Where do hands go? An audit of sequential hand-touch events on a hospital ward

Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. To track potential spread of organisms between surfaces and patients, and to gaina greater understanding into transmission pathways of pathogens during patient care. Hand-touch activities were audited covertly for 40 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room. There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6e58.8] than during 20 winter periods (7%; 95% CI: 3.2e14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94e16.0); P ¼ 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40e65.77; P ¼ 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room. Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning

Serotonin drives a novel GABAergic synaptic current recorded in rat cerebellar purkinje cells: a lugaro cell to purkinje cell synapse

We recorded a novel fast GABAergic synaptic current in cerebellar Purkinje cells in rat brain slices using patch-clamp techniques. Because of a relatively low sensitivity to bicuculline, these currents can be recorded under conditions in which basket and stellate cell inputs are blocked. The observations that the novel synaptic currents occur spontaneously only in the presence of serotonin, and the specific limited positions in the slice from which they can be electrically evoked, suggest that the presynaptic cell is the Lugaro cell. Cell-attached recordings confirm that the Lugaro cell is the only interneuron in the cerebellar cortex with firing behavior consistent with the spontaneous activity recorded in Purkinje cells. The input shows a strong presynaptic modulation mediated by GABAA receptors, resulting in a dynamic range from almost 0 to >90% release probability. Modeling GABAA receptor responses to different GABA transients suggests that the relatively low sensitivity of the synaptic currents to bicuculline, compared with the higher affinity GABAA receptor antagonist SR-95531 (2-(3-carboxypropyl)-3-amino-6-(4-methoxyphenyl) pyridazinium), is attributable to an unusually long GABA dwell time and/or high GABA concentration in the synaptic cleft. The significance of this novel input is discussed in relation to other GABAergic synapses impinging on Purkinje cells. We suggest that the release of GABA onto Purkinje cells from Lugaro cells would primarily occur during motor activity under conditions in which the activity of basket and stellate cells might be inhibited

Serotonin drives a novel GABAergic synaptic current recorded in rat cerebellar purkinje cells: a lugaro cell to Purkinje cell synapse

We recorded a novel fast GABAergic synaptic current in cerebellar Purkinje cells in rat brain slices using patch-clamp techniques. Because of a relatively low sensitivity to bicuculline, these currents can be recorded under conditions in which basket and stellate cell inputs are blocked. The observations that the novel synaptic currents occur spontaneously only in the presence of serotonin, and the specific limited positions in the slice from which they can be electrically evoked, suggest that the presynaptic cell is the Lugaro cell. Cell-attached recordings confirm that the Lugaro cell is the only interneuron in the cerebellar cortex with firing behavior consistent with the spontaneous activity recorded in Purkinje cells. The input shows a strong presynaptic modulation mediated by GABAA receptors, resulting in a dynamic range from almost 0 to >90% release probability. Modeling GABAA receptor responses to different GABA transients suggests that the relatively low sensitivity of the synaptic currents to bicuculline, compared with the higher affinity GABAA receptor antagonist SR-95531 (2-(3-carboxypropyl)-3-amino-6-(4-methoxyphenyl) pyridazinium), is attributable to an unusually long GABA dwell time and/or high GABA concentration in the synaptic cleft. The significance of this novel input is discussed in relation to other GABAergic synapses impinging on Purkinje cells. We suggest that the release of GABA onto Purkinje cells from Lugaro cells would primarily occur during motor activity under conditions in which the activity of basket and stellate cells might be inhibited

Monitoring environmental cleanliness on two surgical wards

Ten hand-touch sites were screened weekly on two surgical wards over two consecutive six-month periods. The results were analysed using hygiene standards, which specify 1) an aerobic colony count (ACC) >2.5cfu/cm2, and 2) presence of coagulase-positive staphylococci, as hygiene failures. Sites most often failing the standards were beds and hoist (64%: 33 of 52 weeks), bedside lockers (62%: 32 of 52) and overbed tables (44%: 23 of 52). Methicillin-susceptible/resistant Staphylococcus aureus (MSSA/MRSA) were more often recovered from lockers, overbed tables and beds. Recovery of MSSA/MRSA at any site was significantly associated with an ACC>2.5cfu/cm2 from that site (p=0.001; OR: 3.35 (95% CI 1.79, 6.28)). In addition, total ACC's>2.5cfu/cm2 each week were significantly associated with weekly bed occupancies >95% (p=0.0004; OR: 2.94 (95% CI 1.44, 6.02)). Higher microbial growth levels from hand-touch sites reflect weekly bed occupancies and indicate a risk for both resistant and susceptible S.aureus. These organisms are more likely to be recovered from near-patient sites on the ward

Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum -lactamase (ESBL)- producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens

Oxygen vacancy levels and electron transport in Al(2)O(3)

The energy levels of the oxygen vacancy in α- and θ-Al2O3 were calculated using the screened exchange hybrid functional, and explain the electron hopping and trapping levels seen in deposited Al2O3 at ∼ 1.8 eV below its conduction band edge. The vacancy supports five accessible charge states, from 2+ to 2−. Electron hopping corresponds to the 0/− level, which lies 1.8 eV below the conduction band edge in θ-Al2O3. This level lies much deeper than it does HfO2. The +/0 level lies at 2.8 eV above oxide valence band in θ-Al2O3 and thus below the Si valence band top

A Cryptographic Moving-Knife Cake-Cutting Protocol

This paper proposes a cake-cutting protocol using cryptography when the cake is a heterogeneous good that is represented by an interval on a real line. Although the Dubins-Spanier moving-knife protocol with one knife achieves simple fairness, all players must execute the protocol synchronously. Thus, the protocol cannot be executed on asynchronous networks such as the Internet. We show that the moving-knife protocol can be executed asynchronously by a discrete protocol using a secure auction protocol. The number of cuts is n-1 where n is the number of players, which is the minimum.Comment: In Proceedings IWIGP 2012, arXiv:1202.422

Light-Cone Quantization of Gauge Fields

Light-cone quantization of gauge field theory is considered. With a careful treatment of the relevant degrees of freedom and where they must be initialized, the results obtained in equal-time quantization are recovered, in particular the Mandelstam-Leibbrandt form of the gauge field propagator. Some aspects of the ``discretized'' light-cone quantization of gauge fields are discussed.Comment: SMUHEP/93-20, 17 pages (one figure available separately from the authors). Plain TeX, all macros include

Multiagent Negotiation for Fair and Unbiased Resource Allocation

This paper proposes a novel solution for the n agent cake cutting (resource allocation) problem. We propose a negotiation protocol for dividing a resource among n agents and then provide an algorithm for allotting portions of the resource. We prove that this protocol can enable distribution of the resource among n agents in a fair manner. The protocol enables agents to choose portions based on their internal utility function, which they do not have to reveal. In addition to being fair, the protocol has desirable features such as being unbiased and verifiable while allocating resources. In the case where the resource is two-dimensional (a circular cake) and uniform, it is shown that each agent can get close to l/n of the whole resource