Effect of copper-impregnated composite bed linens and patient gowns on healthcare-associated infection rates in six hospitals.

BACKGROUND: Hospital linens and patient gowns are frequently touched and contaminated, and may contribute to endogenous, indirect-contact, and aerosol transmission of nosocomial-related pathogens. Recently Sentara Healthcare adopted biocidal copper oxide-impregnated linens across its hospitals. AIM: To assess whether the replacement of the linens resulted in the reduction of healthcare-associated infection (HCAI). METHODS: Rates of HCAI caused by Clostridium difficile and multidrug-resistant organisms (MDROs) were compared in six Sentara Healthcare hospitals with similar patient demo-graphics (total of 1019 beds) in three parallel periods (90, 180 and 240 days) before and after (periods A1, A2 and A3, and periods B1, B2, and B3, respectively), replacing all the regular non-biocidal linens with the copper oxide-impregnated biocidal linens. FINDINGS: During periods B1, B2, and B3, compared with periods A1, A2 and A3, there were 61.2% (P < 0.05), 41.1% (P < 0.05) and 42.9% (P < 0.01) reductions in HCAI per 10,000 patient-days in hospital caused by C. difficile, respectively; 48.3% (P > 0.05), 36.4% (P > 0.05), and 19.2% (P > 0.05) reductions in HCAI per 1000 patient-days caused by MDROs; and 59.8% (P < 0.01), 39.9% (P < 0.05), and 37.2% (P < 0.05) in the reduction of HCAI per 1000 patient-days caused by C. difficile and MDROs combined. CONCLUSION: The use of biocidal copper oxide-impregnated linens in the six analysed Sentara Healthcare hospitals resulted in significant reduction in both HCAI caused by C. difficile, and the combined metric of C. difficile or MDRO infection. Similar reductions in HCAI caused by MDROs were observed, although these reductions did not reach statistical significance, probably due to very low HCAI rates caused by these pathogens in the study facilities.

Accumulated deep sleep is a powerful predictor of LH pulse onset in pubertal children.

CONTEXT: During puberty, reactivation of the reproductive axis occurs during sleep, with LH pulses specifically tied to deep sleep. This association suggests that deep sleep may stimulate LH secretion, but there have been no interventional studies to determine the characteristics of deep sleep required for LH pulse initiation. OBJECTIVE: The objective of this study was to determine the effect of deep sleep fragmentation on LH secretion in pubertal children. DESIGN AND SETTING: Studies were performed in a clinical research center. SUBJECTS: Fourteen healthy pubertal children (11.3-14.1 y) participated in the study. INTERVENTIONS: Subjects were randomized to two overnight studies with polysomnography and frequent blood sampling, with or without deep sleep disruption via auditory stimuli. RESULTS: An average of 68.1 ±10.7 (± SE) auditory stimuli were delivered to interrupt deep sleep during the disruption night, limiting deep sleep to only brief episodes (average length disrupted 1.3 ± 0.2 min vs normal 7.1 ± 0.8 min, P < .001), and increasing the number of transitions between non-rapid eye movement (NREM), REM, and wake (disrupted 274.5 ± 33.4 vs normal 131.2 ± 8.1, P = .001). There were no differences in mean LH (normal: 3.2 ± 0.4 vs disrupted: 3.2 ± 0.5 IU/L), LH pulse frequency (0.6 ± 0.06 vs 0.6 ± 0.07 pulses/h), or LH pulse amplitude (2.8 ± 0.4 vs 2.8 ± 0.4 IU/L) between the two nights. Poisson process modeling demonstrated that the accumulation of deep sleep in the 20 minutes before an LH pulse, whether consolidated or fragmented, was a significant predictor of LH pulse onset (P < .001). CONCLUSION: In pubertal children, nocturnal LH augmentation and pulse patterning are resistant to deep sleep fragmentation. These data suggest that, even when fragmented, deep sleep is strongly related to activation of the GnRH pulse generator.

Computed tomographic measures of airway morphology in smokers and never-smoking normals.

