A Community Education and Intervention Program for Level Crossing Risk Management in Australia

This project aims to design, implement and evaluate a community road safety program using an intervention and control community methodology. It is a 3-year national project funded by the Cooperative Research Centre for Railway Engineering and Technologies in Australia. With level crossing accidents constituting a significant proportion of death and injury associated with rail operations the need to conduct research in level crossing safety is warranted. To date, there has been little research conducted in Australia that evaluates community road safety programs targeting level crossing safety as well as identifying impediments towards the development of safe level crossing behaviour

When good bugs go bad: Epidemiology and antimicrobial resistance profiles of Corynebacterium striatum, an emerging multidrug-resistant, opportunistic pathogen

ABSTRACT Infections with Corynebacterium striatum have been described in the literature over the last 2 decades, with the majority being bacteremia, central line infections, and occasionally, endocarditis. In recent years, the frequency of C. striatum infections appears to be increasing; a factor likely contributing to this is the increased ease and accuracy of the identification of Corynebacterium spp., including C. striatum , from clinical cultures. The objective of this study was to retrospectively characterize C. striatum isolates recovered from specimens submitted as part of routine patient care at a 1,250-bed, tertiary-care academic medical center. Multiple strain types were recovered, as demonstrated by repetitive-sequence-based PCR. Most of the strains of C. striatum characterized were resistant to antimicrobials commonly used to treat Gram-positive organisms, such as penicillin, ceftriaxone, meropenem, clindamycin, and tetracycline. The MIC 50 for ceftaroline was &gt;32 μg/ml. Although there are no interpretive criteria for susceptibility with telavancin, it appeared to have potent in vitro efficacy against this species, with MIC 50 and MIC 90 values of 0.064 and 0.125 μg/ml, respectively. Finally, as previously reported in case studies, we demonstrated rapid in vitro development of daptomycin resistance in 100% of the isolates tested ( n = 50), indicating that caution should be exhibited when using daptomycin for the treatment of C. striatum infections. C. striatum is an emerging, multidrug-resistant pathogen that can be associated with a variety of infection types. </jats:p

Gaseous Mediators in Gastrointestinal Mucosal Defense and Injury

Of the numerous gaseous substances that can act as signaling molecules, the best characterized are nitric oxide, carbon monoxide and hydrogen sulfide. Contributions of each of these low molecular weight substances, alone or in combination, to maintenance of gastrointestinal mucosal integrity have been established. There is considerable overlap in the actions of these gases in modulating mucosal defense and responses to injury, and in some instances they act in a cooperative manner. Each also play important roles in regulating inflammatory and repair processes throughout the gastrointestinal tract. In recent years, significant progress has been made in the development of novel anti-inflammatory and cytoprotective drugs that exploit the beneficial activities of one or more of these gaseous mediators

