Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate. AIM: To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach. METHODS: A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews. FINDINGS: Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence. CONCLUSION: The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.

Implementation of the American Society of Anesthesiologists 2022 paediatric guidelines in a child with mandibular metastasis.

The 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway differ significantly from prior guidelines, particularly regarding paediatric patients. These guidelines place new emphasis on establishing a multidisciplinary team led by an anaesthetist trained in paediatric anaesthesia. Here, we demonstrate the clinical application of the new guidelines by presenting the case of a 16-month-old girl with a rapidly growing mandibular mass. The new guidelines stipulated the need for multidisciplinary team assembly; planning with indirect laryngoscopy; the availability of surgical tracheostomy and extracorporeal membrane oxygenation; and multiple 'time out' stops to confirm team members and plans. The patient tolerated induction of general anaesthesia and mask-ventilation and tracheal intubation was achieved uneventfully on the first attempt. Her trachea was extubated uneventfully 5 days later. We emphasise the importance of paediatric anaesthesia training and videolaryngoscopy and discuss components of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway with reference to a successful outcome in a paediatric difficult airway scenario.

Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review.

OBJECTIVES: To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes. STUDY DESIGN: Scoping review. METHODS: This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria. RESULTS: Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms. CONCLUSION: Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

Acquired immune responses to the seasonal trivalent influenza vaccination in COPD.

Epidemiological data suggest that influenza vaccination protects against all-cause mortality in chronic obstructive pulmonary disease (COPD) patients. However, recent work has suggested there is a defect in the ability of some COPD patients to mount an adequate humoral response to influenza vaccination. The aim of our study was to investigate humoral and cell-mediated vaccine responses to the seasonal trivalent influenza vaccination (TIV) in COPD subjects and healthy controls. Forty-seven subjects were enrolled into the study; 23 COPD patients, 13 age-matched healthy controls (HC ≥ 50) and 11 young healthy control subjects (YC ≤ 40). Serum and peripheral blood mononuclear cells (PBMC) were isolated pre-TIV vaccination and at days 7 and 28 and 6 months post-vaccine for haemagglutinin inhibition (HAI) titre, antigen-specific T cell and antibody-secreting cell analysis. The kinetics of the vaccine response were similar between YC, HC and COPD patients and there was no significant difference in antibody titres between these groups at 28 days post-vaccine. As we observed no disease-dependent differences in either humoral or cellular responses, we investigated if there was any association of these measures with age. H1N1 (r = -0·4253, P = 0·0036) and influenza B (r = -0·344, P = 0·0192) antibody titre at 28 days negatively correlated with age, as did H1N1-specific CD4+ T helper cells (r = -0·4276, P = 0·0034). These results suggest that age is the primary determinant of response to trivalent vaccine and that COPD is not a driver of deficient responses per se. These data support the continued use of the yearly trivalent vaccine as an adjunct to COPD disease management.

Interleukin-32 promotes detachment and activation of human Langerhans cells in a human skin explant model.

BACKGROUND: Cross-talk between skin keratinocytes (KCs) and Langerhans cells (LCs) plays a fundamental role in the body's first line of immunological defences. However, the mechanism behind the interaction between these two major epidermal cells is unknown. Interleukin (IL)-32 is produced in inflammatory skin disorders. We questioned the role of IL-32 in the epidermis. OBJECTIVES: We aimed to determine the role of IL-32 produced by KCs on surrounding LCs. METHODS: We used an ex vivo human explant model from healthy donors and investigated the role of IL-32 on LC activation using imaging, flow cytometry, reverse transcriptase quantitative polymerase chain reaction and small interfering (si)RNA treatment. RESULTS: Modified vaccinia virus ankara (MVA) infection induced KC death alongside the early production of the proinflammatory cytokine IL-32. We demonstrated that IL-32 produced by MVA-infected KCs induced modest but significant morphological changes in LCs and downregulation of adhesion molecules, such as epithelial cell adhesion molecule and very late antigen-4, and CXCL10 production. The treatment of KCs with IL-32-specific siRNA, and anti-IL-32 blocking antibody significantly inhibited LC activation, demonstrating the role of IL-32 in LC activation. We also found that some Toll-like receptor ligands induced a very high level of IL-32 production by KCs, which initiated LC activation. CONCLUSIONS: We propose, for the first time, that IL-32 is a molecular link between KCs and LCs in healthy skin, provoking LC migration from the epidermis to the dermis prior to their migration to the draining lymph nodes.

Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy.

BACKGROUND: Measurement of anti-GM1 IgM antibodies in multifocal motor neuropathy (MMN) sera is confounded by relatively low sensitivity that limits clinical usefulness. Combinatorial assay methods, in which antibodies react to heteromeric complexes of two or more glycolipids, are being increasingly applied to this area of diagnostic testing. METHODS: A newly developed combinatorial glycoarray able to identify antibodies to 45 different heteromeric glycolipid complexes and their 10 individual glycolipid components was applied to a randomly selected population of 33 MMN cases and 57 normal or disease controls. Comparison with an enzyme-linked immunosorbent assay (ELISA) was conducted for selected single glycolipids and their complexes. RESULTS: By ELISA, 22/33 MMN cases had detectable anti-GM1 IgM antibodies, whereas 19/33 MMN samples were positive for anti-GM1 antibodies by glycoarray. Analysis of variance (anova) revealed that of the 55 possible single glycolipids and their 1:1 complexes, antibodies to the GM1:galactocerebroside (GM1:GalC) complex were most significantly associated with MMN, returning 33/33 MMN samples as positive by glycoarray and 29/33 positive by ELISA. Regression analysis revealed a high correlation in absolute values between ELISA and glycoarray. Receiver operator characteristic analysis revealed insignificantly different diagnostic performance between the two methods. However, the glycoarray appeared to offer slightly improved sensitivity by identifying antibodies in four ELISA-negative samples. CONCLUSIONS: The use of combinatorial glycoarray or ELISA increased the diagnostic sensitivity of anti-glycolipid antibody testing in this cohort of MMN cases, without significantly affecting specificity, and may be a useful assay modification for routine clinical screening.

Oral carcinoma cuniculatum in a young child.

From the Department of Dental Specialties, Birmingham Children's Hospital. This case study describes a rare case of oral carcinoma cuniculatum in a 7-year-old female. She presented with an enlarged mass of the anterior maxilla arising from the gingiva. An anterior maxillectomy with immediate prosthetic replacement and obturation of the residual defect were carried out. The management of this case was challenging given the rare nature of the disease, unclear etiology, the patient's young age and the mutilating effects of surgery. The treatment involved a large multidisciplinary team. The provision of obturators was particularly difficult due to poor patient compliance and the extent of surgery carried out in a growing child. Oral cancer in children under 15 years old is extremely rare and this is the youngest case of oral carcinoma cuniculatum reported in the literature.

The association between prepregnancy obesity and screening positive for postpartum depression.

OBJECTIVE: To describe the association between reported prepregnancy body mass index (BMI) and screening positive for depression. DESIGN: Cohort study. SETTING: Four urban hospitals in Utah, USA. POPULATION: Women delivering a term, singleton, live-born infant at one of four urban hospitals in Utah in the period 2005-2007. METHODS: Women were enrolled immediately postpartum. Demographic, anthropometric, stressors, psychiatric, and medical/obstetric and family-history data were obtained. Prepregnancy height, weight, and pregnancy weight gain were self-reported. The primary exposure variable, prepregnancy BMI, was calculated. Women were stratified into the six World Health Organization BMI categories (underweight, normal weight, pre-obese, or obese class 1-3). MAIN OUTCOME MEASURE: At 6-8 weeks postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of > or =12. RESULTS: Among the 1053 women studied, 14.4% of normal weight women screened positive for postpartum depression. This proportion was greater in women classed as underweight (18.0%, n = 11), pre-obese (18.5%, n = 38), obese class 1 (18.8%, n = 16), obese class 2 (32.4%, n = 11), and obese class 3 (40.0%, n = 8) (P < 0.01). Controlling for demographic, psychological, and medical/obstetric factors, prepregnancy class-2 (aOR 2.87, 95% CI 1.21-6.81) and class-3 (aOR 3.94, 95% CI 1.38-11.23) obesity remained strongly associated with screening positive for postpartum depression, compared with women of normal weight. CONCLUSIONS: Self-reported prepregnancy obesity may be associated with screening positive for depression when measured postpartum.

