Assessment of mould remediation in a healthcare setting following extensive flooding.

BACKGROUND: A new hospital building was close to completion when a large pipe carrying clean water broke, causing extensive flooding. AIM: To determine the flood-associated fungal risk to susceptible patients who would use that building. METHODS: Though standard flood remediation by the builders was relatively straightforward, there was no model for specialist assessment of patient risk due to the flood-associated mould growth. As levels of background airborne fungal spores can be expected to vary significantly over time, we could not use absolute levels to indicate either an excess of airborne fungal spores or successful remediation. Therefore it was decided to use weekly settle plates, exposed at the same time in flooded (test) and equivalent non-flooded (control) areas to compensate for variations in background levels. Flood-related risk was estimated by the ratio between fungal colonies on the test and control sets of settle plates, rather than absolute number. FINDINGS: Whereas the physical flood remediation, including the use of 'anti-fungal' treatments, was completed in three weeks post flooding, fungal contamination in flooded areas took 38 weeks to return to control levels and remained so for a further six weeks of observation. CONCLUSION: By the use of this method, we were able to assure the absence of flood-associated fungal risk to susceptible patients who would use that building. We recommend that infection prevention and control teams consider using this approach should they be faced with similar situations.

Age-of-acquisition effects: A literature review.

Age of acquisition (AoA) refers to the age at which people learn a particular item and the AoA effect refers to the phenomenon that early-acquired items are processed more quickly and accurately than those acquired later. Over several decades, the AoA effect has been investigated using neuroscientific, behavioral, corpus and computational techniques. We review the current evidence for the AoA effect stemming from a range of methodologies and paradigms and apply these findings to current explanations of how and where the AoA effect occurs. We conclude that the AoA effect can be found both in the connections between levels of representations and within these representations themselves, and that the effect itself occurs through the process of the distinct coding of early and late items, together with the nature of the connections between levels of representation. This approach strongly suggests that the AoA effect results from the construction of perceptual-semantic representations and the mappings between representations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Transfer of microcystin from freshwater lakes to Puget Sound, WA and toxin accumulation in marine mussels (Mytilus trossulus).

Many eutrophic inland freshwater lakes in the Puget Sound Washington region produce toxic cyanobacteria blooms annually. While such blooms in lakes tend to be viewed as a localized phenomenon, there is significant potential for downstream export of toxins to freshwater streams, and marine and brackish water environments. However, monitoring for cyanotoxins typically associated with freshwaters, such as the hepatotoxin, microcystin (MC) in marine receiving waters is rare. In 2013 we studied four eutrophic Puget Sound area lakes to assess both toxin transport to marine waters and its potential accumulation in marine shellfish, specifically mussels. Shellfish beds are extensive throughout Puget Sound, and recreational harvest occurs downstream of our study lakes, so a study goal was to also assess if shellfish consumption poses a human health risk for MC exposure. We confirm, for the first time, freshwater to marine transfer of MCs in Puget Sound with subsequent bioaccumulation of MC by mussels. ELISA analysis estimated maximum MC concentrations in source lakes of 2700 µg/L, up to 0.34 µg/L in marine waters and 6.5 µg/kg in mussels. Confirmatory analyses by LC-MS/MS on water and mussel samples identified MC-LA as the major toxin. Although we found relatively low MC levels in mussels, our study implies that potential concern for human food safety is justified and warrants further investigation.

Women with bleeding in the first 20 weeks of pregnancy: value of general practice ultrasound in detecting fetal heart movement.

