The presence and prevalence of Legionella spp in collected rainwater and its aerosolisation during common gardening activities.

AIMS: To determine the presence and prevalence of Legionella spp in domestic rainwater storage butts and to quantify its aerosolisation when collected rainwater is used for common gardening activities. METHODS: Volunteers were asked to take a water sample from their garden rainwater storage butt. The presence of Legionella was determined using quantitative polymerase chain reaction (qPCR). Two new rainwater storage butts were installed on-site at PHE Porton and positioned in sunlight or in the shade. Ambient conditions and those within the two 'experimental' water butts were continually monitored. A cyclone air sampler was used to detect the presence of Legionella in the air when collected rainwater was poured from a watering can or delivered via a hosepipe attached to a submersible water butt pump. RESULTS: A total of 63 volunteers provided water samples from 113 different rainwater storage butts. Legionella spp was detected in 107 of these samples at a mean concentration of 4.7 × 104 genomic units l-1. Two of these samples also contained L. pneumophila. The water butt positioned in the shade stored water at a significantly lower temperature than that exposed to sunlight. While the concentration of Legionella was significantly higher in this cooler water, meteorological conditions rather than conditions within the water butt had the greatest effect upon Legionella concentration. No Legionella was detected in the air when rainwater was poured from a watering can. However, using a hose pipe on a 'fine spray' setting increased both the number of organisms detected in the air and their dissemination. CONCLUSION: In this study, Legionella spp were common contaminants of collected rainwater. However, the use of rainwater for common gardening activities should not be discouraged. Aerosolisation of Legionella when using a watering can is minimal and any increased risk associated with hose pipe use can be mitigated by using a coarse spray setting.

Determining primary care physician information needs to inform ambulatory visit note display.

BACKGROUND: With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. METHOD: Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller's and Cochran Q. RESULTS: Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians' highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. CONCLUSION: A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly "not needed," but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load.

Supported employment as an intervention package: a preliminary analysis of functional variables.

In this two-experiment investigation, the long-term (at least 6 months) employment of 51 moderately mentally retarded clients who were placed into 64 supported employment positions was first evaluated relative to 10 training and posttraining components that comprised a supported employment training package. In Experiment 1, chi-square analyses were used to identify three components that differentiated successful (employed for at least 6 months) from unsuccessful clients. In Experiment 2, 4 successful clients were further evaluated in a nonconcurrent multiple baseline design to determine whether the three variables identified during the group analysis (client advocate, collateral behavior, and follow-up plan) were included in the training packages. These results are discussed in terms of the need to establish better the functional variables of supported employment training programs.