Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward

Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. However, this assumes that the effectiveness of hand hygiene is not constrained by other factors and that improved compliance in excess of a given level, in itself, will result in a commensurate reduction in the incidence of HAI. However, several researchers have found the law of diminishing returns to apply to hand hygiene, with the greatest benefits occurring in the first 20% or so of compliance, and others have demonstrated that poor cohorting of nursing staff profoundly influences the effectiveness of hand hygiene measures. Collectively, these findings raise intriguing questions about the extent to which increasing compliance alone can further reduce rates of HAI. In order to investigate these issues further, we constructed a deterministic Ross-Macdonald model and applied it to a hypothetical general medical ward. In this model the transmission of staphylococcal infection was assumed to occur after contact with the transiently colonized hands of HCWs, who, in turn, acquire contamination only by touching colonized patients. The aim of the study was to evaluate the impact of imperfect hand cleansing on the transmission of staphylococcal infection and to identify, whether there is a limit, above which further hand hygiene compliance is unlikely to be of benefit. The model demonstrated that if transmission is solely via the hands of HCWs, it should, under most circumstances, be possible to prevent outbreaks of staphylococcal infection from occurring at a hand cleansing frequencies <50%, even with imperfect hand hygiene. The analysis also indicated that the relationship between hand cleansing efficacy and frequency is not linear - as efficacy decreases, so the hand cleansing frequency required to ensure R0<1 increases disproportionately. Although our study confirmed hand hygiene to be an effective control measure, it demonstrated that the law of diminishing returns applies, with the greatest benefit derived from the first 20% or so of compliance. Indeed, our analysis suggests that there is little benefit to be accrued from very high levels of hand cleansing and that in most situations compliance >40% should be enough to prevent outbreaks of staphylococcal infection occurring, if transmission is solely via the hands of HCWs. Furthermore we identified a non-linear relationship between hand cleansing efficacy and frequency, suggesting that it is important to maximise the efficacy of the hand cleansing process

Hygrothermal performance of wood-hemp insulation in timber frame wall panels with and without a vapour barrier

An in situ experiment on a full-scale timber frame test building was carried out to study the hygrothermal performance of wood-hemp composite insulation in timber frame wall panels with and without a vapour barrier. The heat transfer properties and the likelihood of mould growth and condensation in the panels were compared. Step changes in the internal relative humidity were performed to explore the effects of high, normal and low internal moisture loads on the wall panels. No significant difference in the average equivalent thermal transmittance (U-values) between the panels with and without a vapour barrier was observed. The average equivalent U-values of the panels were close to the U-values calculated from the manufacturers’ declared thermal conductivity values of the insulation. The likelihood of condensation was higher at the interface of the wood-hemp insulation and the oriented strand board (OSB) in the panel without a vapour barrier. In terms of the parametric assessment of the mould germination potential, the relative humidity, the temperature and the exposure conditions in the insulation-OSB interfaces of the panel without a vapour barrier were found to be more favourable to the germination of mould spores. Nonetheless, when the insulations were dismantled, no mould was visually detected

Recognition of cancer warning signs and anticipated time to help-seeking in a population sample of adults in the UK

Background: Not recognising a symptom as suspicious is a common reason given by cancer patients for delayed help-seeking; but inevitably this is retrospective. We therefore investigated associations between recognition of warning signs for breast, colorectal and lung cancer and anticipated time to help-seeking for symptoms of each cancer. Methods: Computer-assisted telephone interviews were conducted with a population-representative sample (N=6965) of UK adults age greater than or equal to50 years, using the Awareness and Beliefs about Cancer scale. Anticipated time to help-seeking for persistent cough, rectal bleeding and breast changes was categorised as >2 vs less than or equal to2 weeks. Recognition of persistent cough, unexplained bleeding and unexplained lump as cancer warning signs was assessed (yes/no). Associations between recognition and help-seeking were examined for each symptom controlling for demographics and perceived ease of health-care access. Results: For each symptom, the odds of waiting for >2 weeks were significantly increased in those who did not recognise the related warning sign: breast changes: OR=2.45, 95% CI 1.47–4.08; rectal bleeding: OR=1.77, 1.36–2.30; persistent cough: OR=1.30, 1.17–1.46, independent of demographics and health-care access. Conclusion: Recognition of warning signs was associated with anticipating faster help-seeking for potential symptoms of cancer. Strategies to improve recognition are likely to facilitate earlier diagnosis

Quantum Gravity in Everyday Life: General Relativity as an Effective Field Theory

This article is meant as a summary and introduction to the ideas of effective field theory as applied to gravitational systems. Contents: 1. Introduction 2. Effective Field Theories 3. Low-Energy Quantum Gravity 4. Explicit Quantum Calculations 5. ConclusionsComment: 56 pages, 2 figures, JHEP style, Invited review to appear in Living Reviews of Relativit

Uncertainty evaluation associated with versatile automated gauging influenced by process variations through design of experiments approach

