Use of a door handle disinfection system to reduce the risks associated with microbial loads on fomites in a healthcare setting.

BACKGROUND: Pathogenic organisms, including those that are multidrug resistant, can survive for extended periods of time on surfaces. Numerous studies show that contaminated hand-touch sites, such as door handles, pose a serious risk for onward transfer to patients. AIM: To compare microbial levels on the handles of ten frequently used door locations, with and without a door handle disinfection system in place, in a busy rehabilitation unit consisting of two wards at the National Orthopaedic Hospital, Dublin. METHODS: A door handle disinfection system (Handle Hygiene®), utilizing an atomizing pump (non-aerosol), automatically delivered a pulse of disinfectant to a door handle each time the door was used. Microbial levels on the handles of frequently used door locations were monitored over a 16-week period, to compare microbial loads with and without a door handle disinfection system in place. Samples of two disinfectant types, Steri-7 (broad-spectrum disinfectant) and Dew (hypochlorous acid), were used in the study. FINDINGS: Levels of ≤2.5 cfu/cm2 were recorded on 93% of samples collected where a door handle disinfection system was in use, with 66% of samples showing no microbes recovered. Where a level of >2.5 cfu/cm2 was recorded, the door handle disinfection system reduced this to a negligible level by the time the next sample was taken, compared with several days where no system was in place. CONCLUSION: Door handle disinfection systems offer an effective solution to reducing microbial levels on frequently touched door handles, as an automated solution with minimal additional costs.

Multiwavelength Light Curves of Two Remarkable Sagittarius A* Flares.

Sgr A*, the supermassive black hole (SMBH) at the center of our Milky Way Galaxy, is known to be a variable source of X-ray, near-infrared (NIR), and submillimeter radiation and therefore a prime candidate to study the electromagnetic radiation generated by mass accretion flow onto a black hole and/or a related jet. Disentangling the power source and emission mechanisms of this variability is a central challenge to our understanding of accretion flows around SMBHs. Simultaneous multiwavelength observations of the flux variations and their time correlations can play an important role in obtaining a better understanding of possible emission mechanisms and their origin. This paper presents observations of two flares that both apparently violate the previously established patterns in the relative timing of submillimeter/NIR/X-ray flares from Sgr A*. One of these events provides the first evidence of coeval structure between NIR and submillimeter flux increases, while the second event is the first example of the sequence of submillimeter/X-ray/NIR flux increases all occurring within ~1 hr. Each of these two events appears to upend assumptions that have been the basis of some analytic models of flaring in Sgr A*. However, it cannot be ruled out that these events, even though unusual, were just coincidental. These observations demonstrate that we do not fully understand the origin of the multiwavelength variability of Sgr A* and show that there is a continued and important need for long-term, coordinated, and precise multiwavelength observations of Sgr A* to characterize the full range of variability behavior.

Simultaneous X-Ray and Infrared Observations of Sagittarius A*'s Variability.

Emission from Saggitarius A* is highly variable at both X-ray and infrared (IR) wavelengths. Observations over the last ~20 yr have revealed X-ray flares that rise above a quiescent thermal background about once per day, while faint X-ray flares from Sgr A* are undetectable below the constant thermal emission. In contrast, the IR emission of Sgr A* is observed to be continuously variable. Recently, simultaneous observations have indicated a rise in IR flux density around the same time as every distinct X-ray flare, while the opposite is not always true (peaks in the IR emission may not be coincident with an X-ray flare). Characterizing the behavior of these simultaneous X-ray/IR events and measuring any time lag between them can constrain models of Sgr A*'s accretion flow and the flare emission mechanism. Using 100+ hours of data from a coordinated campaign between the Spitzer Space Telescope and the Chandra X-ray Observatory, we present results of the longest simultaneous IR and X-ray observations of Sgr A* taken to date. The cross-correlation between the IR and X-ray light curves in this unprecedented data set, which includes four modest X-ray/IR flares, indicates that flaring in the X-ray may lead the IR by approximately 10-20 min with 68% confidence. However, the 99.7% confidence interval on the time-lag also includes zero, i.e., the flaring remains statistically consistent with simultaneity. Long-duration and simultaneous multi-wavelength observations of additional bright flares will improve our ability to constrain the flare timing characteristics and emission mechanisms, and must be a priority for Galactic Center observing campaigns.

