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)

Two-by-two factorial randomised study within a trial (SWAT) to evaluate strategies for follow-up in a randomised prevention trial

BackgroundFailure to collect outcome data in randomised trials can result in bias and loss of statistical power. Further evaluations of strategies to increase retention are required. We assessed the effectiveness of two strategies for retention in a randomised prevention trial using a two-by-two factorial randomised study within a trial (SWAT).MethodsParents of babies included in the host trial were randomised to (1) short message service (SMS) notification prior to sending questionnaires at 3, 6, 12 and 18 months versus no SMS notification and (2) a £10 voucher sent with the invitation letter for the primary follow-up visit at 24 months or given at the visit. The two co-primary outcomes were collection of host trial (1) questionnaire data at interim follow-up times and (2) primary outcome at 24 months during a home/clinic visit with a research nurse.ResultsBetween November 2014 and November 2016, 1394 participants were randomised: 350 to no SMS + voucher at visit, 345 to SMS + voucher at visit, 352 to no SMS + voucher before visit and 347 to SMS + voucher before visit. Overall questionnaire data was collected at interim follow-up times for 75% in both the group allocated to the prior SMS notification and the group allocated to no SMS notification (odds ratio (OR) SMS versus none 1.02, 95% CI 0.83 to 1.25). Host trial primary outcome data was collected at a visit for 557 (80%) allocated to the voucher before the visit in the invitation letter and for 566 (81%) whose parents were allocated to receive the voucher at the visit (OR before versus at visit 0.89, 95% CI 0.69 to 1.17).ConclusionThere was no evidence of a difference in retention according to SMS notification or voucher timing. Future synthesis of SWAT results is required to be able to detect small but important incremental effects of retention strategies

XMM-Newton X-ray Observations of the Wolf-Rayet Binary System WR 147

We present results of a 20 ksec X-ray observation of the Wolf-Rayet (WR) binary system WR 147 obtained with XMM-Newton. Previous studies have shown that this system consists of a nitrogen-type WN8 star plus an OB companion whose winds are interacting to produce a colliding wind shock. X-ray spectra from the pn and MOS detectors confirm the high extinction reported from IR studies and reveal hot plasma including the first detection of the Fe K-alpha line complex at 6.67 keV. Spectral fits with a constant-temperature plane-parallel shock model give a shock temperature kT(shock) = 2.7 keV [T(shock) ~ 31 MK], close to but slightly hotter than the maximum temperature predicted for a colliding wind shock. Optically thin plasma models suggest even higher temperatures, which are not yet ruled out. The X-ray spectra are harder than can be accounted for using 2D numerical colliding wind shock models based on nominal mass-loss parameters. Possible explanations include: (i) underestimates of the terminal wind speeds or wind abundances, (ii) overly simplistic colliding wind models, or (iii) the presence of other X-ray emission mechanisms besides colliding wind shocks. Further improvement of the numerical models to include potentially important physics such as non-equilibrium ionization will be needed to rigorously test the colliding wind interpretation.Comment: 8 pages, 7 figure

Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study.

BACKGROUND: Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). METHODS: This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0-13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. RESULTS: In the matched case-control study, we recruited 292 cases-we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20-0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10,749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31-34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2-91) of bacteraemia cases were attributable to malaria. INTERPRETATION: Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. FUNDING: Wellcome Trust

Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care

<b>Background</b><p></p> There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial.<p></p> <b>Methods</b><p></p> This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures.<p></p> <b>Results</b><p></p> All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients.<p></p> <b>Conclusions</b><p></p> This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context

Gravitational Radiation from Nonaxisymmetric Instability in a Rotating Star

We present the first calculations of the gravitational radiation produced by nonaxisymmetric dynamical instability in a rapidly rotating compact star. The star deforms into a bar shape, shedding $\sim 4\%$ of its mass and $\sim 17\%$ of its angular momentum. The gravitational radiation is calculated in the quadrupole approximation. For a mass $M \sim 1.4$ M$_{\odot}$ and radius $R \sim 10$ km, the gravitational waves have frequency $\sim 4$ kHz and amplitude $h \sim 2 \times 10^{-22}$ at the distance of the Virgo Cluster. They carry off energy $\Delta E/M \sim 0.1\%$ and radiate angular momentum $\Delta J/J \sim 0.7\%$.Comment: 16 pages, LaTeX with REVTEX macros, reprints available - send mailing address to [email protected]. Published: PRL 72, 1314 (1994

The conspicuous absence of X-ray emission from carbon-enriched Wolf-Rayet stars

The carbon-rich WC5 star WR 114 was not detected during a 15.9 ksec XMM-Newton observation, implying an upper limit to the X- ray luminosity of L-X less than or similar to 2.5 x 10(30) erg s(-1) and to the X-ray to bolometric luminosity ratio of L- X/L(bo)l less than or similar to 4 x 10(-9). This confirms indications from earlier less sensitive measurements that there has been no convincing X-ray detection of any single WC star. This lack of detections is reinforced by XMM-Newton and Chandra observations of WC stars. Thus the conclusion has to be drawn that the stars with radiatively-driven stellar winds of this particular class are insignificant X-ray sources. We attribute this to photoelectronic absorption by the stellar wind. The high opacity of the metal-rich and dense winds from WC stars puts the radius of optical depth unity at hundreds or thousands of stellar radii for much of the X-ray band. We believe that the essential absence of hot plasma so far out in the wind exacerbated by the large distances and correspondingly high ISM column densities makes the WC stars too faint to be detectable with current technology. The result also applies to many WC stars in binary systems, of which only about 20% are identified X-ray sources, presumably due to colliding winds