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.

Determinants of exposure to endocrine disruptors following hurricane Harvey.

Hurricane Harvey was a category four storm that induced catastrophic flooding in the Houston metropolitan area. Following the hurricane there was increased concern regarding chemical exposures due to damage caused by flood waters and emergency excess emissions from industrial facilities. This study utilized personal passive samplers in the form of silicone wristbands in Houston, TX to both assess chemical exposure to endocrine disrupting chemicals (EDCs) immediately after the hurricane and determine participant characteristics associated with higher concentrations of exposure. Participants from the Houston-3H cohort (n = 172) wore a wristband for seven days and completed a questionnaire to determine various flood-related and demographic variables. Bivariate and multivariate analysis indicated that living in an area with a high Area Deprivation Index (ADI) (indicative of low socioeconomic status), identifying as Black/African American or Latino, and living in the Houston neighborhoods of Baytown and East Houston were associated with increased exposure to EDCs. These results provide evidence of racial/ethnic and socioeconomic injustices in exposure to EDCs in the Houston Metropolitan Area. Since the multiple regression models conducted did not fully explain exposure (0.047 < R2 < 0.34), more research is needed on the direct sources of EDCs within this area to create effective exposure mitigation strategies.

Dihydroceramide- and ceramide-profiling provides insights into human cardiometabolic disease etiology.

Metabolic alterations precede cardiometabolic disease onset. Here we present ceramide- and dihydroceramide-profiling data from a nested case-cohort (type 2 diabetes [T2D, n = 775]; cardiovascular disease [CVD, n = 551]; random subcohort [n = 1137]) in the prospective EPIC-Potsdam study. We apply the novel NetCoupler-algorithm to link a data-driven (dihydro)ceramide network to T2D and CVD risk. Controlling for confounding by other (dihydro)ceramides, ceramides C18:0 and C22:0 and dihydroceramides C20:0 and C22:2 are associated with higher and ceramide C20:0 and dihydroceramide C26:1 with lower T2D risk. Ceramide C16:0 and dihydroceramide C22:2 are associated with higher CVD risk. Genome-wide association studies and Mendelian randomization analyses support a role of ceramide C22:0 in T2D etiology. Our results also suggest that (dh)ceramides partly mediate the putative adverse effect of high red meat consumption and benefits of coffee consumption on T2D risk. Thus, (dihydro)ceramides may play a critical role in linking genetic predisposition and dietary habits to cardiometabolic disease risk.

Effect of diet energy level and genomic residual feed intake on bred Holstein dairy heifer growth and feed efficiency.

The objective of this study was to determine growth, feed intake, and feed efficiency of postbred dairy heifers with different genomic residual feed intake (RFI) predicted as a lactating cow when offered diets differing in energy density. Postbred Holstein heifers (n = 128, ages 14-20 mo) were blocked by initial weight (high, medium-high, medium-low, and low) with 32 heifers per block. Each weight block was sorted by RFI (high or low) to obtain 2 pens of heifers with high and low genomically predicted RFI within each block (8 heifers per pen). Low RFI heifers were expected to have greater feed efficiency than high RFI heifers. Dietary treatments consisted of a higher energy control diet based on corn silage and alfalfa haylage [HE; 62.7% total digestible nutrients, 11.8% crude protein, and 45.6% neutral detergent fiber; dry matter (DM) basis], and a lower energy diet diluted with straw (LE; 57.0% total digestible nutrients, 11.7% crude protein, and 50.1% neutral detergent fiber; DM basis). Each pen within a block was randomly allocated a diet treatment to obtain a 2 × 2 factorial arrangement (2 RFI levels and 2 dietary energy levels). Diets were offered in a 120-d trial. Dry matter intake by heifers was affected by diet (11.0 vs. 10.0 kg/d for HE and LE, respectively) but not by RFI or the interaction of RFI and diet. Daily gain was affected by the interaction of RFI and diet, with low RFI heifers gaining more than high RFI heifers when fed LE (0.94 vs. 0.85 kg/d for low and high RFI, respectively), but no difference for RFI groups when fed HE (1.16 vs. 1.19 kg/d for low and high RFI, respectively). Respective feed efficiencies were improved for low RFI compared with high RFI heifers when fed LE (10.6 vs. 11.8 kg of feed DM/kg of gain), but no effect of RFI was found when fed HE (9.4 vs. 9.5 kg of DM/kg of gain for high and low RFI, respectively). No effect of RFI or diet on first-lactation performance through 150 DIM was observed. Based on these results, the feed efficiency of heifers having different genomic RFI may be dependent on diet energy level, whereby low RFI heifers utilized the LE diet more efficiently. The higher fiber straw (LE) diet controlled intake and maintained more desirable heifer weight gains. This suggests that selection for improved RFI in lactating cows may improve feed efficiency in growing heifers when fed to meet growth goals of 0.9 to 1.0 kg of gain/d.