Motorist behaviour at railway level crossings : the present context in Australia

Railway level crossing collisions in Australia are a major cause of concern for both rail and road authorities. Despite the fact that the number of railway crash fatalities in Australia has fallen in recent years, level crossing collisions constitute a significant proportion of the national rail toll. Although rail transport is presently one of the safest forms of land transport, collisions at level crossings are three times more likely to involve fatalities as compared to all other types of road crashes (Afxentis, 1994). With many level crossing fatalities and injuries resulting in coronial inquests, litigation and negative media publicity, the actions of rail and road infrastructure providers and the behaviour of motorists, pedestrians and rail users, come under close scrutiny. Historically, research in this area has been plagued by the rail/road interface and the separation of responsibilities between rail and road authorities reflecting the social and political context in which they are contained. With the recent rail reform in Australia, safety at level crossings has become a key priority area. Accordingly, there is a need to better understand the scope and nature of motorist behaviour at level crossings, in order to develop and implement more effective countermeasures for unsafe driving behaviour. However, a number of obstacles have hindered research into the area of level crossing safety. As with many road crashes, the contributing causes and factors are often difficult to determine, however a recent investigation of fatal collisions at level crossings supports the notion that human fault is a major contributor (Australian Transport Safety Bureau, 2002a). Additionally, there is a lack of reliable data available relating to the behavioural characteristics and perceptions of drivers at level crossings. Studies that do exist have lacked a strong theoretical base to guide the interpretation of results. Due to the lack of financial viability of continuing to approach risk management from an engineering perspective, the merits of human factor research need to be examined for suitability. In Australia, there has been considerable recognition regarding the importance of human factor approaches to level crossing safety (Australian Transport Council, 2003). However, little attempt has been made by authorities to scientifically develop and measure the effectiveness of road safety educational interventions. Therefore, there exists a significant need for developing targeted road safety educational interventions to improve current risk management solutions at level crossings. This research program is the first of its kind in investigating motorist behaviour at level crossings and the measuring the effectiveness of educational interventions for improving driving safety. Although other ‘educational’ campaigns exist in this field, no campaign or intervention has been guided by empirical research or theory. This thesis adopted a multidisciplinary approach to theory, reviewing perspectives from psychology, sociology and public health to explain driver behaviour at level crossings. This array of perspectives is necessary due to the variety of behaviours involved in collisions and near-misses at level crossings. The motivation underlying motorist behaviour determines to a large extent how successful behaviour change strategies (e.g. educational interventions) may be. Fishbein’s Integrated Model of Behaviour Change (IM) based largely on the health belief model, theory of reasoned action and theory of planned behaviour (Fishbein, 2000), assisted in the planning and development of a ‘oneoff’ targeted educational intervention specific for three different road user groups and in questionnaire development to ascertain the present context of motorist behaviour at level crossings. As no known research has been conducted that utilizes any psychosocial model to explain or predict level crossing behavior within different road user groups, this research program used this model as an exploratory tool rather than a tool to asses the model’s capacity in explaining such behaviour. The difference between this model and others is the inclusion of two important constructs in driving: skills (or abilities) and environmental factors. Fishbein (2003) suggests that the model recognises the lack of skills (or abilities) and/or environmental constraints may prevent a person from acting on their intentions, in light of the fact that intention is viewed as the primary determinant of behaviour. While the majority of behaviour change theories are limited by a range of conceptual and contextual factors (Parker, 2004), the IM was used to assist this research program as it appeared to be the most applicable model to examining level crossing safety. A variety of data collection methods were used in this research program as much of what is currently known about level crossing collisions is derived from coroner’s findings and statistics. The first study (Study One) was designed to extend this knowledge by undertaking a more thorough examination of contributing factors to level crossing crashes and the road user groups at risk. This study used the method of ‘triangulation’ (i.e. combining research methods to give a range of perspectives) whereby both qualitative (focus groups) and quantitative (modified Delphi technique) research designs were utilised (Barbour, 1999, Bryman, 1992). With the discipline of road safety research requiring methodological strategies that will enhance efforts to conceptualise the multi-faceted nature of motorist behaviour at level crossings, this application provided the robustness required. Results from the Delphi technique indicated that older, younger and heavy vehicle drivers are considered to be three of the highest risk road user groups by experts in the field. For the older driver group, experts agreed that errors in judgment were the most important issue for this group when driving at level crossings. Risk taking by younger drivers, such as trying to beat the train across the crossing, was viewed as the central issue for the younger driver group. Like the younger driver group, a concern by experts with the heavy vehicle group was intentional risk taking at level crossings. However, experts also rated the length of heavy vehicles a major concern due to the possibility of a truck over-hanging a crossing. Results from focus groups with train drivers in Study One indicated that there are unique problems associated with crossings in rural/regional areas compared to urban areas. The metropolitan train drivers generally experienced motorist behaviour at active crossings with flashing lights and boom gates while the regional train drivers experienced behaviours at active crossings with boom gates, crossings with lights only and passive crossings with stationary signs. In the metropolitan train driver group, experiences of motorist behaviour at level crossings included: motorists driving around boom gates, getting stuck under boom gates, queuing over congested crossings and driving through the crossing after the red lights commence flashing. The behaviour of motorists driving around boom gates was noted to occur quite regularly. The majority of metropolitan train drivers reported that it was a common occurrence for motorists to drive through a crossing when the lights are flashing both before and after the booms were activated and some crossings were named as ‘black spots’ (locations where motorists repeatedly violate the road rules). Vehicles protruding into the path of the train and motorists entering congested crossings and then panicking and driving backwards into the boom gates were also mentioned. Regional train drivers indicated that motorists not stopping or giving way to trains is a continual problem at passively controlled crossings (i.e. no boom gates or flashing lights). Regional train drivers generally agreed that the majority of motorists obey protection systems; however some motorists drive through flashing lights or drive around boom gates. Other high risk behaviours included motorists attempting to beat the train across the crossing, speeding up to go through flashing lights, and