Bronchial wall area percent (WA% = 100 × wall area/total bronchial cross sectional area) is a standard computed tomographic (CT) measure of central airway morphology utilized in smokers with chronic obstructive pulmonary disease (COPD). Although it provides significant clinical correlations, the range of reported WA% is narrow. This suggests limited macroscopic change in response to smoking or that remodeling proportionally affects the airway wall and lumen dimensions such that their ratio is preserved. The objective of this study is to assess central airway wall area (WA), lumen area (Ai), and total bronchial area (Ao) from CT scans of 5,179 smokers and 92 never smoking normal subjects. In smokers, WA, Ai, and Ao were positively correlated with forced expiratory volume in 1 s (FEV1) expressed as a percent of predicted (FEV1%), and the WA% was negatively correlated with FEV1% (P < 0.0001 for all comparisons). Importantly, smokers with lower FEV1% tended to have airways of smaller cross-sectional area with lower WA. The increases in the WA% across GOLD stages of chronic obstructive pulmonary disease (COPD) can therefore not be due to increases in WA. The data suggest two possible origins for the WA% increases: 1) central airway remodeling resulting in overall reductions in airway caliber in excess of the decreased WA or 2) those with COPD had smaller native airways before they began smoking. In both cases, these observations provide an explanation for the limited range of values of WA% across stages of COPD.

Physiology-based MR imaging assessment of CSF flow at the foramen magnum with a valsalva maneuver.

BACKGROUND AND PURPOSE: MR imaging is currently not used to evaluate CSF flow changes due to short-lasting physiological maneuvers. The purpose of this study was to evaluate the ability of MR imaging to assess the CSF flow response to a Valsalva maneuver in healthy participants. MATERIALS AND METHODS: A cardiac-gated fast cine-PC sequence with ≤15-second acquisition time was used to assess CSF flow in 8 healthy participants at the foramen magnum at rest, during, and immediately after a controlled Valsalva maneuver. CSF mean displacement volume VCSF during the cardiac cycle and CSF flow waveform App were determined. A work-in-progress real-time pencil-beam imaging method with temporal resolution ≤56 ms was used to scan 2 participants for 90 seconds during which resting, Valsalva, and post-Valsalva CSF flow, respiration, and HR were continuously recorded. Results were qualitatively compared with invasive craniospinal differential pressure measurements from the literature. RESULTS: Both methods showed 1) a decrease from baseline in VCSF and App during Valsalva and 2) an increase in VCSF and App immediately after Valsalva compared with values measured both at rest and during Valsalva. Whereas fast cine-PC produced a single CSF flow waveform that is an average over many cardiac cycles, pencil-beam imaging depicted waveforms for each heartbeat and was able to capture many dynamic features of CSF flow, including transients synchronized with the Valsalva maneuver. CONCLUSIONS: Both fast cine-PC and pencil-beam imaging demonstrated expected changes in CSF flow with Valsalva maneuver in healthy participants. The real-time capability of pencil-beam imaging may be necessary to detect Valsalva-related transient CSF flow obstruction in patients with pathologic conditions such as Chiari I malformation.

Variability of respiratory mechanics during sleep in overweight and obese subjects with and without asthma.

Variability of respiration may provide information regarding disease states. We sought to characterize variability of ventilation and resistance in healthy and asthma, to determine how respiratory control may be altered in sleep and with bi-level positive airway pressure (BPAP). Overweight and obese subjects with and without asthma were studied during sleep at baseline and with BPAP, while measuring respiratory system resistance (Rrs) continuously. Stable periods (>20min) of wake, NREM, and REM sleep were identified and correlation metrics of respiratory parameters were calculated, including coefficient of variation (CV). Variability of Rrs was also characterized over short time scales (20 breaths) during sleep and defined as either "leading to arousal" or "not leading to arousal". Data from 10 control and 10 subjects with asthma were analyzed. CV of Rrs was decreased in asthma at baseline (p<0.001) and decreased on BPAP as compared to baseline (p<0.001). Long time scale correlations were found in respiratory parameters, but the degree of correlations was decreased from wake to sleep (p<0.05). The variance and CV of Rrs was increased preceding an arousal from sleep at baseline; however, during BPAP, the CV was decreased and was not increased preceding arousals. At baseline, resistance was greater in those with asthma, but variability was smaller. BPAP reduced both resistance and overall variability. We conclude that the BPAP-induced decrease in variability may indicate that those with asthma are more likely to remain in a low resistance state, and that low resistance variability may reduce arousals from sleep.