The emerging role of large eddy simulation in industrial practice: challenges and opportunities.

That class of methods for treating turbulence gathered under the banner of large eddy simulation is poised to enter mainstream engineering practice. There is a growing body of evidence that such methods offer a significant stretch in industrial capability over solely Reynolds-averaged Navier-Stokes (RANS)-based modelling. A key enabling development will be the adaptation of innovative processor architectures, resulting from the huge investment in the gaming industry, to engineering analysis. This promises to reduce the computational burden to practicable levels. However, there are many lessons to be learned from the history of the past three decades. These lessons should be analysed in order to inform, if not modulate, the unfolding of this next cycle in the development of industrial modelling capability. This provides the theme for this paper, which is written very much from the standpoint of the informed practitioner rather than the innovator; someone with a strong motivation to improve significantly the competence with which industrial turbulent flows are treated. It is asserted that the reliable deployment of the methodology in the industrial context will prove to be a knowledge-based discipline, as was the case with RANS-based modelling, if not more so. The community at large should collectively make great efforts to put in place that knowledge base from which best practice advice can be derived at the very start of this cycle of advancement and continue to enrich it as the cycle progresses.

Interferon-gamma release assays do not identify more children with active tuberculosis than the tuberculin skin test.

Data are lacking on the performance of interferon-gamma release assays (IGRAs) in children. Although IGRAs are recommended for screening for latent tuberculosis infection (LTBI), many clinicians wish to employ them as a diagnostic test for active tuberculosis (TB). The objective of the present study was to compare the performance of the two commercially available IGRAs and the tuberculin skin test (TST) side-by-side in children with active TB and LTBI. In a prospective study, 209 children were investigated for active (n = 91) or latent TB (n = 118). TST, QuantiFERON-TB Gold In-tube (QFG-IT; Cellestis, Carnegie, Australia) and T-SPOT.TB (Oxford Immunotec, Abingdon, UK) assays were simultaneously used. For culture-confirmed active TB, the sensitivity of the TST was 83%, compared with 80% for QFG-IT and 58% for T-SPOT.TB. IGRAs did not perform significantly better than TST, although QFG-IT was significantly better than T-SPOT.TB. The agreement between QFG-IT and T-SPOT.TB in culture-confirmed TB was poor at 66.7%. In LTBI, the agreement between QFG-IT and T-SPOT.TB was very good (92%) with moderate agreement between TST and T-SPOT.TB (75%) and QFG-IT and TST (77%). A negative interferon-gamma release assay should not dissuade paediatricians from diagnosing and treating presumed active tuberculosis. If used for diagnosis of latent tuberculosis infection, interferon-gamma release assays could significantly reduce the numbers of children receiving chemoprophylaxis. Very good concordance between both tests was found.

Effects of fibre reinforcement on the mechanical properties of brushite cement.

In this study the effect of structure and amount of polyglactin fibre incorporation into a brushite forming calcium phosphate cement system and the effect of mechanical compaction on the fibre modified system were investigated. In comparison the effect of resorbable polycaprolactone surface coating of cement specimens was investigated. The results showed that, apart from the mechanical properties of the reinforcing material, the structure of the incorporated fibres, regular or random, is crucial for the resulting flexural strength and modulus of elasticity. Fibre reinforcement could also be combined with mechanical compaction of the cement/fibre composite paste leading to a possible 7-fold increase in flexural strength or an almost 5-fold increase in modulus of elasticity. Reinforcement of the tensile surface of cement grafts may ultimately improve strength where required, especially in conjunction with bone fixation devices.

Population-based association analyses of the HOPA12bp polymorphism for schizophrenia and hypothyroidism.