Recent advances in versatile automated gauging have enabled accurate geometric tolerance assessment on the shop floor. This paper is concerned with the uncertainty evaluation associated with comparative coordinate measurement using the design of experiments (DOE) approach. It employs the Renishaw Equator which is a software-driven comparative gauge based on the traditional comparison of production parts to a reference master part. The fixturing requirement of each production part to the master part is approximately ±1 mm for a comparison process with an uncertainty of ±2 μm. Therefore, a number of experimental designs are applied with the main focus on the influence of part misalignment from rotation between master and measure coordinate frames on the comparator measurement uncertainty. Other factors considered include measurement mode mainly in scanning and touch-trigger probing (TTP) and alignment procedure used to establish the coordinate reference frame (CRF) with respect to the number of contact points used for each geometric feature measured. The measurement uncertainty analysis of the comparator technique used by the Equator gauge commences with a simple measurement task using a gauge block to evaluate the three-dimensional (3D) uncertainty of length comparative coordinate measurement influenced by an offset by tilt in one direction (two-dimensional angular misalignment). Then, a specific manufactured measurement object is employed so that the comparator measurement uncertainty can be assessed for numerous measurement tasks within a satisfactory range of the working volume of the versatile gauge. Furthermore, in the second case study, different types of part misalignment including both 2D and 3D angular misalignments are applied. The time required for managing the re-mastering process is also examined. A task specific uncertainty evaluation is completed using DOE. Also, investigating the effects of process variations that might be experienced by such a device in workshop environments. It is shown that the comparator measurement uncertainties obtained by all the experiments agree with system features under specified conditions. It is also demonstrated that when the specified conditions are exceeded, the comparator measurement uncertainty is associated with the measurement task, the measurement strategy used, the feature size, and the magnitude and direction of offset angles in relation to the reference axes of the machine. In particular, departures from the specified part fixturing requirement of Equator have a more significant effect on the uncertainty of length measurement in comparator mode and a less significant effect on the diameter measurement uncertainty for the specific Equator and test conditions

Stent vs. Stent-less Ileal Conduits After Radical Cystectomies: Is There Difference In Early Postoperative Outcomes?

Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) diversion has long been common practice, which has recently been called into question. In this study, we aim to investigate the difference in 30-day outcomes between patients who did and did not receive ureteral stents after RCIC.https://jdc.jefferson.edu/urologyfposters/1003/thumbnail.jp

Host Immune Response to Mosquito-Transmitted Chikungunya Virus Differs from That Elicited by Needle Inoculated Virus

Mosquito-borne diseases are a worldwide public health threat. Mosquitoes transmit viruses or parasites during feeding, along with salivary proteins that modulate host responses to facilitate both blood feeding and pathogen transmission. Understanding these earliest events in mosquito transmission of arboviruses by mosquitoes is essential for development and assessment of rational vaccine and treatment strategies. In this report, we compared host immune responses to chikungunya virus (CHIKV) transmission by (1) mosquito bite, or (2) by needle inoculation.Differential cytokine expression was measured using quantitative real-time RT-PCR, at sites of uninfected mosquito bites, CHIKV-infected mosquito bites, and needle-inoculated CHIKV. Both uninfected and CHIKV infected mosquitoes polarized host cytokine response to a TH2 profile. Compared to uninfected mosquito bites, expression of IL-4 induced by CHIKV-infected mosquitoes were 150 fold and 527.1 fold higher at 3 hours post feeding (hpf) and 6 hpf, respectively. A significant suppression of TH1 cytokines and TLR-3 was also observed. These significant differences may result from variation in the composition of uninfected and CHIKV-infected mosquito saliva. Needle injected CHIKV induced a robust interferon-gamma, no detectable IL-4, and a significant up-regulation of TLR-3.This report describes the first analysis of cutaneous cytokines in mice bitten by CHIKV-infected mosquitoes. Our data demonstrate contrasting immune activation in the response to CHIKV infection by mosquito bite or needle inoculation. The significant role of mosquito saliva in these earliest events of CHIKV transmission and infection are highlighted

Quasi steady state and dynamic hygrothermal performance of fibrous Hemp and Stone Wool insulations: Two innovative laboratory based investigations

Moisture and heat management properties of Hemp and Stone Wool insulations were studied by mounting them between a hot and a cold climate chamber. Both insulations were exposed to identical hygrothermal boundary conditions. Quasi steady state and dynamic tests were carried out at a range of relative humidity exposures. The likelihood of interstitial condensation was assessed and equivalent thermal conductivity values of the insulations were determined. The adsorption-desorption isotherms of the insulations were also determined in a dynamic vapour sorption (DVS) instrument. It was observed that the likelihood of condensation was higher in Stone Wool insulation than in Hemp insulation. Hemp insulation performed better in managing moisture due to its high hygric inertia and water absorption capacity. It was observed that the equivalent thermal conductivity of Stone Wool insulation was dependent on enthalpy flow and phase change of moisture. The equivalent thermal conductivity of Hemp insulation was close to its declared thermal conductivity in dynamic conditions when high relative humidity exposures were transient. In quasi steady state boundary conditions, when the insulation was allowed to reach the equilibrium moisture content at ranges of relative humidity, there was a moisture dependent increase of thermal conductivity in Hemp insulation

Qubit portrait of the photon-number tomogram and separability of two-mode light states

In view of the photon-number tomograms of two-mode light states, using the qubit-portrait method for studying the probability distributions with infinite outputs, the separability and entanglement detection of the states are studied. Examples of entangled Gaussian state and Schr\"{o}dinger cat state are discussed.Comment: 20 pages, 6 figures, TeX file, to appear in Journal of Russian Laser Researc