Insights into puberty: the relationship between sleep stages and pulsatile LH secretion.

CONTEXT: During the pubertal transition, LH secretion initially increases only during sleep; however, its relationship to sleep stage is unknown. OBJECTIVES: Our objective was to determine whether the initiation of LH pulses is related to a specific sleep stage in pubertal children. DESIGN AND SETTING: Frequent blood sampling and polysomnographic studies were performed in a Clinical Research Center. SUBJECTS: Fourteen studies were performed in nine healthy pubertal children, ages 9.9-15.6 yr. INTERVENTIONS: Subjects underwent one to two overnight studies with polysomnography and blood sampling for LH at 10-min intervals. RESULTS: Alignment of polysomnographic records and LH pulses demonstrated that LH pulses (n = 58) occurred most frequently during slow-wave sleep (SWS) (1.1 pulse/h, n = 30) compared with all other sleep stages or periods of wake after sleep onset (P < 0.001). There was also a significant increase in the amount of SWS in the 15 min preceding and the 5 min following each pulse compared with the amount of SWS seen across the study night (P < 0.01). CONCLUSIONS: During puberty, the majority of LH pulses that occur after sleep onset are preceded by SWS, suggesting that SWS is intimately involved in the complex control of pubertal onset. These studies raise concerns about the potential hormonal repercussions of the increasing prevalence of sleep disturbances in adolescents.

Geometric hysteresis of alveolated ductal architecture.

Low Reynolds number airflow in the pulmonary acinus and aerosol particle kinetics therein are significantly conditioned by the nature of the tidal motion of alveolar duct geometry. At least two components of the ductal structure are known to exhibit stress-strain hysteresis: smooth muscle within the alveolar entrance rings, and surfactant at the air-tissue interface. We hypothesize that the geometric hysteresis of the alveolar duct is largely determined by the interaction of the amount of smooth muscle and connective tissue in ductal rings, septal tissue properties, and surface tension-surface area characteristics of surfactant. To test this hypothesis, we have extended the well-known structural model of the alveolar duct by Wilson and Bachofen (1982, "A Model for Mechanical Structure of the Alveolar Duct," J. Appl. Physiol. 52(4), pp. 1064-1070) by adding realistic elastic and hysteretic properties of (1) the alveolar entrance ring, (2) septal tissue, and (3) surfactant. With realistic values for tissue and surface properties, we conclude that: (1) there is a significant, and underappreciated, amount of geometric hysteresis in alveolar ductal architecture; and (2) the contribution of smooth muscle and surfactant to geometric hysteresis are of opposite senses, tending toward cancellation. Quantitatively, the geometric hysteresis found experimentally by Miki et al. (1993, "Geometric Hysteresis in Pulmonary Surface-to-Volume Ratio during Tidal Breathing," J. Appl. Physiol. 75(4), pp. 1630-1636) is consistent with little or no smooth muscle tone in anesthetized rabbits in control conditions, and with substantial smooth muscle activation following methacholine challenge. The observed local hysteretic boundary motion of the acinar duct would result in irreversible acinar flow fields, which might be important mechanistic contributors to aerosol mixing and deposition deep in the lung.

Biomechanical effects of environmental and engineered particles on human airway smooth muscle cells.

