Psychological decision-making process of construction worker safety behavior: an agent-based simulation approach.

Objectives. Relationships between safety behavior and its antecedents have been widely studied. However, the psychological decision-making process of construction worker safety behavior (CWSB) is rarely examined from the systematic perspective. Thus, this study constructed the theoretical framework for the decision-making process of CWSB and systematically explored effects of individual factors (education, age and safety knowledge), organizational factors (safety climate and leader-member exchange [LMX]) and psychological factors (psychological capital [PsyCap] and communication competence [CommComp]) on the dynamic performance of CWSB. Methods. Data were collected from the literature and 536 construction workers in China. The theoretical model was tested with the agent-based simulation (ABS) technique. Results. High level of education, safety knowledge, safety climate, LMX, PsyCap and CommComp help to reduce unsafe behavior at the cut-off point. However, the age-safety relationship might present a U-shape, which denotes that reasonable age structure of construction worker groups may be an option for bettering safety performance. The results indicate that the psychological decision-making process of CWSB is not only the result of individual rational decision, but also the product of organizational and psychological impacts. Findings of this study shed lights on safety behavior management practices based on the psychological decision-making process of CWSB.

Classification of pathogenic bacteria by Raman spectroscopy combined with variational auto-encoder and deep learning.

Rapid and early identification of pathogens is critical to guide antibiotic therapy. Raman spectroscopy as a noninvasive diagnostic technique provides rapid and accurate detection of pathogens. Raman spectrum of single cells serves as the "fingerprint" of the cell, revealing its metabolic characteristics. Rapid identification of pathogens can be achieved by combining Raman spectroscopy and deep learning. Traditional classification techniques frequently require lots of data for training, which is time costing to collect Raman spectra. For trace samples and strains that are difficult to culture, it is difficult to provide an accurate classification model. In order to reduce the number of samples collected and improve the accuracy of the classification model, a new pathogen detection method integrating Raman spectroscopy, variational auto-encoder (VAE), and long short-term memory network (LSTM) is proposed in this paper. We collect the Raman signals of pathogens and input them to VAE for training. VAE will generate a large number of Raman spectral data that cannot be distinguished from the real spectrum, and the signal-to-noise ratio is higher than that of the real spectrum. These spectra are input into the LSTM together with the real spectrum for training, and a good classification model is obtained. The results of the experiments reveal that this method not only improves the average accuracy of pathogen classification to 96.9% but also reduces the number of Raman spectra collected from 1000 to 200. With this technology, the number of Raman spectra collected can be greatly reduced, so that strains that are difficult to culture or trace can be rapidly identified.

Relationship between leader-member exchange and construction worker safety behavior: the mediating role of communication competence.

Purpose. Leader-member exchange (LMX) has widely been adopted to explore its influence on job performance. However, most previous studies considered LMX as a unidimensional construct and neglected the effects of its subdimensions, thereby reducing its practicality to improve work performance. This study empirically tested the relationship between subdimensions of LMX and safety behaviors, while incorporating communication competence as a mediator. Method. Data were collected from Chinese construction industry workers. The theoretical model was built and checked using the structural equation modeling technique. Results. The affect and contribution dimensions of LMX positively associated with safety behaviors, while the loyalty and professional respect dimensions had negative and no relations with safety behaviors respectively. These findings demonstrate that a multidimensional view on LMX should be taken while checking its effects on safety behaviors. The affect and professional respect dimensions of LMX had indirect effects on safety participation via communication competence, which illustrate the mediating role of communication competence for construction safety. This study sheds lights on safety behavior research based on the theories of LMX. Enhancing the leadership and communication skills of safety staff and fostering a supportive safety atmosphere at sites are suggested to improve construction safety performance.

Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital.