general risk taking by younger drivers in particular. Motorists not allowing enough time to cross in front of the train or hesitating (stopstarting) at crossings were also noted to be at high risk. There was a general perception by regional train drivers that motorists are unable to judge the speed and distance of an approaching train to determine a safe gap during which to cross. Local motorists were also reported to be a problem at level crossings for regional train drivers. A theme common to regional and metropolitan train drivers was the risk of catastrophic consequence associated with level crossing collisions. The reasons given for this were the threat of derailment, serious property damage, the high risk of a fatality, personal injury and, most earnestly, the potential for enduring psychological consequences. Drivers uniformly spoke about the continual fear they had of being involved in a collision with a heavy vehicle, and many spoke of the effects that such collisions had on train drivers involved. For this reason, train drivers were said to consider any near-miss incident involving trucks particularly serious. The second study undertaken as part of this research program (Study Two), involved formative research as part of the planning, development and delivery of behavioural interventions for each of the three road user groups identified in Study One. This study also used both qualitative and quantitative data collection methods to provide methodological triangulation and ensure reliability of the data. The overall objective of the qualitative data collection was to obtain rich data using a qualitative mode of inquiry, based on the key variables of attitudes, norms, self-efficacy (perceived behavioural control), perceived risk, environmental constraints and the skills/abilities of drivers. The overall objective of the quantitative data collection was to prioritise the issues identified in order to direct and allocate project resources for intervention planning, development and delivery. This combined recruitment strategy was adopted as it was an appropriate and practical data collection strategy within the qualitative and exploration methodology. Information obtained from each of the groups was critical in assisting, guiding, and identifying priority areas for message and material development. The use of focus groups and one-on-one interviews provided insights into why drivers think or do what they do at level crossings. The qualitative component of this study found that for the older driver group, regional drivers hold a greater perception of risk at level crossings than urban older drivers, with many recalling near-misses. Participants from the urban older driver group indicated that level crossings are not as dangerous as other aspects of driving, with many participants being doubtful that motorists are killed while driving at level crossings. Both urban and regional younger drivers tended to hold a low perception of risk for driving at level crossings, however many participants reported having great difficulty in judging the distance a train is from a crossing. Impatience for waiting at level crossings was reported to be the major reason for any risk taking at level crossings in the younger driver group. Complacency and distraction were viewed by heavy vehicle participants as two of the major driver factors that put them at risk at level crossings, while short-stacking (when the trailer of the truck extends onto the crossing), angle of approach (acute or obtuse angle) and lack of advance warning systems were seen as the major engineering problems for driving a truck at level crossings. The quantitative component of this study involving research with train drivers found that at the aggregate train driver level, it is apparent that train drivers consider motorists’ deliberate violations of the road rules and negligently lax approach to hazard detection as the predominant causes of dangerous driving at level crossings. Experts were observed to rank risk taking behaviours slightly lower than train drivers, although they agreed with train drivers that ‘trying to beat the train’ is the single most critical risk taking behaviour observed by motorists. The third study (Study Three) involved three parts. The aim of Part One of this study was to develop targeted interventions specific to each of the three road user groups by using Fishbein’s theoretical model (Integrated Model of Behaviour Change) as a guide. The development of interventions was originally seen as being outside of the scope of this project, however it became intertwined in questionnaire development and thus deemed to be within the realms of the current mode of inquiry. The interventions were designed in the format of a pilot radio road safety advertisement, as this medium was found to be one of the most acceptable to each of the road user groups as identified in the formative research undertaken in Study Two. The interventions were used as a ‘one-off’ awareness raising intervention for each road user group. Part Two involved the investigation of the present context of unsafe driving behaviour at level crossings. This second part involved the examination of the present context of motorist behaviour at level crossings using key constructs from Fishbein’s Integrated Model of Behaviour Change (IM). Part Three involved trialing a pilot road safety radio advertisement using an intervention and control methodology. This part investigated the changes in pre and post-test constructs including intentions, self-reported behaviour, attitudes, norms, selfefficacy/ perceived behaviour control, perceived risks, environment constraints and skills/ability. Results from this third study indicated that younger drivers recognise that level crossings are potentially a highly dangerous intersection yet are still likely to engage in risk taking behaviours. Additionally, their low levels of self-efficacy in driving at level crossings pose challenges for developing interventions with this age group. For the older driver sample, this research confirms the high prevalence of functional impairments such as increasing trouble adjusting to glare and night-time driving, restricted range of motion to their neck and substantial declines in their hearing. While factors contributing to the over-representation of older drivers in collisions at level crossings are likely to be complex and multi-faceted, such functional impairments are expected to play a critical role. The majority of heavy vehicle drivers reported driving safely and intending to drive safely in the future, however, there is a sub-set of drivers that indicate they have in the past and will in the future take risks when traversing crossings. Although this sub-set is relatively small, if generalised to the larger trucking industry it could be problematic for the rail sector and greater public alike. Familiarity was a common factor that was found to play a role in driving intention at level crossings for all three road user groups. This finding supports previous research conducted by Wigglesworth during the 1970’s in Australia (Wigglesworth, 1979). Taken together, the results of the three studies in this research program have a number of implications for level crossing safety in Australia. Although the ultimate goal to improve level crossing safety for all motorists would be to have a combination of engineering, education and enforcement countermeasures, the small number of fatalities in comparison to the national road toll limits this. It must be noted though that the likelihood of creating behavioural change would be increased if risk taking at level crossings by all motorists was detected and penalised, or alternatively, if perceptions of such detection were increased. The instilling of fear in drivers with the threat of punishment via some form of sanction can only be achieved through a combination of a mass media campaign and increasing police presence. Ideally, the aim would be to combine fear of punishment with the guilt associated with the social non-acceptability of disobeying road rules at level crossings. Such findings have direct implications for improving the present context of motorist behaviour at level crossings throughout Australia