Variability Timescale and Spectral Index of Sgr A* in the Near Infrared: Approximate Bayesian Computation Analysis of the Variability of the Closest Supermassive Black Hole.

Sagittarius A* (Sgr A*) is the variable radio, near-infrared (NIR), and X-ray source associated with accretion onto the Galactic center black hole. We present an analysis of the most comprehensive NIR variability data set of Sgr A* to date: eight 24 hr epochs of continuous monitoring of Sgr A* at 4.5 µm with the IRAC instrument on the Spitzer Space Telescope, 93 epochs of 2.18 µm data from Naos Conica at the Very Large Telescope, and 30 epochs of 2.12 µm data from the NIRC2 camera at the Keck Observatory, in total 94,929 measurements. A new approximate Bayesian computation method for fitting the first-order structure function extracts information beyond current fast Fourier transformation (FFT) methods of power spectral density (PSD) estimation. With a combined fit of the data of all three observatories, the characteristic coherence timescale of Sgr A* is τ b = 243 - 57 + 82 minutes (90% credible interval). The PSD has no detectable features on timescales down to 8.5 minutes (95% credible level), which is the ISCO orbital frequency for a dimensionless spin parameter a = 0.92. One light curve measured simultaneously at 2.12 and 4.5 µm during a low flux-density phase gave a spectral index α s = 1.6 ± 0.1 ( F ν ∝ ν - α s ) . This value implies that the Sgr A* NIR color becomes bluer during higher flux-density phases. The probability densities of flux densities of the combined data sets are best fit by log-normal distributions. Based on these distributions, the Sgr A* spectral energy distribution is consistent with synchrotron radiation from a non-thermal electron population from below 20 GHz through the NIR.

Young Stellar Objects in the Massive Star-forming Regions W51 and W43.

We present the results of our investigation of the star-forming complexes W51 and W43, two of the brightest in the first Galactic quadrant. In order to determine the young stellar object (YSO) populations in W51 and W43 we used color-magnitude relations based on Spitzer mid-infrared and 2MASS/UKIDSS near-infrared data. We identified 302 Class I YSOs and 1178 Class II/transition disk candidates in W51, and 917 Class I YSOs and 5187 Class II/transition disk candidates in W43. We also identified tens of groups of YSOs in both regions using the Minimal Spanning Tree (MST) method. We found similar cluster densities in both regions, even though Spitzer was not able to probe the densest part of W43. By using the Class II/I ratios, we traced the relative ages within the regions and, based on the morphology of the clusters, we argue that several sites of star formation are independent of one another in terms of their ages and physical conditions. We used spectral energy distribution-fitting to identify the massive YSO (MYSO) candidates since they play a vital role in the star formation process, and then examined them to see if they are related to any massive star formation tracers such as UCH II regions, masers, or dense fragments. We identified 17 MYSO candidates in W51, and 14 in W43, respectively, and found that groups of YSOs hosting MYSO candidates are positionally associated with H II regions in W51, though we do not see any MYSO candidates associated with previously identified massive dense fragments in W43.

YOUNG STELLAR OBJECTS IN THE MASSIVE STAR-FORMING REGION W49.

We present the initial results of our investigation of the star-forming complex W49, one of the youngest and most luminous massive star-forming regions in our Galaxy. We used Spitzer/Infrared Array Camera (IRAC) data to investigate massive star formation with the primary objective of locating a representative set of protostars and the clusters of young stars that are forming around them. We present our source catalog with the mosaics from the IRAC data. In this study we used a combination of IRAC, MIPS, Two Micron All Sky Survey, and UKIRT Deep Infrared Sky Survey (UKIDSS) data to identify and classify the young stellar objects (YSOs). We identified 232 Class 0/I YSOs, 907 Class II YSOs, and 74 transition disk candidate objects using color-color and color-magnitude diagrams. In addition, to understand the evolution of star formation in W49, we analyzed the distribution of YSOs in the region to identify clusters using a minimal spanning tree method. The fraction of YSOs that belong to clusters with ⩾7 members is found to be 52% for a cutoff distance of 96″, and the ratio of Class II/I objects is 2.1. We compared the W49 region to the G305 and G333 star-forming regions and concluded that W49 has the richest population, with seven subclusters of YSOs.