BACKGROUND: Nosocomial carbapenemase-producing Enterobacterieceae (CPE) infections constitute a major global health concern and are associated with increased morbidity and mortality. Rectal colonization with CPE is a risk factor for bacterial translocation leading to subsequent endogenous CPE infections. This prospective observational study was aimed to investigate the prevalence and epidemiology of rectal colonization of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in high-risk patients from ICU and HSCT wards in a university hospital in China. METHODS: In a prospective cohort study, 150 fecal samples from rectal swabs were consecutively obtained for inpatients from the intensive care unit (ICU) and hematopoietic stem cell transplantation (HSCT) wards from November 2018 to May 2019, and screening test for CPE was conducted by using prepared in-house trypsin soybean broth (TSB) selective media and MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and carbapenemase genes were characterized by both the GeneXpert Carba-R and PCR for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA. Multi-locus sequence typing (MLST) was employed to characterize the genetic relationships among the carbapenemase-producing K. Pneumonia (CPKP) isolates. In order to further investigate the risk factors and clinical outcomes of CPE colonization, a prospective case-control study was also performed. RESULTS: Twenty-six suspected CPE strains, including 17 Klebsiella pneumoniae, 6 Escherichia coli, 1 Citrobacter freundii, 1 Enterobacter Kobe, and 1 Raoultella ornithinolytica, were identified in 25 non-duplicated rectal swab samples from 25 patients, with a carriage rate of 16.67% (25/150). Through GeneXpert Carba-R and subsequent PCR and sequencing, all the suspected CPE isolates were identified to be positive for the carbapenemase genes, of which 17 were blaKPC-carriers, and another 9 were blaNDM-producers. MLST designated all the CPKP isolates to be ST11 clone. Multivariate analysis indicated that urinary system diseases, operation of bronchoscopy, and combined use of antibiotics were independent risk factors for acquiring CPE colonization in high-risk patients from the ICU and HSCT wards. CONCLUSIONS: This study revealed a high prevalence of rectal CPE colonization in high-risk patients from ICU and HSCT wards, and a predominant colonization of the KPC-producing K. pneumoniae clone ST11. Stricter infection control measures are urgently needed to limit the dissemination of CPE strains, especially in patients who were afflicted by urinary system diseases, have underwent bronchoscopy, and were previously exposed to combined antibiotic use.

Evaluation of Modified Rapid Carbapenem Inactivation Method (mrCIM) Combined with Rapid EDTA-Modified Carbapenem Inactivation Method (reCIM) to Detect Carbapenemase and Distinguish Metallo-Carbapenemase in Enterobacteriaceae Within Four Hours.

PURPOSE: To develop a rapid EDTA-modified carbapenem inactivation method (reCIM) combined with modified rapid carbapenem inactivation method (mrCIM) to detect carbapenemase and distinguish metallo-ß-lactamases from carbapenemases in Enterobacteriaceae in 4 hrs. MATERIALS AND METHODS: The sensitivities and specificities of mrCIM and reCIM were retrospectively evaluated in 247 carbapenem-resistant Enterobacteriaceae of which 107 were carbapenemase producers confirmed by PCR and sequencing. In addition, mrCIM and reCIM were prospectively evaluated with 47 carbapenem-resistant enterobacterial isolates. RESULTS: The sensitivity and specificity of mrCIM were 96.3% and 97.1% at 2.5 hrs post incubation, and the specificity increased to 98.6% at 3 hrs. The combined mrCIM and reCIM showed a sensitivity of 95.4% and a specificity of 100% at 2.5 hrs post incubation in identifying metallo-ß-lactamases, and the sensitivity increased to 97.0% at 3 hrs. These performance characteristics are comparable to mCIM and eCIM; however, compared with mCIM and reCIM tests which need at least 24 hrs to detect results, the mrCIM and reCIM required less than 4 hrs of total work time. CONCLUSION: The combined mrCIM and reCIM can be used to accurately and quickly detect carbapenemase and metallo-ß-lactamases in Enterobacteriaceae in 4 hrs and are suitable for routine use in most clinical microbiology laboratories.

Eight-Year Surveillance of Uropathogenic Escherichia coli in Southwest China.

PURPOSE: To assess antimicrobial resistance profiles change in uropathogenic Escherichia coli (UPEC) during an 8-year period, especially extended-spectrum ß-lactamase (ESBL)-producing and carbapenem-resistant isolates. MATERIALS AND METHODS: A retrospective observational study of urinary tract infections (UTIs) was performed in a territory hospital between 2012 and 2019. Isolates were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry or the VITEK 2 Compact system. The antimicrobial susceptibility testing was performed using the VITEK 2 Compact system and the ï»¿modified Kirby-Bauer disc diffusion method. RESULTS: Of the 7713 non-repetitive UPEC isolates, 7075 (91.7%) were from inpatients and 638 (8.3%) were from outpatients. The prevalence of ESBL declined from 62.5% to 49.7% (P = 0.003). Except for cefoxitin, the resistance rates of ESBL-producing isolates were mostly higher than that of non-ESBL-producing isolates (P < 0.001). The resistance rates of ampicillin (P = 0.013), ampicillin/sulbactam (P = 0.013), ceftriaxone (P < 0.001), gentamycin (P = 0.001), tobramycin (P = 0.011), and trimethoprim/sulfamethoxazole (P = 0.028) declined slightly, while the resistance rate of imipenem increased slightly (P = 0.001). The prevalence of carbapenem-resistant Escherichia coli was <2.0%. CONCLUSION: ESBL-producing Escherichia coli is still the main drug-resistant bacteria causing UTIs. We should pay attention to antimicrobial resistance in high-risk inpatient areas and take effective measures to prevent and control nosocomial infections.