Frequency of instrument, environment, and laboratory technologist contamination during routine diagnostic testing of infectious specimens

ABSTRACT Laboratory testing to support the care of patients with highly infectious diseases may pose a risk for laboratory workers. However, data on the risk of virus transmission during routine laboratory testing conducted using standard personal protective equipment (PPE) are sparse. Our objective was to measure laboratory contamination during routine analysis of patient specimens. Remnant specimens were spiked with the nonpathogenic bacteriophage MS2 at 1.0 × 10 7 PFU/ml, and contamination was assessed using reverse transcriptase PCR (RT-PCR) for MS2. Specimen containers were exteriorly coated with a fluorescent powder to enable the visualization of gross contamination using UV light. Testing was performed by two experienced laboratory technologists using standard laboratory PPE and sample-to-answer instrumentation. Fluorescence was noted on the gloves, bare hands, and laboratory coat cuffs of the laboratory technologist in 36/36 (100%), 13/36 (36%), and 4/36 (11%) tests performed, respectively. Fluorescence was observed in the biosafety cabinet (BSC) in 8/36 (22%) tests, on test cartridges/devices in 14/32 (44%) tests, and on testing accessory items in 29/32 (91%) tests. Fluorescence was not observed on or in laboratory instrumentation or adjacent surfaces. In contrast to fluorescence detection, MS2 detection was infrequent (3/286 instances [1%]) and occurred during test setup for the FilmArray instrument and on FilmArray accessory equipment. The information from this study may provide opportunities for the improvement of clinical laboratory safety practices so as to reduce the risk of pathogen transmission to laboratory workers. </jats:p

Draft genome sequence of the blaOXA-436- and blaNDM-1-harboring Shewanella putrefaciens SA70 isolate

ABSTRACT We sequenced a carbapenem-resistant Shewanella putrefaciens isolate cultured from the sink handle of a Pakistan hospital room. Assembly annotation indicates that the isolate has a chromosomal bla OXA-436 carbapenemase and a plasmid-borne bla NDM-1 gene. To our knowledge, this is the first report of a Shewanella species harboring bla NDM . </jats:p

Superficieibacter electus gen. nov., sp. nov., an extended-spectrum β-lactamase possessing member of the enterobacteriaceae family, isolated from Intensive Care Unit surfaces

