Improving Sustainability of the Domestically Laundered Healthcare Uniform

Sustainability is an important consideration in today’s society and all areas of textiles contribute to a negative environmental impact; in production, during the ‘in use’ phase and importantly, at the end of life. The use of fibres with alternative end of life options, such as recycling, to divert from landfill disposal, along with reduced temperatures for domestic laundering are becoming of increasing importance. However, concern arises when applied to the healthcare market, in particular, healthcare uniforms which could be contaminated with harmful microorganisms. It is common practice for healthcare uniforms in the United Kingdom to be laundered domestically by staff and, therefore, to establish current practices undertaken, a questionnaire to healthcare staff was distributed and resulted in 265 responses. Results were analysed to determine the most commonly used temperatures, detergents, frequency of laundering and items laundered with healthcare uniforms. The data showed that uniforms are not always laundered after every shift and the use of 40°C was common (33%, n=265). The survival of two frequently observed healthcare associated infections in hospitals, Escherichia coli and Staphylococcus aureus, on the surface of polyester and cotton was established and the attachment analysed using Scanning Electron Microscopy. These results demonstrated that polyester had the lowest survival of both microorganisms and less attachment was seen on the surface of the fibre when compared to cotton. Polyester was selected for textile testing and a range of development fabrics were created using variations in yarn type and fabric structure. Conventional test methods were used to determine the comfort properties of the fabrics created, with results indicating that equal or better performance can be achieved when compared to current fabrics used for healthcare uniforms. To determine the optimal laundering process to achieve removal of microorganisms from the surface of textile items, three household detergents along with a standard reference detergent were tested for their efficacy against E. coli and S. aureus at three temperatures (40°C, 60°C and 71°C) and three times (3, 10 and 15 minutes). A domestic laundering cycle was then simulated whereby an inoculated swatch of fabric was washed and tested for recovery of bacteria to determine the most appropriate temperature for use in the home. The results of the investigation indicated that a standard 40°C domestic wash cycle was ineffective at achieving complete removal of microbial contamination and could allow cross contamination to occur. The use of a 60°C standard domestic wash cycle was found to be significantly more effective, achieving complete removal of microbial contamination

When Does Disengagement Correlate with Performance in Spoken Dialog Computer Tutoring?

In this paper we investigate how student disengagement relates to two performance metrics in a spoken dialog computer tutoring corpus, both when disengagement is measured through manual annotation by a trained human judge, and also when disengagement is measured through automatic annotation by the system based on a machine learning model. First, we investigate whether manually labeled overall disengagement and six different disengagement types are predictive of learning and user satisfaction in the corpus. Our results show that although students’ percentage of overall disengaged turns negatively correlates both with the amount they learn and their user satisfaction, the individual types of disengagement correlate differently: some negatively correlate with learning and user satisfaction, while others don’t correlate with eithermetric at all. Moreover, these relationships change somewhat depending on student prerequisite knowledge level. Furthermore, using multiple disengagement types to predict learning improves predictive power. Overall, these manual label-based results suggest that although adapting to disengagement should improve both student learning and user satisfaction in computer tutoring, maximizing performance requires the system to detect and respond differently based on disengagement type. Next, we present an approach to automatically detecting and responding to user disengagement types based on their differing correlations with correctness. Investigation of ourmachine learningmodel of user disengagement shows that its automatic labels negatively correlate with both performance metrics in the same way as the manual labels. The similarity of the correlations across the manual and automatic labels suggests that the automatic labels are a reasonable substitute for the manual labels. Moreover, the significant negative correlations themselves suggest that redesigning ITSPOKE to automatically detect and respond to disengagement has the potential to remediate disengagement and thereby improve performance, even in the presence of noise introduced by the automatic detection process

Exploring affect-context dependencies for adaptive system development

We use χ2 to investigate the context dependency of student affect in our computer tutoring dialogues, targeting uncertainty in student answers in 3 automatically monitorable contexts. Our results show significant dependencies between uncertain answers and specific contexts. Identification and analysis of these dependencies is our first step in developing an adaptive version of our dialogue system.

