MOVEing Microorganisms:The effect of the built environment of the hospital and screening strategies on microbial safety

In this dissertation the results of the MOVE study are described, which determined if the transition to solely single-occupancy rooms in the new hospital building of the Erasmus MC contributed to a microbial safer hospital. Additionally, the effect of screenings methods for MDRO at admission of patients was evaluated

Ion cyclotron wall conditioning experiments on Tore Supra in presence of the toroidal magnetic field

Wall conditioning techniques applicable in the presence of the high toroidal magnetic field will be required for the operation of ITER for tritium removal, isotopic ratio control and recovery to normal operation after disruptions. Recently ion cyclotron wall conditioning (ICWC) experiments have been carried out on Tore Supra in order to assess the efficiency of this technique in ITER relevant conditions. The ICRF discharges were operated in He/H-2 Mixtures at the Tore Supra nominal field (3.8 T) and a RF frequency of 48 MHz, i.e. within the ITER operational space. RF pulses of 60 s (max.) were applied using a standard Tore Supra two-strap resonant double loop antenna in ICWC mode, operated either in pi or 0-phasing with a noticeable improvement of the RF coupling in the latter case. In order to assess the efficiency of the technique for the control of isotopic ratio the wall was first preloaded using a D-2 glow discharge. After 15 minutes of ICWC in He/H-2 gas mixtures the isotopic ratio was altered from 4% to 50% at the price of an important H implantation into the walls. An overall analysis comparing plasma production and the conditioning efficiency as a function of discharge parameters is given

A perishable product inventory system operating in a random environment

A model of a perishable product inventory system operating in a random environment is studied. For the sake of simplicity, the stochastic environment is considered to alternate randomly over time between two states 0 and 1 according to an alternating renewal process. When the environment is in state 'k', the items in the inventory have a perishing rate 'kμ' , the demand rate is 'kλ' and the replenishment cost is 'kCR'. Assuming instantaneous replenishment at the epoch of the first demand after the stock-out and associating a Markov renewal process with the inventory system, the stationary distribution of the inventory level and the performance of various measures of the system evolution are obtained. Numerical examples illustrate the results obtained.‘n Model van ‘n voorraadsisteem van ‘n bederfbare produk wat aangehou word in ‘n toevalsomgewing word voorgehou. Die stogastiese omgewing word vir doeleindes van vereenvoudiging beskryf deur twee toestande, nul en een, wat op toevalswyse die wisselende hernuwingsproses behandel. Wanneer die omgewing in toestand 'k' is, is die bederftempo 'kμ',die vraagtempo 'kλ ', en die aanvullingskoste 'kCR' . As aanvulling oombliklik plaasvind na vooraaduitputting en Markov-hernuwings geassosieer word met die voorraadsisteem, word die stasionêre verdeling van voorraadvlak en ander prestasiemaatstawe van die sisteem verkry. ‘n Numeriese voorbeeld ondersteun die resultate wat verkry is.http://sajie.journals.ac.z

Residual confounding after adjustment for age: a minor issue in breast cancer screening effectiveness

Residual confounding, after adjustment for age, is the major criticism of observational studies on breast cancer screening effectiveness. We developed realistic scenarios for the prevalence and strength of risk factors on screened and not screened groups, and explored the impact of residual confounding bias. Our results demonstrate that residual confounding bias is a minor issue in screening programme evaluations

Acquisition of multidrug-resistant Enterobacterales during international travel: A systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

Background: International tourism increased from 25 million tourist arrivals in 1950 to over 1.3 billion in 2017. These travelers can be exposed to (multi) resistant microorganisms, may become colonized, and bring them back home. This systematic review aims to identify the carriage rates of multidrug-resistant Enterobacterales (MDR-E) among returning travelers, to identify microbiological methods used, and to identify the leading risk factors for acquiring MDR-E during international travel. Methods: Articles related to our research question were identified through a literature search in multiple databases (until June 18, 2019)-Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar. Results: Out of 3211 potentially relevant articles, we included 22 studies in the systematic review, and 12 studies in 7 random-effects meta-analyses. Highest carriage rates of MDR-E were observed after travel to Southern Asia (median 71%), followed by travel to Northern Africa (median 42%). Carbapenemase-producing Enterobacterales (CPE) were identified in 5 out of 22 studies, from a few patients. However, in only eight out of 22 studies (36.4%) the initial laboratory method targeted detection of the presence of CPE in the original samples. The risk factor with the highest pooled odds ratio (OR) for MDR-E was travel to Southern Asia (pooled OR = 14.16, 95% confidence interval [CI] = 5.50 to 36.45), followed by antibiotic use during travel (pooled OR = 2.78, 95% CI = 1.76 to 4.39). Conclusions: Risk of acquiring MDR-E while travelling increases depending on travel destination and if antibiotics are used during travel. This information is useful for the development of guidelines for healthcare facilities with low MDR-E prevalence rates to prevent admission of carriers without appropriate measures. The impact of such guidelines should be assessed

Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication

Objective: Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships. Methods: Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65 85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report. Results: Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10 2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not. Conclusion: Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medicationsSources of support: The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports (grant no 311669, grant recipient D.J.H. Deeg). The Pe~nagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (grant no FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143, grant recipients A. Otero, M.V. Castell). The Hertfordshire Cohort Study is supported by the Medical Research Council of Great Britain, Versus Arthritis, the British Heart Foundation and the International Osteoporosis Foundation (grant no MRC_MC_UP_A620_1014, grant recipients C. Cooper, E. Dennison). The Italian cohort was supported by the National Research Council of Italy (CNR), Research Project “Aging: molecular and technological innovations for improving the health of the elderly population" (Prot. MIUR 2867, grant recipient: S. Maggi). The Swedish Twin Registry is managed by Karolinska Institutet and receives funding through the Swedish Research Council (grant no 2017-00641, grant recipient Karolinska Institutet

Universal screening or a universal risk assessment combined with risk-based screening for multidrug-resistant microorganisms upon admission:Comparing strategies

OBJECTIVE: Timely identification of patients who carry multidrug-resistant microorganisms (MDRO) is needed to prevent nosocomial spread to other patients and to the hospital environment. We aimed to compare the yield of a universal screening strategy upon admission to the currently installed universal risk assessment combined with risk-based screening upon admission. METHODS: This observational study was conducted within a prospective cohort study. From January 1, 2018, until September 1, 2019, patients admitted to our hospital were asked to participate. Nasal and perianal samples were taken upon admission and checked for the presence of MDRO. The results of the universal risk assessment and risk-based screening were collected retrospectively from electronic health records. RESULTS: In total, 1017 patients with 1069 separate hospital admissions participated in the study. Universal screening identified 38 (3.6%) unknown MDRO carriers upon admission (37 individual patients), all carrying extended-spectrum beta-lactamase-producing Enterobacterales. For 946 of 1069 (88.5%) patients, both the universal risk assessment and universal screening were performed. For 19 (2.0%) admissions, ≥1 risk factor was identified. The universal risk assessment identified one (0.1%) unknown carrier, compared to 37 out of 946 carriers for the universal screening (P&lt;0.001). Of the 37 carriers identified through the universal screening, 35 (94.6%) reported no risk factors. CONCLUSIONS: Our results show that in our low endemic setting, a universal screening strategy identified significantly more MDRO carriers than the currently implemented universal risk-assessment. When implementing a universal risk-assessment, risk factors should be carefully selected to be able to identify ESBL-E carriers. While the universal screening identified more MDRO carriers, further research is needed to determine the cost-effectiveness of this strategy.</p

Impact of prevalent and incident vertebral fractures on utility: results from a patient-based and a population-based sample

Data are scarce on the impact of vertebral fractures (VFX) on utility. The objective of this study was to assess the impact of prevalent and incident VFX on utility in both a patient-based and population-based sample. Data from the Multiple Outcomes of Raloxifene Evaluation (MORE) study (n = 550 for prevalent VFX and n = 174 for incident VFX) and the European Prospective Osteoporosis Study (EPOS) (n = 236) were used. Utility was assessed by the index score of the EQ-5D. In the MORE study, highly statistically significant associations were found between utility and the presence of prevalent VFX (p < 0.001), number of prevalent VFX (p < 0.001), severity of prevalent VFX (p < 0.001), the combination of number and severity of prevalent VFX (p = 0.001) and location of prevalent VFX (p = 0.019). The mean utility was significantly lower among women who suffered an incident VFX (utility = 0.67) than among women who did not (utility = 0.77) (p = 0.005), although utility loss was not significantly different between the two groups (p = 0.142). In EPOS, the combination of number and severity of incident VFX was significantly related to utility (p = 0.030). In conclusion, utility is lower among persons with prevalent and incident VFX, especially in a patient-based sample. Utility loss was not significantly different between women without and with incident VFX