Effect of diet energy density and genomic residual feed intake on prebred dairy heifer feed efficiency, growth, and manure excretion.

The objective of this study was to determine the growth, feed efficiency, and manure excretion of prebred dairy heifers with differing predicted genomic residual feed intakes (RFI) when offered diets differing in energy density. Prebred Holstein heifers (n = 128, ages 4 to 8 mo) were blocked by weight (low, medium-low, medium-high, or high) with 32 heifers per block. Heifers in each weight block were grouped by RFI and randomly assigned to obtain 2 pens of high (HRFI) and 2 pens of low RFI (LRFI) heifers within each block (8 heifers/pen). Heifers with LRFI were hypothesized to have greater feed efficiency than HRFI heifers. Dietary treatments were a high-energy diet (HE; 66.6% total digestible nutrients, 14.0% crude protein, and 36.3% neutral detergent fiber, dry matter basis) and a low-energy diet (LE; 63.8% total digestible nutrients, 13.5% crude protein, and 41.2% neutral detergent fiber, dry matter basis). Each pen of heifers was randomly assigned to a treatment to obtain a 2 × 2 factorial arrangement (2 RFI levels × 2 diet energy densities). Diets were offered in a 120-d trial. Dry matter intake was not affected by diet, RFI, or their interaction. Average daily gain (ADG) was affected by diet, with heifers fed HE having greater ADG than heifers fed LE. In addition, RFI affected ADG, with LRFI heifers having greater ADG than HRFI heifers, whereas the interaction of RFI and diet was not significant. Feed efficiency was improved for heifers fed the HE diet, but it was not affected by RFI or the interaction of RFI and diet. Overall, feed efficiency of prebred heifers was not dependent on predicted genomic RFI, because the greater ADG of LRFI heifers was accompanied by slightly higher dry matter intake. Feed efficiency of heifers was reduced when heifers were fed the LE diet, but this resulted in more optimal ADG compared with the HE diet fed for ad libitum intake.

Transmission of multi-drug resistant Pseudomonas aeruginosa between two flexible ureteroscopes and an outbreak of urinary tract infection: the fragility of endoscope decontamination.

OBJECTIVES: Flexible endoscopes are difficult to decontaminate, and endoscope-associated infections are increasing. This report describes an outbreak of multi-drug resistant Pseudomonas aeruginosa identified following an increase in incidence of clinical infections associated with flexible ureteroscopy at a tertiary care centre in the UK. METHODS: Clinical, laboratory and central decontamination unit (CDU) records were reviewed to determine the extent of the problem, and links to the used endoscopes. Audits of the ureteroscopy procedure, endoscopy unit and CDU were performed. Endoscopes were sampled, cultured and examined for structural integrity. All available isolates were typed. RESULTS: Thirteen patients developed clinical infections linked to two flexible ureteroscopes. The first ureteroscope was likely colonized from a known infected patient and the second ureteroscope after use on another patient infected by the first. Risk factors identified include surface cuts, stretching and puckering of the outer cover in both ureteroscopes, absence of bedside cleaning, overnight delay between the ureteroscopy and decontamination, inadequate drying after decontamination and non-traceability of connector valves. CONCLUSIONS: The adequacy of flexible endoscope decontamination depends on numerous steps. With the increasing global incidence of multi-drug resistant organisms, stringent monitoring of the flexible endoscopy process by users and decontamination units is essential.

Guidance for the decontamination of intracavity medical devices: the report of a working group of the Healthcare Infection Society.

BACKGROUND: Intracavity medical devices (ICMDs) are used in a wide variety of healthcare settings. The approach to their decontamination and the resources available also differ widely. Their potential for infection transmission is considerable. AIM: To produce a comprehensive risk assessment-based approach to the decontamination of ICMDs, accompanied by an adaptable audit tool.

Acinetobacter - the trojan horse of infection control?

