Managing occupational hazards confronting healthcare workers

The primary goal of this thesis is to identify, evaluate, and control occupational hazards that may exist in health care facilities. Due to the complex nature of health care facilities, healthcare workers are always challenged by an imposing group of occupational hazards. The magnitude and diversity of these hazards, and the constantly changing nature of government regulations make it difficult to guarantee absolute protection and accuracy of the material contained herein. However, awareness of the risks, compliance with basic preventive measures, and adequate interventions are all essential components to consider in protecting healthcare workers. Therefore, potential health effects of various hazards such as back injuries, heat, noise, infectious hazards, pharmaceutical hazards, chemicals, exposure to radiation, and prevalent psychosocial (stress) problems are reviewed, and rational approaches to managing and preventing these problems are offered. This thesis also presents a broad overview of hospital safety programs, and job safety analyses; it offers assistance in understanding and complying with regulations and guidelines issued by the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

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New therapeutic alternatives to treat Acute Bacterial Skin and Skin Structure Infections (ABSSI

Revisiting Block-Diagonal SDP Relaxations for the Clique Number of the Paley Graphs

This work addresses the block-diagonal semidefinite program (SDP) relaxations for the clique number of the Paley graphs. The size of the maximal clique (clique number) of a graph is a classic NP-complete problem; a Paley graph is a deterministic graph where two vertices are connected if their difference is a quadratic residue modulo certain prime powers. Improving the upper bound for the Paley graph clique number for odd prime powers is an open problem in combinatorics. Moreover, since quadratic residues exhibit pseudorandom properties, Paley graphs are related to the construction of deterministic restricted isometries, an open problem in compressed sensing and sparse recovery. Recent work provides evidence that the current upper bounds can be improved by the sum-of-squares (SOS) relaxations. In particular the bounds given by the SOS relaxations of degree 4 (SOS-4) are asymptotically growing at an order smaller than square root of the prime. However computations of SOS-4 become intractable with respect to large graphs. Gvozdenovic et al. introduced a more computationally efficient block-diagonal hierarchy of SDPs that refines the SOS hierarchy. They computed the values of these SDPs of degrees 2 and 3 (L2 and L3 respectively) for the Paley graph clique numbers associated with primes p less or equal to 809. These values bound from the above the values of the corresponding SOS-4 and SOS-6 relaxations respectively. We revisit these computations and determine the values of the L2 relaxation for larger p's. Our results provide additional numerical evidence that the L2 relaxations, and therefore also the SOS-4 relaxations, are asymptotically growing at an order smaller than the square root of p

Initiation but no execution - modulation of peripheral blood lymphocyte apoptosis in rheumatoid arthritis - a potential role for heat shock protein 70

<p>Abstract</p> <p>Background</p> <p>Rheumatoid arthritis (RA) is a chronic autoimmune disease, which causes synovial damage. Persistence of lymphocyte infiltrates in the rheumatoid synovium has been attributed to abnormal apoptosis. While not comprehensively investigated, perturbations in peripheral blood lymphocyte (PBL) apoptosis may also be involved in perpetuation of autoimmune processes in RA.</p> <p>Methods</p> <p>We investigated total, CD4+ and CD19+ PBL apoptosis in our study cohort by monitoring the translocation of phosphatidylserine using the Annexin-V assay. To examine the role of death receptor mediated apoptosis as well as activation-induced-cell-death (AICD), PBLs were labeled with CD95/Fas and CD69 markers and enumerated by flow cytometry. Proteolytic activity of initiator and executioner caspases was determined by luminometry. DNA fragmentation assays were used to examine whether apoptotic signals were transduced to the nucleus. Quantitative PCR arrays were used to investigate apoptotic pathways associated with RA-PBLs. Since heat-shock-protein-70 (HSP70) is an inducible protein which modulates apoptotic signals, we determined HSP70 levels by intra-cellular flow cytometry and western blots.</p> <p>Results</p> <p>The RA-PBLs showed signs of elevated apoptosis whilst in circulation. These include increases in the loss of plasma membrane asymmetry, indicated by increased externalization of phosphatidylserine (especially in B-lymphocytes). RA-PBLs showed a bias to CD95/Fas mediated apoptotic pathways, but low levels of the CD69 marker suggested that this was not associated with immune activation. Although downstream markers of apoptosis such as caspase-3/7 activity, were increased, no DNA fragmentation was observed in RA-PBLs. Interestingly, elevated levels of apoptosis did not correlate with absolute lymphocyte counts in RA patients. Levels of HSP70 were highly elevated in RA-PBLs compared to controls.</p> <p>Conclusion</p> <p>The results suggest that while apoptosis may be initiated in RA-PBLs, they may lack commitment to fully executing the apoptotic program. This may be related to inhibition on apoptotic transduction by HSP70. This study provides evidence that abnormalities in RA-PBLs apoptosis may occur whilst still in circulation and may contribute to pathogenesis of the disease.</p

Introduction of a Waterless Alcohol-based Hand Rub in a Long-term Care Facility

OBJECTIVE: To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF). METHODS: Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs\u27 hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub. RESULTS: Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change. CONCLUSION: The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs

Hydroxylated texaphyrins

A method of using texaphyrins as radiosensitizers. Advantageous properties of texaphyrins for use as a radiosensitizer include i) a low redox potential which allows radiation induced solvated electrons to flow to texaphyrin rather than neutralizing hydroxyl radicals, allowing the hydroxyl radicals to cause cellular damage, ii) a relatively stable texaphyrin radical which, nevertheless, reacts readily to covalently modify neighboring molecules causing further cellular damage, and iii) intrinsic biolocalization and indifference to the presence of O.sub.2 which allow texaphyrin to be particularly effective for treating the hypoxic areas of solid tumors. Sensitizer enhancement ratios of 1.62 and 2.2 were achieved at 20 .mu.M and 80 .mu.M gadolinium-texaphyrin, respectively, with a mouse leukemia cell line. Methods of treatment for an individual having a tumor include the use of a texaphyrin as a radiosensitizer and as an agent for photodynamic tumor therapy, or the use of a texaphyrin for internal and for external ionizing radiation. New water soluble hydroxy-substituted texaphyrins are described.Board of Regents, University of Texas Syste