HOPA is an Xq13 chromosome gene that codes for a RXR nuclear receptor co-activator. In a prior study of the genetic basis of schizophrenia, we showed that exonic polymorphisms in HOPA were associated with increased risk of schizophrenia and hypothyroidism in a large cohort of probands from New York. In an attempt to replicate these findings, we examined this relationship in a cohort of 173 schizophrenic probands (128 males and 45 females providing 218 alleles) from Iowa. Consistent with the prior findings, we found an increased rate of the HOPA12bP exonic polymorphism in schizophrenic probands compared with random newborn controls (9 of 218 alleles vs. 33 of 2,049 alleles, P < 0.02). Furthermore, retrospective review of the medical records showed that two of the nine probands possessing the HOPA12bp allele in whom thyroid function was assessed were hypothyroid compared with 6 of 164 probands possessing the normal HOPAwild allele(s) (P < 0.06). We conclude that the HOPA12bp polymorphism shows a nominally significant association with schizophrenia and a nominal trend for association with hypothyroidism in our study and that further studies are required to define the features of this syndrome and the molecular mechanisms of disease pathogenesis.

Four rules for taking your message to Wall Street.

Managers fail to communicate effectively with Wall Street for all sorts of reasons. But neglecting the investment community--particularly the analysts whose opinions shape the market and whose recommendations often make or break a company's share price--can knock the most carefully conceived and brilliantly executed strategy off course. The companies that struggle the most with providing good information to analysts are those in rapidly evolving industries, where the gap between traditional performance metrics and economic realities is at its widest. In these industries, a company's strategy and the variables that govern its performance can change radically in a short time. What's more, the metrics used to report performance often fail to capture the drivers of value in today's information economy. Few accounting measures are helpful when it comes to assessing the intangible assets--knowledge, skilled employees, and so forth--on which many of today's fastest-growing companies build their strategies. According to Amy Hutton, an associate professor at Harvard Business School, there are four basic rules for clear communications with Wall Street. First, make sure that your company's financial reporting reflects your strategy as closely as possible. Second, popularize the nonfinancial metrics that best predict--and flatter--the performance of your businesses. Third, appoint managers with recognized credibility to your strategic operations. Finally, cultivate the market experts who cover the industries in which you seek to compete. Hutton shows how AOL successfully followed these rules as it significantly changed its strategic direction and competitive arena.

Olfactory discrimination deficits in n-3 fatty acid-deficient rats.

Docosahexaenoic acid (DHA), a long chain n-3 fatty acid, is present in high concentrations in the central nervous system. Although the role that DHA may play in neural function is not well understood, infants fed formulas containing low levels of n-3 fatty acids have decreased visual acuity and neurodevelopmental test scores. The present experiment assessed whether dietary manipulations that decrease the concentration of DHA in the brain interfered with olfactory-based learning. We fed rats a diet that provided adequate n-3 fatty acids or a diet that was deficient in n-3 fatty acids for two generations. The second generation n-3-deficient group had 81% less brain DHA (82% less in olfactory bulb) compared to the n-3-adequate group and made significantly more errors in a series of olfactory-cued, 2-odor discrimination tasks compared to the adequate group. These results suggest that lower levels of central nervous system DHA lead to poorer performance in a series of simple odor discrimination tasks.

The enculturation of our nursing graduates.

The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates' perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates' needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.

Intensive care nurses' experiences with end-of-life care.

BACKGROUND: With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. OBJECTIVES: To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients. METHODS: A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined. RESULTS: "Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward. CONCLUSIONS: Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

Rats with low levels of brain docosahexaenoic acid show impaired performance in olfactory-based and spatial learning tasks.

Studies were carried out to determine if decreased levels of central nervous system docosahexaenoic acid (DHA), a result of consuming an n-3-deficient diet, had an effect on learning- and memory-related behaviors in adult male rats. Females were reared on an n-3-deficient or n-3-adequate diet beginning at 21 d of life. Their male pups, the F2 generation, were weaned to the diet of the dam and tested at 9-12 wk of age. An olfactory-based discrimination and Morris water maze task were used to assess performance. Whole brain was collected after the behavioral experiments and central nervous system fatty acid content was analyzed in olfactory bulb total lipid extracts. F2 generation male rats consuming the n-3-deficient diet had an 82% decrease in DHA compared to rats consuming the n-3-adequate diet. The n-3-deficient animals made significantly more total errors in a 7-problem, 2-odor discrimination task compared to the n-3-adequate group. Furthermore, the escape latency in the Morris water maze task was significantly longer for the n-3-deficient rats compared to the n-3-adequate rats. These results indicate that rats with decreased DHA levels in the central nervous system perform poorer in these tasks compared to rats with higher DHA levels and suggest the presence of learning deficits in these animals.