The past decade has seen significant increases in combustion-generated ambient particles, which contain a nanosized fraction (less than 100 nm), and even greater increases have occurred in engineered nanoparticles (NPs) propelled by the booming nanotechnology industry. Although inhalation of these particulates has become a public health concern, human health effects and mechanisms of action for NPs are not well understood. Focusing on the human airway smooth muscle cell, here we show that the cellular mechanical function is altered by particulate exposure in a manner that is dependent upon particle material, size and dose. We used Alamar Blue assay to measure cell viability and optical magnetic twisting cytometry to measure cell stiffness and agonist-induced contractility. The eight particle species fell into four categories, based on their respective effect on cell viability and on mechanical function. Cell viability was impaired and cell contractility was decreased by (i) zinc oxide (40-100 nm and less than 44 microm) and copper(II) oxide (less than 50 nm); cell contractility was decreased by (ii) fluorescent polystyrene spheres (40 nm), increased by (iii) welding fumes and unchanged by (iv) diesel exhaust particles, titanium dioxide (25 nm) and copper(II) oxide (less than 5 microm), although in none of these cases was cell viability impaired. Treatment with hydrogen peroxide up to 500 microM did not alter viability or cell mechanics, suggesting that the particle effects are unlikely to be mediated by particle-generated reactive oxygen species. Our results highlight the susceptibility of cellular mechanical function to particulate exposures and suggest that direct exposure of the airway smooth muscle cells to particulates may initiate or aggravate respiratory diseases.

Universal behavior of the osmotically compressed cell and its analogy to the colloidal glass transition.

Mechanical robustness of the cell under different modes of stress and deformation is essential to its survival and function. Under tension, mechanical rigidity is provided by the cytoskeletal network; with increasing stress, this network stiffens, providing increased resistance to deformation. However, a cell must also resist compression, which will inevitably occur whenever cell volume is decreased during such biologically important processes as anhydrobiosis and apoptosis. Under compression, individual filaments can buckle, thereby reducing the stiffness and weakening the cytoskeletal network. However, the intracellular space is crowded with macromolecules and organelles that can resist compression. A simple picture describing their behavior is that of colloidal particles; colloids exhibit a sharp increase in viscosity with increasing volume fraction, ultimately undergoing a glass transition and becoming a solid. We investigate the consequences of these 2 competing effects and show that as a cell is compressed by hyperosmotic stress it becomes progressively more rigid. Although this stiffening behavior depends somewhat on cell type, starting conditions, molecular motors, and cytoskeletal contributions, its dependence on solid volume fraction is exponential in every instance. This universal behavior suggests that compression-induced weakening of the network is overwhelmed by crowding-induced stiffening of the cytoplasm. We also show that compression dramatically slows intracellular relaxation processes. The increase in stiffness, combined with the slowing of relaxation processes, is reminiscent of a glass transition of colloidal suspensions, but only when comprised of deformable particles. Our work provides a means to probe the physical nature of the cytoplasm under compression, and leads to results that are universal across cell type.

A System for Open-Access He Human Lung Imaging at Very Low Field.

We describe a prototype system built to allow open-access very-low-field MRI of human lungs using laser-polarized (3)He gas. The system employs an open four-coil electromagnet with an operational B(0) field of 4 mT, and planar gradient coils that generate gradient fields up to 0.18 G/cm in the x and y direction and 0.41 G/cm in the z direction. This system was used to obtain (1)H and (3)He phantom images and supine and upright (3)He images of human lungs. We include discussion on challenges unique to imaging at 50 -200 kHz, including noise filtering and compensation for narrow-bandwidth coils.

3He lung imaging in an open access, very-low-field human magnetic resonance imaging system.

The human lung and its functions are extremely sensitive to gravity; however, the conventional high-field magnets used for most laser-polarized (3)He MRI of the human lung restrict subjects to lying horizontally. Imaging of human lungs using inhaled laser-polarized (3)He gas is demonstrated in an open-access very-low-magnetic-field (<5 mT) MRI instrument. This prototype device employs a simple, low-cost electromagnet, with an open geometry that allows variation of the orientation of the imaging subject in a two-dimensional plane. As a demonstration, two-dimensional lung images were acquired with 4-mm in-plane resolution from a subject in two orientations: lying supine and sitting in a vertical position with one arm raised. Experience with this prototype device will guide optimization of a second-generation very-low-field imager to enable studies of human pulmonary physiology as a function of subject orientation.