BACKGROUND: Real-time ultrasound scanning has made it possible to ascertain whether the fetus is alive in women who have bleeding in early pregnancy. Portable ultrasound machines are capable of detecting fetal heart movement reliably after the ninth week of pregnancy, and can be used in a general practice setting. An ultrasound clinic was set up in a health centre and 22 general practitioners in the local area could refer women patients with bleeding in early pregnancy. AIM: A study was carried out among women with bleeding in early pregnancy to compare the presence of fetal heart movement detected at the initial ultrasound scan with subsequent fetal survival during the first 20 weeks of pregnancy. METHOD: Data were collected during a three-year period on women referred opportunistically by their general practitioners. An abdominal scan was performed on the same day or the day after presentation and the presence or absence of fetal heart movement recorded. Diagnoses and outcome at 20 weeks were ascertained from patients' health centre records. RESULTS: A total of 240 women with bleeding in early pregnancy were scanned and at the first examination fetal heart movement was detected in 115 of the fetuses (48%). Three fetuses were subsequently miscarried spontaneously while 109 of the 115 continued to the 20th week (95%). Three fetuses had gross abnormalities and these pregnancies were subsequently terminated. No heart movement was detected in 117 fetuses (49%); all were subsequently miscarried. For eight women scanned it was not clear whether fetal heart movement was present. Three of these eight pregnancies survived to the 20th week. Predictive values of fetal survival to the 20th week of pregnancy from fetal heart movement detected by general practice ultrasound scan for women with bleeding in early pregnancy showed a sensitivity of 97% and a specificity of 98%. CONCLUSION: If fetal heart movement is detected at the initial scan, approximately 19 out of every 20 viable pregnancies (those in which the fetus appears normal) will not miscarry before the 20th week. Using ultrasound in general practice it was possible to identify promptly those women with bleeding whose fetus was alive. For those women found to have a non-viable pregnancy, appropriate arrangements could be made at an early stage in the knowledge that a miscarriage was inevitable, thus avoiding unnecessary bed rest for the patient. Where fetal heart movement was detected, there was a good prognosis and thus women could be given strong reassurance.

Characteristics of prenatal interviews provided by pediatricians.

A questionnaire regarding use of pediatric prenatal interviews was mailed to 235 pediatricians. From 197 responses, we identified 118 practicing pediatricians who see a minimum of 25 newborns per year. Eighty-six (73%) of this group of 118 physicians conduct prenatal visits. In the practices of these physicians, an average of 22% of mothers (or couples) have a prenatal visit. Physicians unanimously favored father's presence at the visit. Prenatal visits were more frequently done by urban than by nonurban physicians. Only 15% charge for a prenatal visit, despite spending an average of 20 office minutes as compared to 16 office minutes for a well-baby visit. Pediatricians have positive attitudes about the use of prenatal interviews, regardless of whether or not they conduct them. High consensus regarding the importance of these visits combined with the low prevalence of their actual use suggest the need for more parent and physician education of this aspect of pediatric care.

Use of pediatric prenatal visits by family physicians.

A questionnaire regarding the use of pediatric prenatal counseling interviews was mailed to 235 randomly chosen family physicians. From 164 responses, 69 practicing family physicians who see a minimum of ten newborns per year were identified. Thirty-five (51 percent) of this study group conducted pediatric prenatal visits with the expectant parents. They saw a mean of 65 percent of mothers (or couples) for such an interview and were unanimously in favor of fathers" attending the session. Whether members of the study group did or did not conduct prenatal visits did not correlate with geographic location, number of years in practice, or board certification. Those who did conduct prenatal interviews saw significantly more newborns per year than those who did not. The average prenatal visit lasted significantly longer than a well-baby visit. Study group members, regardless of whether they conducted prenatal interviews, had positive attitudes about their use. High consensus regarding the usefulness and importance of prenatal visit combined with the low prevalence of their actual use suggest the need for more parent and physician education around this aspect of the care of infants and parents.

The effectiveness of pediatric nurse associates as clinical instructors of medical students.

Pediatric nurse associates (PNAs) have provided health care services for children, taught physical diagnosis to first-year medical students, and acted as role models for students and residents. Their role as clinical instructors has not been measured objectively. This study evaluated the effect of PNA interaction with medical students in a pediatric clerkship. Students taught by PNAs had higher gains in factual knowledge and greater skills in physical examination as measured by a videotape of a patient encounter. The PNAs demonstrated that they can be effective instructors of medical students.

The effectiveness of pediatric nurse associates as teachers of medical students in ambulatory setting.

Pediatric Nurse Associates (PNA) can be effective teachers of medical students. This was measured by a greater gain in score on a post-test over a pre-test for those students with PNA interaction as compared to those who had no PNA contact.