ERRATUM: "YOUNG STELLAR OBJECTS IN THE MASSIVE STAR FORMING REGION W49".

[This corrects the article PMC7489494.].

Depth of a strong jovian jet from a planetary-scale disturbance driven by storms.

The atmospheres of the gas giant planets (Jupiter and Saturn) contain jets that dominate the circulation at visible levels. The power source for these jets (solar radiation, internal heat, or both) and their vertical structure below the upper cloud are major open questions in the atmospheric circulation and meteorology of giant planets. Several observations and in situ measurements found intense winds at a depth of 24 bar, and have been interpreted as supporting an internal heat source. This issue remains controversial, in part because of effects from the local meteorology. Here we report observations and modelling of two plumes in Jupiter's atmosphere that erupted at the same latitude as the strongest jet (23 degrees N). The plumes reached a height of 30 km above the surrounding clouds, moved faster than any other feature (169 m s(-1)), and left in their wake a turbulent planetary-scale disturbance containing red aerosols. On the basis of dynamical modelling, we conclude that the data are consistent only with a wind that extends well below the level where solar radiation is deposited.

Chemopreventive effects of various concentrations of alpha-santalol on skin cancer development in CD-1 mice.

Previous studies from this laboratory have indicated that alpha-santalol (5%) provides chemopreventive effects in 7,12-dimethylbenz[a]anthracene (DMBA)-initiated and 12-O-tetradecanoylphorbol-13-acetate (TPA)-promoted skin cancer in CD-1 and SENCAR mice. Skin cancer development is associated with increased ornithine decarboxylase (ODC) activity, DNA synthesis and rapid proliferation of epidermal cells. The purpose of this investigation was to determine the effects of various concentrations (1.25% and 2.5%) of alpha-santalol on DMBA-initiated and TPA-promoted skin cancer development, TPA-induced ODC activity, and DNA synthesis in CD-1 mice. alpha-Santalol treatment at both concentrations (1.25% and 2.5%) prevented the skin cancer development. alpha-Santalol treatment (1.25% and 2.5%) resulted in a significant decrease in the TPA-induced ODC activity and incorporation of [3H]thymidine in DNA in the epidermis of CD-1 mice. There was no significant difference in the effects of 1.25% and 2.5% alpha-santalol on tumour incidence, multiplicity, epidermal TPA-induced ODC activity, or DNA synthesis in CD-1 mice.

The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy.

In a prospective controlled trial on 46 patients undergoing lumbar discectomy, three classes of variables (medical data including MRI-identified morphological abnormalities, general psychological factors and psychosocial aspects of work) were analyzed with regard to their predictive value for the outcome of lumbar disc surgery at 2 year follow-up. Multiple regression analyses were used to identify the best predictor variables of four different outcome measures (i.e. pain relief, reduction of disability in daily activities, return to work and surgical outcome). MRI-identified nerve root compromise and social support from the spouse were independent predictors of pain relief 2 years after surgery (R2 = 0.40, P < 0.01). Return to work 2 years after surgery was best predicted by depression and occupational mental stress (R2 = 0.36, P < 0.001). MRI-identified extent of herniation and depression were significant predictors of a good surgical outcome after lumbar discectomy (R2 = 0.61, P < 0.001). This study has demonstrated that the outcome of discectomy is critically dependent on which outcome variables are selected and that different sorts of predictor variables have a distinct influence on the various outcome variables. Obvious morphological alterations (i.e. disc extrusions, nerve root compromise) proved to be significant predictors of postoperative pain relief and improvement of disability in daily activities justifying a surgical treatment approach in these cases. The most important finding of this study was that return to work was not influenced by any clinical findings or MR-identified morphological alterations, but solely by psychological factors (i.e. depression) and psychological aspects of work (i.e. occupational mental stress).