Time course of air hunger mirrors the biphasic ventilatory response to hypoxia.

Determining response dynamics of hypoxic air hunger may provide information of use in clinical practice and will improve understanding of basic dyspnea mechanisms. It is hypothesized that air hunger arises from projection of reflex brain stem ventilatory drive ("corollary discharge") to forebrain centers. If perceptual response dynamics are unmodified by events between brain stem and cortical awareness, this hypothesis predicts that air hunger will exactly track ventilatory response. Thus, during sustained hypoxia, initial increase in air hunger would be followed by a progressive decline reflecting biphasic reflex ventilatory drive. To test this prediction, we applied a sharp-onset 20-min step of normocapnic hypoxia and compared dynamic response characteristics of air hunger with that of ventilation in 10 healthy subjects. Air hunger was measured during mechanical ventilation (minute ventilation = 9 +/- 1.4 l/min; end-tidal Pco(2) = 37 +/- 2 Torr; end-tidal Po(2) = 45 +/- 7 Torr); ventilatory response was measured during separate free-breathing trials in the same subjects. Discomfort caused by "urge to breathe" was rated every 30 s on a visual analog scale. Both ventilatory and air hunger responses were modeled as delayed double exponentials corresponding to a simple linear first-order response but with a separate first-order adaptation. These models provided adequate fits to both ventilatory and air hunger data (r(2) = 0.88 and 0.66). Mean time constant and time-to-peak response for the average perceptual response (0.36 min(-1) and 3.3 min, respectively) closely matched corresponding values for the average ventilatory response (0.39 min(-1) and 3.1 min). Air hunger response to sustained hypoxia tracked ventilatory drive with a delay of approximately 30 s. Our data provide further support for the corollary discharge hypothesis for air hunger.

Regional rheological differences in locomoting neutrophils.

Intracellular rheology is a useful probe of the mechanisms underlying spontaneous or chemotactic locomotion and transcellular migration of leukocytes. We characterized regional rheological differences between the leading, body, and trailing regions of isolated, adherent, and spontaneously locomoting human neutrophils. We optically trapped intracellular granules and measured their displacement for 500 ms after a 100-nm step change in the trap position. Results were analyzed in terms of simple viscoelasticity and with the use of structural damping (stress relaxation follows a power law in time). Structural damping fit the data better than did viscoelasticity. Regional viscoelastic stiffness and viscosity or structural damping storage and loss moduli were all significantly lower in leading regions than in pooled body and/or trailing regions (the latter were not significantly different). Structural damping showed similar levels of elastic and dissipative stresses in body and/or trailing regions; leading regions were significantly more fluidlike (increased power law exponent). Cytoskeletal disruption with cytochalasin D or nocodazole made body and/or trailing regions approximately 50% less elastic and less viscous. Cytochalasin D completely suppressed pseudopodial formation and locomotion; nocodazole had no effect on leading regions. Neither drug changed the dissipation-storage energy ratio. These results differ from those of studies of neutrophils and other cell types probed at the cell membrane via beta(2)-integrin receptors, which suggests a distinct role for the cell cortex or focal adhesion complexes. We conclude that 1) structural damping well describes intracellular rheology, and 2) while not conclusive, the significantly more fluidlike behavior of the leading edge supports the idea that intracellular pressure may be the origin of motive force in neutrophil locomotion.

Linearity and time-scale invariance of the creep function in living cells.

We report here the creep function measured in three cell types, after a variety of interventions, and over three time decades (from 3 ms to 3.2 s). In each case the response conformed to a power law, implying that no distinct molecular relaxation times or time constants could characterize the response. These results add to a growing body of evidence that stands in contrast to widely used viscoelastic models featuring at most a few time constants. We show instead that the ability of the matrix to deform is time-scale invariant and characterized by only one parameter: the power law exponent that controls the transition between solid-like and liquid-like behaviour. Moreover, we validate linearity by comparison of measurements in the time and frequency domains.

Kinematically irreversible acinar flow: a departure from classical dispersive aerosol transport theories.

