Does size matter? The impact of a small but targeted cleaning training intervention within a paediatric ward

Background: Cleaning is a critical tool for infection prevention and control, and is a key intervention for preventing healthcare associated infections (HCAIs) and controlling intermediate transmission routes between patient and environment. This study sought to identify potential areas of weakness in clinical surface cleaning, and assess the effectiveness of a staff group specific training intervention. Observations: One-hundred hours of audit observations in a paediatric cardiac intensive care unit (CICU) assessed surface cleaning technique of healthcare staff within bedspaces. Cleaning was assessed with a 5-component bundle, with each cleaning opportunity scored out of five. Training Intervention: Fifty hours of audit observations before and after a training intervention tested the efficacy of a staff group specific education intervention. The intervention was developed and implemented for 69% of nurses and 100% of cleaners. Results: One hundred and eighteen cleaning opportunities were observed before training, and scored an average of 2.4. One hundred and twenty-one cleaning opportunities were observed after training and scored an average 3.0. On average, before training, each cleaning opportunity by nurses and cleaners fulfilled 2.4 and 2.5, respectively, of the 5 bundle components. Following training, this improved to 3.3 and 2.9 respectively. There was a statistically significant improvement in bundle scores for nurses (P=.004) and cleaners (P=.0003). Conclusions: Surface wipe methods were inconsistent between all staff groups. The education based intervention resulted in a small improvement in most of the cleaning components. This study has identified how a small but targeted cleaning training intervention can have a significant (P= <.0001) impact on cleaning bundle compliance for both nurses and cleaners

How to carry out microbiological sampling of healthcare environment surfaces? A review of current evidence

BACKGROUND: There is increasing evidence that the hospital surface environment contributes to the spread of pathogens. However, evidence on how best to sample these surfaces is patchy and there is no guidance or legislation in place on how to do this. AIM: The aim of this review was to assess current literature on surface sampling methodologies, including the devices used, processing methods, the environmental and biological factors that might influence results. METHODS: Studies published prior to March 2019 were selected using relevant keywords from ScienceDirect, Web of Science and PubMed. Abstracts were reviewed and all data-based studies in peer-reviewed journals in the English language were included. Microbiological air and water sampling in the hospital environment were not included. FINDINGS: Although the numbers of cells or virions recovered from hospital surface environments were generally low, the majority of surfaces sampled were microbiologically contaminated. Of the organisms detected, multi-drug resistant organisms and clinically significant pathogens were frequently isolated and could, therefore, present a risk to vulnerable patients. Great variation was found between methods and the available data was incomplete and incomparable. CONCLUSION: Available literature on sampling methods demonstrated deficits with potential improvements for future research. Many of the studies included in the review were laboratory based and not undertaken in the real hospital environment where sampling recoveries could be affected by the many variables present in a clinical environment. It was therefore difficult to draw overall conclusions, however some recommendations for the design of routine protocols for surface sampling of healthcare environments can be made

Transdimensional ambient noise tomography of Bass Strait, southeast Australia, reveals the sedimentary basin and deep crustal structure beneath a failed continental rift

Debate is ongoing as to which tectonic model is most consistent with the known geology of southeast Australia, formerly part of the eastern margin of Gondwana. In particular, numerous tectonic models have been proposed to explain the enigmatic geological relationship between Tasmania and the mainland, which is separated by Bass Strait. One of the primary reasons for the lack of certainty is the limited exposure of basement rocks, which are masked by the sea and thick Mesozoic–Cenozoic sedimentary and volcanic cover sequences. We use ambient noise tomography recorded across Bass Strait to generate a new shear wave velocity model in order to investigate crustal structure. Fundamental mode Rayleigh wave phase velocity dispersion data extracted from long-term cross-correlation of ambient noise data are inverted using a transdimensional, hierarchical, Bayesian inversion scheme to produce phase velocity maps in the period range 2–30 s. Subsequent inversion for depth-dependent shear wave velocity structure across a dense grid of points allows a composite 3-D shear wave velocity model to be produced. Benefits of the transdimensional scheme include a data-driven parametrization that allows the number and distribution of velocity unknowns to vary, and the data noise to also be treated as an unknown in the inversion. The new shear wave velocity model clearly reveals the primary sedimentary basins in Bass Strait as slow shear velocity zones which extend down to 14 km in depth. These failed rift basins, which formed during the early stages of Australia–Antarctica break-up, appear to be overlying thinned crust, where high velocities of 3.8–4.0 km s−1 occur at depths greater than 20 km. Along the northern margin of Bass Strait, our new model is consistent with major tectonic boundaries mapped at the surface. In particular, we identify an east dipping velocity transition zone in the vicinity of the Moyston Fault, a major tectonic boundary between the Lachlan and Delamerian orogens, which are part of the Phanerozoic accretionary terrane that makes up eastern Australia. A pronounced lineament of high shear wave velocities (∼3.7–3.8 km s−1) in the lower crust of our new model may represent the signature of relict intrusive magmatism from failed rifting in the early stages of Australia–Antarctica break-up along a crustal scale discontinuity in the Selwyn Block microcontinent which joins Tasmania and Victoria

A phylogenomic perspective on diversity, hybridization and evolutionary affinities in the stickleback genus Pungitius