<p>Two Gram-negative bacilli strains, designated BP-1(T) and BP-2, were recovered from two different Intensive Care Unit surfaces during a longitudinal survey in Pakistan. Both strains were unidentified using the bioMerieux VITEK MS IVD v2.3.3 and Bruker BioTyper MALDI-TOF mass spectrometry platforms. To more precisely determine the taxonomic identity of BP-1(T) and BP-2, we employed a biochemical and phylogenomic approach. The 16S rRNA gene sequence of strain BP-1(T) had the highest identity to Citrobacter farmeri CDC 2991-81(T) (98.63%) Citrobacter amalonaticus CECT 863(T) (98.56%), Citrobacter sedlakii NBRC 105722(T) (97.74%) and Citrobacter rodentium NBRC 105723(T) (97.74%). The biochemical utilization scheme of BP-1(T) using the Analytic Profile Index for Enterobacteriaceae (API20E) indicated its enzymatic functions are unique within the Enterobacteriaceae but most closely resemble Kluyvera spp., Enterobacter cloacae and Citrobacter koseri/farmeri. Phylogenomic analysis of the shared genes between BP-1(T), BP-2 and type strains from Kluyvera, Citrobacter, Escherichia, Salmonella, Kosakonia, Siccibacter and Shigella indicate that BP-1(T) and BP-2 isolates form a distinct branch from these genera. Average Nucleotide Identity analysis indicates that BP-1(T) and BP-2 are the same species. The biochemical and phylogenomic analysis indicate strains BP-1(T) and BP-2 represent a novel species from a new genus within the Enterobacteriaceae family, for which the name Superficieibacter electus gen. nov., sp. nov., is proposed. The type strain is BP-1(T) (= ATCC BAA-2937, = NBRC 113412).</p

Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing

OBJECTIVETo evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage.DESIGNProspective pilot study.SETTINGTertiary-care hospital.PARTICIPANTSA total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE.INTERVENTIONSHCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped, and protocol deviations were recorded.RESULTSOverall, 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning, and 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (P=.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, versus 1 among CP PPE HCWs. Also, 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 EVD PPE HCWs (44%) and 5 CP PPE HCWs (28%), most commonly on hands. MS2 was recovered from 2 EVD PPE HCWs (11%) and 3 CP PPE HCWs (17%).CONCLUSIONSProtocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and/or the trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study.Infect Control Hosp Epidemiol 2017;38:1077–1083</jats:sec

Targeting liver myofibroblasts: a novel approach in anti-fibrogenic therapy

Chronic liver disease results in a liver-scarring response termed fibrosis. Excessive scarring leads to cirrhosis, which is associated with high morbidity and mortality. The only treatment for liver cirrhosis is liver transplantation; therefore, much attention has been directed toward therapies that will slow or reverse fibrosis. Although anti-fibrogenic therapies have been shown to be effective in experimental animal models, licensed therapies have yet to emerge. A potential problem for any anti-fibrogenic therapy in the liver is the existence of the body’s major drug metabolising cell (the hepatocyte) adjacent to the primary fibrosis-causing cell, the myofibroblast. This article reviews the development of a human recombinant single-chain antibody (scAb) that binds to the surface of myofibroblasts. This antibody binds specifically to myofibroblasts in fibrotic mouse livers. When conjugated with a compound that stimulates myofibroblast apoptosis, the antibody directs the specific apoptosis of myofibroblasts with greater specificity and efficacy than the free compound. The antibody also reduces the adverse effect of liver macrophage apoptosis and—in contrast to the free compound—reversed fibrosis in the sustained injury model used. These data suggest that specifically stimulating the apoptosis of liver myofibroblasts using a targeting antibody has potential in the treatment of liver fibrosis

"...they should be offering it": a qualitative study to investigate young peoples' attitudes towards chlamydia screening in GP surgeries

<p>Abstract</p> <p>Background</p> <p>Despite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP) to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP) surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group).</p> <p>Methods</p> <p>We undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically.</p> <p>Results</p> <p>GP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgemental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them.</p> <p>Conclusion</p> <p>Young people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgemental attitude and minimising barriers to screening such as embarrassment. The GP surgery is the ideal place to screen young people for chlamydia as it is not a threatening place for them and our study has shown that they think it is the normal place to go to discuss health matters.</p