BACKGROUND: Five cases of multi-resistant Acinetobacter baumanii (MRA) producing OXA-23 and OXA-51 occurred in a regional burn intensive care unit (BICU). Three were repatriated from other parts of the world (Dubai and Mumbai) and colonized on admission. Despite optimal precautions, two patients acquired MRA. Both had been nursed in the same room. METHODS: Multi-disciplinary outbreak investigation of MRA in a regional BICU. FINDINGS: The mechanism of transfer for the first case is thought to have been contaminated air from theatre activity releasing MRA bacteria into the communal corridor. No MRA patients went to theatre between the first and second acquired cases. The mechanism of transfer for the second case is thought to have been via a shower unit that was decontaminated inadequately between patients. CONCLUSION: In an outbreak where contact precautions and environmental cleaning are optimal, it is important to give careful consideration to other mechanisms of spread. If there is a failure to do this, it is likely that the true causes of transmission will not be addressed and the problem will recur. It is recommended that burn theatres within burn facilities should be designed to operate at negative pressure; this is the opposite of normal operating theatre ventilation. Where showers are used, both the shower head and the hose should be changed after a patient with a resistant organism. The role of non-contact disinfection (e.g. hydrogen peroxide dispersal) should be reconsidered, and constant vigilance should be given to any 'trojan horse' item in the room.

An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the North of England: challenges of infection prevention and control in a complex setting.

BACKGROUND: Burns patients are at high risk of nosocomial infection, and Pseudomonas aeruginosa is one of the most common causes of wound and systemic infections resulting in significant morbidity and mortality in burns patients. AIM: To describe an outbreak of multidrug-resistant P. aeruginosa (MDR-Pa) at a specialist burns service and highlight the challenges in identifying the reservoir of infection despite extensive epidemiological, microbiological, and environmental investigations. METHODS: Multi-disciplinary outbreak control investigation. FINDINGS: Following an inter-hospital transfer of a burns patient from another country, an admission screen revealed that the patient was colonized with MDR-Pa. Subsequently nine more patients contracted MDR-Pa in the period from November 2015 to September 2017. Given the relatively long gap between confirmation of the index and subsequent cases, it was not possible to identify with certainty the reservoirs and mechanisms of spread of infection, although contamination of the burns service environment and equipment are likely to be contributory factors. CONCLUSION: Preventing infection transmission in specialist burns services is highly challenging, and it may not always be possible to identify and eradicate the reservoirs of infection for P. aeruginosa outbreaks. Our study supports the literature, providing additional evidence that inanimate, common contact surfaces play an important role in nosocomial transmission of P. aeruginosa. These surfaces should either be decontaminated efficiently between patient contacts or be single patient use. Enhanced vigilance is crucial, and, with strict adherence to infection prevention and control procedures, it is possible to reduce the risk of acquisition and spread of infection in patients.

Evidence for degraded low frequency verbal concepts in left resected temporal lobe epilepsy patients.

According to a large neuropsychological and neuroimaging literature, the bilateral anterior temporal lobe (ATL) is a core region for semantic processing. It seems therefore surprising that semantic memory appears to be preserved in temporal lobe epilepsy (TLE) patients with unilateral ATL resection. However, recent work suggests that the bilateral semantic system is relatively robust against unilateral damage and semantic impairments under these circumstances only become apparent with low frequency specific concepts. In addition, neuroimaging studies have shown that the function of the left and right ATLs differ and therefore left or right ATL resection should lead to a different pattern of impairment. The current study investigated hemispheric differences in the bilateral semantic system by comparing left and right resected TLE patients during verbal semantic processing of low frequency concepts. Picture naming and semantic comprehension tasks with varying word frequencies were included to investigate the pattern of impairment. Left but not right TLE patients showed impaired semantic processing, which was particularly apparent on low frequency items. This indicates that, for verbal information, the bilateral semantic system is more sensitive to damage in the left compared to the right ATL, which is in line with theories that attribute a more prominent role to the left ATL due to connections with pre-semantic verbal regions.

The PF4/PPBP/CXCL5 Gene Cluster Is Associated with Periodontitis.