Hybridization and convergent evolution are phenomena of broad interest in evolutionary biology, but their occurrence poses challenges for reconstructing evolutionary affinities among affected taxa. Sticklebacks in the genus Pungitius are a case in point: evolutionary relationships and taxonomic validity of different species and populations in this circumpolarly distributed species complex remain contentious due to convergent evolution of traits regarded as diagnostic in their taxonomy, and possibly also due to frequent hybridization among taxa. To clarify the evolutionary relationships among different Pungitius species and populations globally, as well as to study the prevalence and extent of introgression among recognized species, genomic data sets of both reference genome-anchored single nucleotide polymorphisms and de novo assembled RAD-tag loci were constructed with RAD-seq data. Both data sets yielded topologically identical and well-supported species trees. Incongruence between nuclear and mitochondrial DNA-based trees was found and suggested possibly frequent hybridization and mitogenome capture during the evolution of Pungitius sticklebacks. Further analyses revealed evidence for frequent nuclear genetic introgression among Pungitius species, although the estimated proportions of autosomal introgression were low. Apart from providing evidence for frequent hybridization, the results challenge earlier mitochondrial and morphology-based hypotheses regarding the number of species and their affinities in this genus: at least seven extant species can be recognized on the basis of genetic data. The results also shed new light on the biogeographical history of the Pungitius-complex, including suggestion of several trans-Arctic invasions of Europe from the Northern Pacific. The well-resolved phylogeny should facilitate the utility of this genus as a model system for future comparative evolutionary studies.Peer reviewe

Temperature dependence of the anomalous effective action of fermions in two and four dimensions

The temperature dependence of the anomalous sector of the effective action of fermions coupled to external gauge and pseudo-scalar fields is computed at leading order in an expansion in the number of Lorentz indices in two and four dimensions. The calculation preserves chiral symmetry and confirms that a temperature dependence is compatible with axial anomaly saturation. The result checks soft-pions theorems at zero temperature as well as recent results in the literature for the pionic decay amplitude into static photons in the chirally symmetric phase. The case of chiral fermions is also considered.Comment: RevTex, 19 pages, no figures. References adde

Vancomycin-induced Henoch-Schönlein purpura: a case report

<p>Abstract</p> <p>Introduction</p> <p>Henoch-Schönlein purpura is a small-vessel systemic vasculitis. Although its exact pathophysiology remains unknown, Henoch-Schönlein purpura has been reported in association with various medical conditions including hypersensitivity. We report the case of a patient with vancomycin-induced Henoch-Schönlein purpura.</p> <p>Case presentation</p> <p>A 42-year-old Caucasian man who had previously undergone a heart transplant was diagnosed as having an intra-abdominal abscess after he underwent a Hartmann procedure. At 15 days after initiation of antibiotic therapy including vancomycin, he developed a purpuric rash of the lower limbs, arthralgia, and macroscopic hematuria. At that time, our patient was already on hemodialysis for end-stage renal disease. Henoch-Schönlein purpura was diagnosed. After a second 15-day course of vancomycin, a second flare of Henoch-Schönlein purpura occurred. Skin biopsies showed leucocytoclastic vasculitis with IgA deposits and eosinophils in the peri-capillary inflammatory infiltrate, suggesting an allergic mechanism. After vancomycin was stopped, we did not observe any further flares. Only five cases of isolated cutaneous vasculitis, one case of lupus-like syndrome and one case of Henoch-Schönlein purpura after vancomycin treatment have been described to date in the literature.</p> <p>Conclusions</p> <p>Clinicians should be aware that systemic vasculitis can be induced by some treatments. Vancomycin is a widely prescribed antibiotic. Occurrence of rare but serious Henoch-Schönlein purpura associated with vancomycin requires its prompt discontinuation.</p

An investigation of corrosion in liquid-metal heat pipes

Research is underway to develop a 75-kW heat pipe to transfer solar energy from the focus of a parabolic dish concentrator to the heater tubes of a Stirling engine. The high flux levels and high total power level encountered in this application have made it necessary to use a high-performance wick structure with fibers on the order of 4 to 8 microns in diameter. This fine wick structure is highly susceptible to corrosion damage and plugging, as dissolved contaminants plate out on the evaporator surface. Normal operation of the heat pipe also tends to concentrate contaminants in localized areas of the evaporator surface where heat fluxes are the highest. Sandia National Laboratories is conducting a systematic study to identify procedures that reduce corrosion and contamination problems in liquid-metal heat pipes. A series of heat pipes are being tested to explore different options for cleaning heat-pipe systems. Models are being developed to help understand the overall importance of operating parameters on the life of heat-pipe systems. In this paper, the authors present their efforts to reduce corrosion damage

Implications for megathrust earthquakes and tsunamis from seismic gaps south of Java Indonesia

Abstract: Relocation of earthquakes recorded by the agency for meteorology, climatology and geophysics (BMKG) in Indonesia and inversions of global positioning system (GPS) data reveal clear seismic gaps to the south of the island of Java. These gaps may be related to potential sources of future megathrust earthquakes in the region. To assess the expected inundation hazard, tsunami modeling was conducted based on several scenarios involving large tsunamigenic earthquakes generated by ruptures along segments of the megathrust south of Java. The worst-case scenario, in which the two megathrust segments spanning Java rupture simultaneously, shows that tsunami heights can reach ~ 20 m and ~ 12 m on the south coast of West and East Java, respectively, with an average maximum height of 4.5 m along the entire south coast of Java. These results support recent calls for a strengthening of the existing Indonesian Tsunami Early Warning System (InaTEWS), especially in Java, the most densely populated island in Indonesia