rather than genetic selection of SOR is the underlying driver of population differentiation, which has significant implications for the emergence and potential spread of SOR within and between these parasite populations

A Review of Photocatalysts Prepared by Sol-Gel Method for VOCs Removal

The sol-gel process is a wet-chemical technique (chemical solution deposition), which has been widely used in the fields of materials science, ceramic engineering, and especially in the preparation of photocatalysts. Volatile organic compounds (VOCs) are prevalent components of indoor air pollution. Among the approaches to remove VOCs from indoor air, photocatalytic oxidation (PCO) is regarded as a promising method. This paper is a review of the status of research on the sol-gel method for photocatalyst preparation and for the PCO purification of VOCs. The review and discussion will focus on the preparation and coating of various photocatalysts, operational parameters, and will provide an overview of general PCO models described in the literature

Electronic structure of the iron-based superconductor LaOFeP

The recent discovery of superconductivity in the so-called iron-oxypnictide family of compounds has generated intense interest. The layered crystal structure with transition metal ions in planar square lattice form and the discovery of spin-density-wave order near 130 K seem to hint at a strong similarity with the copper oxide superconductors. A burning current issue is the nature of the ground state of the parent compounds. Two distinct classes of theories have been put forward depending on the underlying band structures: local moment antiferromagnetic ground state for strong coupling approach and itinerant ground state for weak coupling approach. The local moment magnetism approach stresses on-site correlations and proximity to a Mott insulating state and thus the resemblance to cuprates; while the latter approach emphasizes the itinerant electron physics and the interplay between the competing ferromagnetic and antiferromagnetic fluctuations. Such a controversy is partly due to the lack of conclusive experimental information on the electronic structures. Here we report the first angle-resolved photoemission spectroscopy (ARPES) investigation of LaOFeP (Tc = 5.9 K), the first reported iron-based superconductor. Our results favor the itinerant ground state, albeit with band renormalization. In addition, our data reveal important differences between these and copper based superconductors.Comment: 17 pages, 4 figure

Identification of new participants in the rainbow trout (Oncorhynchus mykiss) oocyte maturation and ovulation processes using cDNA microarrays

BACKGROUND: The hormonal control of oocyte maturation and ovulation as well as the molecular mechanisms of nuclear maturation have been thoroughly studied in fish. In contrast, the other molecular events occurring in the ovary during post-vitellogenesis have received far less attention. METHODS: Nylon microarrays displaying 9152 rainbow trout cDNAs were hybridized using RNA samples originating from ovarian tissue collected during late vitellogenesis, post-vitellogenesis and oocyte maturation. Differentially expressed genes were identified using a statistical analysis. A supervised clustering analysis was performed using only differentially expressed genes in order to identify gene clusters exhibiting similar expression profiles. In addition, specific genes were selected and their preovulatory ovarian expression was analyzed using real-time PCR. RESULTS: From the statistical analysis, 310 differentially expressed genes were identified. Among those genes, 90 were up-regulated at the time of oocyte maturation while 220 exhibited an opposite pattern. After clustering analysis, 90 clones belonging to 3 gene clusters exhibiting the most remarkable expression patterns were kept for further analysis. Using real-time PCR analysis, we observed a strong up-regulation of ion and water transport genes such as aquaporin 4 (aqp4) and pendrin (slc26). In addition, a dramatic up-regulation of vasotocin (avt) gene was observed. Furthermore, angiotensin-converting-enzyme 2 (ace2), coagulation factor V (cf5), adam 22, and the chemokine cxcl14 genes exhibited a sharp up-regulation at the time of oocyte maturation. Finally, ovarian aromatase (cyp19a1) exhibited a dramatic down-regulation over the post-vitellogenic period while a down-regulation of Cytidine monophosphate-N-acetylneuraminic acid hydroxylase (cmah) was observed at the time of oocyte maturation. CONCLUSION: We showed the over or under expression of more that 300 genes, most of them being previously unstudied or unknown in the fish preovulatory ovary. Our data confirmed the down-regulation of estrogen synthesis genes during the preovulatory period. In addition, the strong up-regulation of aqp4 and slc26 genes prior to ovulation suggests their participation in the oocyte hydration process occurring at that time. Furthermore, among the most up-regulated clones, several genes such as cxcl14, ace2, adam22, cf5 have pro-inflammatory, vasodilatory, proteolytics and coagulatory functions. The identity and expression patterns of those genes support the theory comparing ovulation to an inflammatory-like reaction

Onchocerciasis: The Pre-control Association between Prevalence of Palpable Nodules and Skin Microfilariae

*Background*: The prospect of eliminating onchocerciasis from Africa by mass treatment with ivermectin has been rejuvenated following recent successes in foci in Mali, Nigeria and Senegal. Elimination prospects depend strongly on local transmission conditions and therefore on pre-control infection levels. Pre-control infection levels in Africa have been mapped largely by means of nodule palpation of adult males, a relatively crude method for detecting infection. We investigated how informative pre-control nodule prevalence data are for estimating the pre-control prevalence of