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China.

BACKGROUND: Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China. METHODS: A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing. RESULTS: Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT- isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A + B + CDT-. CONCLUSIONS: Different genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.

Impact of psychological capital on construction worker safety behavior: Communication competence as a mediator.

INTRODUCTION: Construction workers face a work environment of high risk and mental stress. Psychological capital (PsyCap) could influence employee's mental health and work performance. It would be helpful to determine whether PsyCap affects worker safety behavior. However, few studies empirically examined the impacts of the sub-dimensions of PsyCap on the safety behavior in construction settings, reducing the potential practicability of PsyCap to improve workplace safety performance. Thus, this study tested the relationship between sub-dimensions of PsyCap (self-efficacy, hope, resilience, optimism) and safety behaviors (safety compliance, safety participation), while the mediating role of communication competence was also explored. METHOD: Data were collected from 655 construction workers in China using a psychological capital questionnaire (PCQ). The theoretical model were tested with confirmatory factor analyses (CFA) and structural equation modeling (SEM) techniques. RESULTS: Results show that: (a) the self-efficacy dimension of PsyCap positively affected safety compliance and safety participation, while the resilience dimension positively impacted safety participation; (b) the hope dimension was not directly related to safety behaviors, while the optimism dimension negatively associated with safety participation; and (c) communication competence mediated the relationships between the hope and optimism dimensions of PsyCap and safety participation. CONCLUSIONS: A multidimensional perspective on PsyCap should be taken while examining its effects on safety behavior and the individual communication competence helps to enhance construction safety. Findings of this study shed lights on safety behavior promotion practices based on the multidimensional model. Initiating flexible psychological capital training and intervention, and strengthening communication skills of construction employees are suggested to improve safety performance in the construction industry.

Distinct Antimicrobial Resistance Profiling Of Clinically Important Aeromonas Spp. In Southwest China: A Seven-Year Surveillance Study.

BACKGROUND: Co-evolution of host and aeromonads has diversified their spectrums of diseases and antibiograms, while a paucity of data was concerning about this diversity in China. To fill this gap, this study was aimed to investigate and compare antimicrobial resistance (AMR) patterns of clinically important Aeromonas spp. from various clinical sources. METHODS: A multicenter retrospective surveillance study was conducted in Chongqing from 2011 to 2017. Data of strains were retrieved from the database of China Antimicrobial Resistance Surveillance System (CARSS). Whonet 5.6 and Graphpad Prism 6 Software were adopted to determine and compare distribution and AMR patterns. RESULTS: Among 1135 Aeromonas strains, Aeromonas hydrophila complex (65.6%, 745/1135) was the most predominant species, followed by Aeromonas veronii complex (16.7%, 190/1135) and Aeromonas caviae complex (15.3%, 174/1135). Sputum was the most frequent source of strains (27.7%), followed by wound (20.8%), bloodstream (10.8%) and urine (8.8%). Urinary strains demonstrated the highest resistance rates to ceftriaxone (65.6%), ceftazidime (52.1%), cefepime (38.3%), ciprofloxacin (47.7%) and trimethoprim-sulfamethoxazole (56.6%). Similar AMR pattern was observed in intestinal strains, with corresponding resistance rates of 29.4%, 28.9%, 22.2%, 27.3% and 45%, respectively. However, respiratory, bloodstream and skin strains exhibited resistance rates of less than 20% to most of the antimicrobials tested. In terms of species, approximately 30% of Aeromonas hydrophila complex and Aeromonas caviae complex strains were resistant to ceftriaxone and trimethoprim-sulfamethoxazole, while Aeromonas veronii complex strains harbored resistance rates of less than 20% to all tested antimicrobials. Although antibiograms of these species were distinct, they remained constant from 2011 to 2017. CONCLUSIONS: Distinct AMR patterns between species and sources highlighted the predominance of Aeromonas hydrophila complex and high resistance of strains in urine and intestine to extended-spectrum cephalosporins, ciprofloxacin and trimethoprim-sulfamethoxazole in Southwest China. Temporally constant AMR patterns should not relax the vigilance of antimicrobial resistance in clinically important Aeromonas species.

Corrigendum to "Determinants of Mortality in Patients with Nosocomial Acinetobacter baumannii Bacteremia in Southwest China: A Five-Year Case-Control Study".

[This corrects the article DOI: 10.1155/2018/3150965.].