Tissue characterization of symptomatic and asymptomatic disc herniations by quantitative magnetic resonance imaging.

The purpose of this investigation was to determine differences in tissue composition of symptomatic and asymptomatic disc herniations as reflected in T1 and T2 relaxation times (quantitative magnetic resonance imaging). Thirty patients with sciatica severe enough to require a discectomy and 46 asymptomatic volunteers (controls) were included in this study. Both groups had a clinical examination as well as a magnetic resonance investigation of the lumbar spine. The longitudinal and transverse magnetic relaxation times (T1 and T2, respectively) were calculated from a set of 20 images obtained with five single-slice/multi-echo sequences at different repetition time values on a commercial whole-body system (1.5 T). Twenty-two symptomatic and asymptomatic disc herniations could be matched according to age, gender, disc level, and the extent of herniation (protrusion or extrusion) and were compared with regard to T1 and T2 relaxation times. Symptomatic disc herniations exhibited significantly (pT1 < 0.04 and pT2 < 0.003) shorter T1 (delta T1: -182.1 milliseconds, -15%) and T2 (delta T2: -11.0 milliseconds, -21%) relaxation times than matched asymptomatic herniations. Symptomatic disc herniations also exhibited more advanced disc degeneration as graded by Pearce's criteria (p < 0.01). These results suggest that symptomatic and morphologically matched asymptomatic disc herniations differ with regard to disc matrix composition.

Earth-Based Observations of the Galileo Probe Entry Site

Earth-based observations of Jupiter indicate that the Galileo probe probably entered Jupiter's atmosphere just inside a region that has less cloud cover and drier conditions than more than 99 percent of the rest of the planet. The visual appearance of the clouds at the site was generally dark at longer wavelengths. The tropospheric and stratospheric temperature fields have a strong longitudinal wave structure that is expected to manifest itself in the vertical temperature profile.

The prognosis of cranioplasty following large craniectomy in children.

The experience acquired during 10 years treatment of 33 children having undergone a large craniectomy with an average follow-up time of 5.3 years is presented. Different methods of primary and delayed closure of the skull defect are documented and discussed. Whenever possible the deep frozen conserved skull flap was reimplanted. The problem of skull flap resorption and insufficient spontaneous ossification and the alternative of a heterologous cranioplasty with methylmethacrylate (MMA) in cases of insufficient reossification is considered. The decision to use MMA as a secondary skull defect graft should be delayed at least one year after craniectomy, since a spontaneous reossification of the defect is possible until adolescence.

Nuclear acceptor sites for steroid hormone receptors: comparisons of steroids and antisteroids.

The respective chromatin binding sites (acceptor sites) for both the avian oviduct progesterone receptor (PR) and the rabbit uterine estrogen receptor (ER) reported by two separate laboratories are compared. Support for a saturable, high affinity binding to the chromatin acceptor sites by both receptors is described. Nonradiolabelled PR or ER compete with their homologous radiolabelled receptors for binding. However, there is no competition between the heterologous ER and PR for the nuclear binding sites. In both receptor systems, evidence for a receptor dependent, receptor specific binding, which mimics the binding measured in vivo, is reported. With both the PR and ER, evidence for extensive masking in chromatin of many of the acceptor sites is described. The PR and ER acceptor sites appear to be composed of specific acceptor proteins bound to DNA. The dissociation of these proteins from DNA causes a loss of specific binding. Reannealing of these same chromatin protein fractions, but not other protein fractions, back to the DNA reinstates the specific PR binding. Antibodies against the PR acceptors proteins are described. These antibodies block PR but not ER binding to the chromatin acceptor sites, supporting the steroid receptor specific acceptor sites. In the rabbit uterine system, the ER acceptor proteins dissociate from chromatin in three distinct fractions according to their affinity for the DNA. Each of these fractions contains acceptor activity in that each can be reannealed to the DNA to reconstitute specific ER binding sites, i.e. those which are saturable, high affinity, and receptor dependent. Interestingly, the antiestrogen receptor complexes do not bind to one fraction of acceptor proteins which does bind the native estrogen receptor complex. This ER acceptor protein fraction contains two regions of acceptor activity in the molecular mass range of 50,000 and 12,000 daltons. The latter species is in the size range of the PR acceptor proteins. This difference in binding to chromatin acceptor sites by the estrogen receptor, complexed with an estrogen or antiestrogen, may explain the differential regulation of gene expression and the differential biological response to antiestrogens compared to the native estrogens.