Current theories describe aerosol transport in the lung as a dispersive (diffusion-like) process, characterized by an effective diffusion coefficient in the context of reversible alveolar flow. Our recent experimental data, however, question the validity of these basic assumptions. In this study, we describe the behavior of fluid particles (or bolus) in a realistic, numerical, alveolated duct model with rhythmically expanding walls. We found acinar flow exhibiting multiple saddle points, characteristic of chaotic flow, resulting in substantial flow irreversibility. Computations of axial variance of bolus spreading indicate that the growth of the variance with respect to time is faster than linear, a finding inconsistent with dispersion theory. Lateral behavior of the bolus shows fine-scale, stretch-and-fold striations, exhibiting fractal-like patterns with a fractal dimension of 1.2, which compares well with the fractal dimension of 1.1 observed in our experimental studies performed with rat lungs. We conclude that kinematic irreversibility of acinar flow due to chaotic flow may be the dominant mechanism of aerosol transport deep in the lungs.

Measuring surface-area-to-volume ratios in soft porous materials using laser-polarized xenon interphase exchange nuclear magnetic resonance.

We demonstrate a minimally invasive nuclear magnetic resonance (NMR) technique that enables determination of the surface-area-to-volume ratio (S/V) of soft porous materials from measurements of the diffusive exchange of laser-polarized 129Xe between gas in the pore space and 129Xe dissolved in the solid phase. We apply this NMR technique to porous polymer samples and find approximate agreement with destructive stereological measurements of S/V obtained with optical confocal microscopy. Potential applications of laser-polarized xenon interphase exchange NMR include measurements of in vivo lung function in humans and characterization of gas chromatography columns.

Scaling the microrheology of living cells.

We report a scaling law that governs both the elastic and frictional properties of a wide variety of living cell types, over a wide range of time scales and under a variety of biological interventions. This scaling identifies these cells as soft glassy materials existing close to a glass transition, and implies that cytoskeletal proteins may regulate cell mechanical properties mainly by modulating the effective noise temperature of the matrix. The practical implications are that the effective noise temperature is an easily quantified measure of the ability of the cytoskeleton to deform, flow, and reorganize.

Selected contribution: time course and heterogeneity of contractile responses in cultured human airway smooth muscle cells.

We measured the time course and heterogeneity of responses to contractile and relaxing agonists in individual human airway smooth muscle (HASM) cells in culture. To this end, we developed a microrheometer based on magnetic twisting cytometry adapted with a novel optical detection system. Ferromagnetic beads (4.5 microm) coated with Arg-Gly-Asp peptide were bound to integrins on the cell surface. The beads were twisted in a sinusoidally varying magnetic field at 0.75 Hz. Oscillatory bead displacements were recorded using a phase-synchronized video camera. The storage modulus (cell stiffness; G'), loss modulus (friction; G"), and hysteresivity (eta; ratio of G" to G') could be determined with a time resolution of 1.3 s. Within 5 s after addition of histamine (100 microM), G' increased by 2.2-fold, G" increased by 3.0-fold, and eta increased transiently from 0.27 to 0.34. By 20 s, eta decreased to 0.25, whereas G' and G" remained above baseline. Comparable results were obtained with bradykinin (1 microM). These changes in G', G", and eta measured in cells were similar to but smaller than those reported for intact muscle strips. When we ablated baseline tone by adding the relaxing agonist dibutyryl cAMP (1 mM), G' decreased within 5 min by 3.3-fold. With relaxing and contracting agonists, G' could be manipulated through a contractile range of 7.3-fold. Cell populations exhibited a log-normal distribution of baseline stiffness (geometric SD = 2.8) and a heterogeneous response to both contractile and relaxing agonists, partly attributable to variability of baseline tone between cells. The total contractile range of the cells (from maximally relaxed to maximally stimulated), however, was independent of baseline stiffness. We conclude that HASM cells in culture exhibit a clear, although heterogeneous, response to contractile and relaxing agonists and express the essential mechanical features characteristic of the contractile response observed at the tissue level.