Periodontitis is a common dysbiotic inflammatory disease with an estimated heritability of 50%. Due to the limited sample size of available periodontitis cohorts and the underlying trait heterogeneity, genome-wide association studies (GWAS) of chronic periodontitis (CP) have been unsuccessful in discovering susceptibility factors. A strategy that combines agnostic GWAS with a well-powered candidate-gene approach has the potential to discover novel loci. We combined RNA-seq data from gingival tissues with quantitative trait loci (QTLs) that were identified in a F2-cross of mice resistant and susceptible to infection with oral bacterial pathogens. Four genes, which were located within the mapped QTLs, showed differential expression. The chromosomal regions across the human orthologous were interrogated for putative periodontitis-associated variants using existing GWAS data from a German case-control sample of aggressive periodontitis (AgP; 651 cases, 4,001 controls), the most severe and early onset form of periodontitis. Two haplotype blocks, one upstream to the coding region of UGT2A1 (rs146712414, P = 9.1 × 10-5; odds ratio [OR], 1.34; 95% confidence interval [CI], 1.16-1.56) and one downstream of the genes PF4/PPBP/CXCL5 (rs1595009, P = 1.3 × 10-4; OR, 1.32; 95% CI, 1.15-1.52), were associated with AgP. The association of rs1595009 was validated in an independent cohort of CP of European Americans (1,961 cases and 1,864 controls; P = 0.03; OR, 1.45; 95% CI, 1.01-1.29). This association was further replicated in another sample of 399 German CP cases (disease onset <60 y of age) and 1,633 controls ( P = 0.03; OR, 1.75; 95% CI, 1.06-2.90). The combined estimates of association from all samples were P = 2.9 × 10-5 (OR, 1.2; 95% CI, 1.1-1.3). This study shows the strength of combining QTL mapping and RNA-Seq data from a mouse model with association studies in human case-control samples to identify genetic risk variants of periodontitis.

Cryoconite pans on Snowball Earth: supraglacial oases for Cryogenian eukaryotes?

Geochemical, paleomagnetic, and geochronological data increasingly support the Snowball Earth hypothesis for Cryogenian glaciations. Yet, the fossil record reveals no clear-cut evolutionary bottleneck. Climate models and the modern cryobiosphere offer insights on this paradox. Recent modeling implies that Snowball continents never lacked ice-free areas. Wind-blown dust from these areas plus volcanic ash were trapped by snow on ice sheets and sea ice. At a Snowball onset, sea ice was too thin to flow and ablative ice was too cold for dust retention. After a few millenia, sea ice reached 100 s of meters in thickness and began to flow as a 'sea glacier' toward an equatorial ablation zone. At first, dust advected to the ablative surface was recycled by winds, but as the surface warmed with rising CO2 , dust aka cryoconite began to accumulate. As a sea glacier has no terminus, cryoconite saturated the surface. It absorbed solar radiation, supported cyanobacterial growth, and sank to an equilibrium depth forming holes and decameter-scale pans of meltwater. As meltwater production rose, drainages developed, connecting pans to moulins, where meltwater was flushed into the subglacial ocean. Flushing cleansed the surface, creating a stabilizing feedback. If the dust flux rose, cryoconite was removed; if the dust flux waned, cryoconite accumulated. In addition to cyanobacteria, modern cryoconite holes are inhabited by green algae, fungi, protists, and certain metazoans. On Snowball Earth, cryoconite pans provided stable interconnected habitats for eukaryotes tolerant of fresh to brackish cold water on an ablation surface 60 million km2 in area. Flushing and burial of organic matter was a potential source of atmospheric oxygen. Dominance of green algae among Ediacaran eukaryotic primary producers is a possible legacy of Cryogenian cryoconite pans, but a schizohaline ocean-supraglacial freshwater and subglacial brine-may have exerted selective stress on early metazoans, or impeded their evolution.

Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations.

BACKGROUND: Thoracic aortic aneurysms and dissections (TAAD) are silent but possibly lethal condition with up to 40 % of cases being hereditary. Genetic background is heterogeneous. Recently next-generation sequencing enabled efficient and cost-effective examination of gene panels. Aim of the study was to define the diagnostic yield of NGS in the 51 TAAD patients and to look for genotype-phenotype correlations within families of the patients with TAAD. METHODS: 51 unrelated TAAD patients were examined by either whole exome sequencing or TruSight One sequencing panel. We analyzed rare variants in 10 established thoracic aortic aneurysms-associated genes. Whenever possible, we looked for co-segregation in the families. Kaplan-Meier survival curve was constructed to compare the event-free survival depending on genotype. Aortic events were defined as acute aortic dissection or first planned aortic surgery. RESULTS AND DISCUSSION: In 21 TAAD patients we found 22 rare variants, 6 (27.3 %) of these were previously reported, and 16 (73.7 %) were novel. Based on segregation data, functional analysis and software estimations we assumed that three of novel variants were causative, nine likely causative. Remaining four were classified as of unknown significance (2) and likely benign (2). In all, 9 (17.6 %) of 51 probands had a positive result when considering variants classified as causative only and 18 (35.3 %) if likely causative were also included. Genotype-positive probands (n = 18) showed shorter mean event free survival (41 years, CI 35-46) than reference group, i.e. those (n = 29) without any plausible variant identified (51 years, CI 45-57, p = 0.0083). This effect was also found when the 'genotype-positive' group was restricted to probands with 'likely causative' variants (p = 0.0092) which further supports pathogenicity of these variants. The mean event free survival was particularly low (37 years, CI 27-47) among the probands with defects in the TGF beta signaling (p = 0.0033 vs. the reference group). CONCLUSIONS: This study broadens the spectrum of genetic background of thoracic aneurysms and dissections and supports its potential role as a prognostic factor in the patients with the disease.