Nuclear acceptor sites for sex steroid hormone receptors in chromatin.

The steroid receptor interactions in vitro with specific acceptor sites composed of acceptor protein-DNA complexes fulfill many of the criteria of a physiologically significant binding system. Chromatin acceptor sites for many steroid receptors (especially for the progesterone and estrogen receptor) are specific since they are saturable and competitive with unlabelled receptors, have high affinity for the receptor, distinguish between functional and nonfunctional receptors and demonstrate target tissue specificity. Pure DNA as acceptor sites does not display many of these properties. Therefore, it is clear that certain chromatin proteins provide the necessary specificity for the acceptor sites for the steroid receptors. For the progesterone receptor in the chick oviduct, these nuclear sites appear to contain specific chromosomal proteins as well as specific DNA sequences. The substitution of other chromosomal proteins or the genomic DNAs from evolutionarily distant organisms results in a loss of the specific nuclear binding. The nuclear acceptor sites appear to be resistant to the DNase activity which is not characteristic of transcriptionally active domains of the genome. Further studies using the ovalbumin gene sequences from genomic clones also indicate that none of the sequences within this domain and the 3-k flanking regions appear to contain the specific acceptor sequences. These observations have led to development of a model suggesting that the steroid receptors bind to acceptor sites distant from the structural genes the steroids ultimately regulate. Neighboring these acceptor sites are regulatory genes which code for regulatory substances which in turn (as secondary messengers) regulate at great distances the expression of the structural gene. This model might better fit the sex steroids which require 1-2 h to measurably alter gene transcription, as opposed to the glucocorticoids which more rapidly alter gene expression.

Nuclease resistance and the enrichment of native nuclear acceptor sites for the avian oviduct progesterone receptor.

High-affinity nucleoprotein acceptor sites for the avian oviduct progesterone receptor (PR) have been enriched by a combination of nuclease digestion and centrifugation. These enriched binding elements exhibited markedly enhanced PR binding on a per mass DNA basis compared to chromatin (20- to 25-fold) or dehistonized chromatin (4- to 5-fold). Electrophoretic analysis of the nuclease-resistant DNA showed that there is a set of DNA fragments of 100-150 base pairs that are protected from digestion. Excessive digestion resulted in smaller DNA fragments and a loss of PR binding activity. The PR binding was saturable using a crude receptor preparation and displayed a competition with the same receptor preparation that was labeled with nonradioactive progesterone. The enhanced binding was also demonstrable using highly purified receptor preparations that exhibit two classes of binding sites both of which are of high affinity and saturable as assessed by Scatchard analyses. These two high-affinity classes of binding sites are shown to be competed by unlabeled purified PR. The nuclease resistance of these nucleoprotein acceptor sites from chromatin is a property similar to the nuclear matrix binding sites suggesting a relationship between these two classes of nuclear acceptor sites.

Estrogen regulation of the biological activity of the avian oviduct progesterone receptor and its ability to induce avidin.