The Effect of Low Temperature Laundering and Detergents on the Survival of Escherichia coli and Staphylococcus aureus on Textiles Used in Healthcare Uniforms

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Aims: To determine the survival of Escherichia coli and Staphylococcus aureus on cotton and polyester and the effectiveness of low temperature laundering and detergents on the removal of microorganism from healthcare laundry. Methods and Results: Survival of E. coli and S. aureus on polyester or cotton was assessed over 3 weeks and the efficacy of a domestic wash (40°C and 60°C) and a range of detergents was also determined. Both bacteria were able to survive on cotton (5 log(10)) and polyester (0.28 log(10)) for up to 3 weeks. Laundering at 40°C resulted in a 3.5 log(10) removal of the initial 7.7 log(10) inoculum and some cross contamination to sterile fabrics (3 log(10). Increasing the temperature to 60°C resulted in the complete removal of the initial inoculum. Conclusions: This study shows that most of the microorganisms are removed at 40°C however, those cells still remaining may have the potential for further contamination to the clinical environment and patients Significance and Impact of Study: National Health Service (NHS) nurses are required to domestically launder their uniforms at 60°C to ensure safe removal of microorganisms, 33% of NHS staff questioned said they launder their uniforms at 40°C, which could potentially result in transmission of Hospital Acquired Infections (HAIs)

Genetic and environmental drivers of colour and pattern in the Australian jacky dragon (Amphibolurus muricatus)

The underlying drivers of variation in the colouration (colour and pattern) of animals can be genetic, non-genetic, or more likely, a combination of both. Understanding the role of heritable genetic elements, as well as non-genetic factors such as age, habitat or temperature, in shaping colouration can provide insight into the evolution and function of these traits, as well as the speed of response to changing environments. This project examined the genetic and non-genetic drivers of continuous variation in colouration in a lizard, the jacky dragon (Amphibolurus muricatus). We leveraged a large captive experiment that manipulated parental and offspring thermal environment to simultaneously estimate the genetic and non-genetic drivers of variation in colouration. We found that the overall brightness, the elongation of the longitudinal stripes on the dorsum and the contrast between light and dark patches of the pattern were all heritable. Colouration varied according to the age of the hatchling; however, the thermal environment of neither the parents nor offspring contributed significantly to colouration. It appears that developmental plasticity and maternal effects associated with temperature are not important drivers of variation in our measures of colouration

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (April 2018) in accordance with the publisher’s archiving policyMany gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions – and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women

Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

Objective: To develop and validate a risk prediction model for venous thromboembolism in the first six weeks after delivery (early postpartum). Design: Cohort study. Setting: Records from England based Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and data from Sweden based registry. Participants: All pregnant women registered with CPRD-HES linked data between 1997 and 2014 and Swedish medical birth registry between 2005 and 2011 with postpartum follow-up. Main outcome measure: Multivariable logistic regression analysis was used to develop a risk prediction model for postpartum venous thromboembolism based on the English data, which was externally validated in the Swedish data. Results: 433 353 deliveries were identified in the English cohort and 662 387 in the Swedish cohort. The absolute rate of venous thromboembolism was 7.2 per 10 000 deliveries in the English cohort and 7.9 per 10 000 in the Swedish cohort. Emergency caesarean delivery, stillbirth, varicose veins, pre-eclampsia/eclampsia, postpartum infection, and comorbidities were the strongest predictors of venous thromboembolism in the final multivariable model. Discrimination of the model was similar in both cohorts, with a C statistic above 0.70, with excellent calibration of observed and predicted risks. The model identified more venous thromboembolism events than the existing national English (sensitivity 68% v 63%) and Swedish guidelines (30% v 21%) at similar thresholds. Conclusion: A new prediction model that quantifies absolute risk of postpartum venous thromboembolism has been developed and externally validated. It is based on clinical variables that are available in many developed countries at the point of delivery and could serve as the basis for real time decisions on obstetric thromboprophylaxis

Effectiveness of a structured, framework-based approach to implementation: the Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial

BACKGROUND: Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning. DESIGN/METHODS: The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure). RESULTS: We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully. CONCLUSION: Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015