Relationship between processing score and kernel-fraction particle size in whole-plant corn silage.

Kernel processing increases starch digestibility in whole-plant corn silage (WPCS). Corn silage processing score (CSPS), the percentage of starch passing through a 4.75-mm sieve, is widely used to assess degree of kernel breakage in WPCS. However, the geometric mean particle size (GMPS) of the kernel-fraction that passes through the 4.75-mm sieve has not been well described. Therefore, the objectives of this study were (1) to evaluate particle size distribution and digestibility of kernels cut in varied particle sizes; (2) to propose a method to measure GMPS in WPCS kernels; and (3) to evaluate the relationship between CSPS and GMPS of the kernel fraction in WPCS. Composite samples of unfermented, dried kernels from 110 corn hybrids commonly used for silage production were kept whole (WH) or manually cut in 2, 4, 8, 16, 32 or 64 pieces (2P, 4P, 8P, 16P, 32P, and 64P, respectively). Dry sieving to determine GMPS, surface area, and particle size distribution using 9 sieves with nominal square apertures of 9.50, 6.70, 4.75, 3.35, 2.36, 1.70, 1.18, and 0.59 mm and pan, as well as ruminal in situ dry matter (DM) digestibilities were performed for each kernel particle number treatment. Incubation times were 0, 3, 6, 12, and 24 h. The ruminal in situ DM disappearance of unfermented kernels increased with the reduction in particle size of corn kernels. Kernels kept whole had the lowest ruminal DM disappearance for all time points with maximum DM disappearance of 6.9% at 24 h and the greatest disappearance was observed for 64P, followed by 32P and 16P. Samples of WPCS (n=80) from 3 studies representing varied theoretical length of cut settings and processor types and settings were also evaluated. Each WPCS sample was divided in 2 and then dried at 60 °C for 48 h. The CSPS was determined in duplicate on 1 of the split samples, whereas on the other split sample the kernel and stover fractions were separated using a hydrodynamic separation procedure. After separation, the kernel fraction was redried at 60°C for 48 h in a forced-air oven and dry sieved to determine GMPS and surface area. Linear relationships between CSPS from WPCS (n=80) and kernel fraction GMPS, surface area, and proportion passing through the 4.75-mm screen were poor. Strong quadratic relationships between proportion of kernel fraction passing through the 4.75-mm screen and kernel fraction GMPS and surface area were observed. These findings suggest that hydrodynamic separation and dry sieving of the kernel fraction may provide a better assessment of kernel breakage in WPCS than CSPS.

Decontamination of breast pump milk collection kits and related items at home and in hospital: guidance from a Joint Working Group of the Healthcare Infection Society and Infection Prevention Society.

INTRODUCTION: A variety of methods are in use for decontaminating breast pump milk collection kits and related items associated with infant feeding. This paper aims to provide best practice guidance for decontamination of this equipment at home and in hospital. It has been compiled by a Joint Working Group of the Healthcare Infection Society and the Infection Prevention Society. METHODS: The guidance has been informed by a search of the literature in Medline, the British Nursing Index, the Cumulative Index to Nursing and Allied Health Literature, Midwifery and Infant Care, and the results of two surveys of UK neonatal units in 2002/3 and 2006, and of members of the Infection Prevention Society in 2014. Since limited good quality evidence was available from these sources, much of the guidance represents good practice based on the consensus view of the Working Group. CONCLUSION: This guidance provides practical recommendations to support the safe decontamination of breast pump milk collection kits for healthcare professionals to use and communicate to other groups such as parents and carers.