During primary estrogen stimulation of chick oviduct development, estrogen withdrawal, or secondary estrogen treatment, changes in the oviduct progesterone receptor (PR) occur. The presence of estrogen appears to regulate not only PR concentration but also its biochemical activity, i.e. its capacity to bind to nuclear acceptor sites and alter RNA synthesis. This study reports that estrogen regulates the nuclear binding capacity of the PR even more rapidly than previously reported in fully developed oviducts of chicks that have been injected daily for 4 weeks with diethylstilbestrol (DES). Further, the nuclear binding capacity of the PR correlates with the ability of progesterone (P) to induce avidin protein concentrations in the oviducts in vivo. The PR concentration in the oviducts increases 2-fold within 8 h of the last injection and the decreases to a minimal value by 24 h. Injection of [3H]P into the chicks shows that the in vivo nuclear localization of the steroid increases almost 4-fold at 8 h, followed by a similar decrease to minimal values by 24 h. Cell-free nuclear binding assays, using PR isolated at various times after the last DES injection and oviduct nucleoprotein complexes, indicate that the capacity of the receptors to bind to nuclear acceptor sites is regulated by the estrogen. The enhanced nuclear binding capacity of the isolated PR increases to maximal values by 12-14 h after the last estrogen treatment and then begins to decrease to minimal values by 24 h. Similarly, the ability of P to induce in vivo avidin protein concentrations and to alter general RNA synthesis in the oviducts is reduced by 70% (of the estrogen non-withdrawn chick levels) by 24 h after the last estrogen injection. These changes over the 24-h period after the last DES treatment are not due to changes in the serum DES concentrations. The following 10-day period of estrogen withdrawal reveals a cyclic decaying pattern in the capacity of the PR for nuclear binding. The P induction of avidin and alteration of RNA polymerase II activity, using nuclear run-off experiments, also show a similar cyclic decaying pattern. By 6 days of estrogen withdrawal, the PR is incapable of any nuclear binding, and P cannot induce avidin protein concentrations in the oviducts. Serum DES concentrations over this 10-day period display only a gradual decay.(ABSTRACT TRUNCATED AT 400 WORDS)

A rapid, sensitive assay for analyzing defects in metabolism of steroids in normal and diseased human tissues.

In this report, we describe a simple, rapid biopsy-steroid metabolism assay that is applicable to any steroid tissue system. It consists of mincing the sample, tissue culture incubation, extraction of the steroids and their metabolites from the tissue, and fractionation of the metabolites by high-pressure liquid chromatography (HPLC). Radioimmunoassay is used to verify the elution patterns of certain steroids. Studies of the metabolism of [3H]progesterone in the avian oviduct showed the generation of metabolites that eluted from the HPLC system in a pattern similar to androgens, estrogens, and glucocorticoids. Studies of the metabolism of [3H]testosterone in the human foreskin showed the production of metabolites that eluted from the HPLC system similar to 5 alpha-dihydrotestosterone and 5 alpha-androstane-3,17-dione (androstanedione) from the parent [3H]testosterone. In the production of the metabolite that eluted as androstanedione in samples of foreskin from normal subjects, a significant (P less than 0.001) correlation was found with the age of the donor. Preliminary studies of patients with hypospadias showed a significant (P less than 0.005) decrease in the production of "androstanedione" compared with that in normal subjects. Because of the wide range in rates of metabolism of testosterone in the patients with hypospadias, the effect of age does not seem to be the sole determinant of a low rate of metabolism in these patients. Some samples of hypospadias foreskin had a decreased rate of production of a metabolite that eluted as dihydrotestosterone in comparison with normal foreskin, even when the age of the donor was considered. The assay described herein should be applicable to any surgical biopsy specimen and to all steroids.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intracranial pressure measurement--indications and results]. / Intrakranielle Druckmessung--Indikation und Ergebnisse.

Intracranial pressure was measured in 82 patients in the Neurosurgical Clinic, Basle, from 1978-1982. The methods used werette Gobiet Screw (62 patients), the Gealtec Probe (17 patients) and intraventricular drainage. Intracranial pressure monitoring was carried out in 54 patients with severe craniocerebral injury in 12 patients with large cranial bone defects and a subsequent cranioplasty, in 12 patients to diagnose hydrocephalus and in 4 patients for other reasons. Indications for intracranial monitoring results and therapy are discussed.