Shifting trends and age distribution of ESKAPEEc resistance in bloodstream infection, Southwest China, 2012-2017.

Background: ESKAPEEc contribute to a majority of bloodstream infections (BSIs) and their antibiogram have changed overtime, while data concerning about these alterations are lacking in China. Added that a paucity of studies referred to ESKAPEEc in pediatric BSIs, our study aimed to demonstrate the longitudinal alterations of ESKAPEEc distribution and antibiogram in adult and pediatric BSIs in Southwest China. Methods: A multicenter retrospective surveillance study was launched from 2012 to 2017. Data of China Antimicrobial Resistance Surveillance System (CARSS) was analyzed by Whonet 5.6 and Graphpad Prism 6 Software. Chi-square test or Fisher's exact test was used to examine and compare temporal changes. Results: A total of 32,259 strains was isolated, with 17.4% from pediatric BSIs. ESKAPEEc contributed to 58.67% (18,924/32,259) of BSIs, with 65.3% of adult BSIs and 27.2% of pediatric BSIs. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) were the two predominant species. Carbapenem resistance was prevalent in 0.76, 4.60, 9.47,13.66, 59.47% of E. coli, K. pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii), respectively. The proportions of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREFM) were 28.91% and 2.20%, respectively. Between 2012-2014 and 2015-2017, E. coli and K. pneumonia showed significantly increased resistance rates to imipenem but decreased to ceftriaxone and ceftazidime, while A. baumannii exhibited reduced resistances to almost all the beta-lactams tested. The prevalence of antimicrobial resistance to most of agents against Gram-positive ESKAPEEc did not significantly varied during the same timeframe. In comparison with those from adult BSIs, K. pneumoniae from pediatric BSIs exhibited high resistance rates to all the beta-lactams tested, especially to carbapenems (12.79% vs 3.87%), while A. baumannii showed low resistance rates to all the agents. Conclusions: Ongoing burden of ESKAPEEc in BSIs and increasing trend of imipenem resistance in E. coli and K. pneumoniae call for continued surveillance. Carbapenems are still active against Gram-negative ESKAPEEc, except for A. baumannii and vancomycin or linezolid is still effective against Gram-positive ESKAPEEc. Carbapenem-resistant K. pneumoniae in children and carbapenem-resistant A. baumannii in adults necessitate effective antimicrobial strategies in consideration of age stratification.

Determinants of Mortality in Patients with Nosocomial Acinetobacter baumannii Bacteremia in Southwest China: A Five-Year Case-Control Study.

PURPOSE: This study was aimed to identify the determinants of in-hospital mortality in Acinetobacter baumannii (A. baumannii) bacteremia and to assess impact of carbapenem resistance on mortality. METHODS: A five-year case-control study was conducted from January 2011 to December 2015 in a tertiary teaching hospital with 3200 beds, Southwest China. Clinical outcomes and potential determinants of mortality in patients with nosocomial A. baumannii bacteremia and carbapenem-resistant A. baumannii (CRAB) bacteremia were evaluated using Cox and logistic regression analyses. RESULTS: A total of 118 patients with nosocomial A. baumannii bacteremia were included. Seventy-one percent (84/118) of them had carbapenem-resistant A. baumannii (CRAB) bacteremia. The in-hospital mortality of nosocomial A. baumannii bacteremia was 21.2%, and the attributable in-hospital mortality rate due to CRAB was 21.5%. Significant difference of 30-day in-hospital mortality in the Kaplan-Meier curves was found between CRAB and CSAB groups (log-rank test, P=0.025). The Cox regression analysis showed that patients with CRAB bacteremia had 2.72 times higher risk for 30-day in-hospital mortality than did those with carbapenem-susceptible A. baumannii (CSAB) bacteremia (95% confidence intervals (CIs) 1.14-6.61, P=0.016). The logistic regression analysis reported that mechanical ventilation and respiratory tract as origin of bacteremia were independent predictors of mortality among patients with nosocomial A. baumannii bacteremia and CRAB bacteremia, while high APACHE II score on the day of bacteremia and multiple organ dysfunction syndromes (MODS) during hospitalization were independent predictors of mortality among patients with nosocomial A. baumannii bacteremia but not CRAB bacteremia. CONCLUSION: It was the severity of illness (high APACHE II score and MODS) not carbapenem resistance that highlighted the mortality of patients with nosocomial A. baumannii bacteremia. The impact of mechanical ventilation on mortality suggested that respiratory dysfunction might prime the poor outcome. Protection of respiratory function during the progression of nosocomial A. baumannii bacteremia should be given more importance. Early identification and intervention of patients with nosocomial A. baumannii bacteremia in critical ill conditions were advocated.

Mucosal immunization with purified OmpA elicited protective immunity against infections caused by multidrug-resistant Acinetobacter baumannii.

Multidrug-resistant Acinetobacter baumannii (A. baumannii) is a rapidly emerging pathogen causing infections with high mortality rates due to inadequate medical treatment. New ways to prevent and treat such infections are of a critical medical need. In this study, intranasal vaccination with A. baumannii outer membrane protein A (OmpA) induced both systemic and mucosal antibodies. After challenge intraperitoneally by clinical strains of multidrug-resistant A. baumannii, mice immunized with OmpA had a significantly higher survival rate than control mice. The OmpA protein level tested positive by western blot in clinical strains of A. baumannii. Furthermore, characterization of human sera for anti-OmpA immunoglobulin G (IgG) antibody levels demonstrated that OmpA protein was immunogenic in healthy individuals and patients with A. baumannii invasive infections. In conclusion, to the best of our knowledge, this is the first study protective efficacy of mucosal immunization with OmpA as a protein antigen against multidrug-resistant A. Baumannii.

Characterization of carbapenemases, extended spectrum ß-lactamases, quinolone resistance and aminoglycoside resistance determinants in carbapenem-non-susceptible Escherichia coli from a teaching hospital in Chongqing, Southwest China.

Carbapenem-resistant Escherichiacoli isolates harboring carbapenemases or combining an extended-spectrum ß-lactamase (ESBL) enzyme with loss of porins present an increasingly urgent clinical danger. Combined resistance to aminoglycosides and fluoroquinolones in carbapeneme non-susceptible (CNS) isolates will inevitably create problems. In the current study, we characterized the carbapenemases and ESBLs, and the prevalence of quinolone resistance determinants and aminoglycoside resistance determinants in carbapenem-non-susceptible (CNS) E.coli isolates from a teaching hospital in Chongqing, Southwest China in 2012. Thirty non-duplicated CNS E.coli isolates were screened via antimicrobial susceptibility testing, and the drug resistance profiles of the 30 strains were analyzed. Carbapenemase genes blaKPC-2, ESBL genes including blaCTX-M-3, blaCTX-M-14, blaCTX-M-55 and blaTEM, ARD genes including aac(6')-Ib, armA and rmtB, and QRD genes including qnrA, qnrB, qnrC, qnrD, qnrS and aac(6')-Ib-cr were identified and clonal relatedness was investigated by pulsed-field gel electrophoresis. Of the 30 isolates, 2 (6.7%) harbored carbapenemase gene blaKPC-2; 29 (96.7%) carried ESBLs; 20 (66.7%) were QRD positive; and 11 (36.7%) were ARD positive. Between the two blaKPC-2 positive strains, one contained ESBL, QRD and ARD genes, while the other expressed ESBL genes but was negative for both QRD and ARD genes. Of the 29 ESBLs positive isolates, 2 (6.9%) were carbapenemase positive, 19 (65.5%) were QRD positive, and 11 (37.9%) were ARD positive. PFGE revealed genetic diversity among the 30 isolates, indicating that the high prevalence of CNS E. coli isolates was not caused by clonal dissemination. Production of ESBLs was associated with the carbapenem resistance and QRD genes were highly prevalent among the CNS E. coli isolates. Multiple resistant genes were co-expressed in the same isolates. This is the first report of a multidrug resistant carbapenem-non-susceptible E.coli co-harboring resistant determinants blaKPC-2, blaCTX-M-14, blaCTX-M-55, blaTEM, aac(6')-Ib-cr, qnrB, aac(6')-Ib and rmtB from Chongqing, mainland China.

Synthesis, crystal structure and luminescent properties of one coordination polymer of cadmium(II) with mixed thiocyanate and hexamethylenetetramine ligands.

A novel Cd(II) coordination polymer [Cd(SCN)(2)(hmt)(1/2)(H(2)O)](2).H(2)O (hmt=hexamethylenetetramine) has been synthesized and characterized by IR, elemental analysis, TG technique and X-ray crystallography. Cd(II) atom has an distorted octahedral environment with an N(3)S(2)O donor set. Every six Cd(II) centers are linked by hmt and thiocyanato bridges to form a planar 2D coordination polymer containing hexagonal metallocyclic rings [Cd(6)(SCN)(8)(hmt)(2)]. A 2D layer structure is held together with its neighboring ones via a set of hydrogen-bonding interactions to form a 3D supramolecular structure. The luminescent properties of the title complex in the solid state were investigated.