Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021.

BACKGROUND: There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. AIMS: To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. METHODS: Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. FINDINGS: In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. CONCLUSION: This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.

Mental Disorders and Oral Diseases: Future Research Directions.

The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.

The effect of inner-sphere reorganization on charge separated state lifetimes at sensitized TiO2 interfaces.

Improving the efficiency of photo-electrocatalytic cells depends on controlling the rates of interfacial electron transfer to promote the formation of long-lived charge separated states. Ultimately, for efficient catalytic assemblies to see widespread implementation, repeated electron transfer in the absence of charge recombination needs to be realized. In this study, a series of manganese-based transition metal complexes known to undergo charge transfer-induced spin crossover are employed to study how significant increases in inner-sphere reorganization energy affect the rates of interfacial electron transfer. Each complex is characterized by transient spectroscopic and electrochemical methods to calculate the rate of electron transfer to a model chromophore anchored to the surface of a TiO2 film. Likewise, open-circuit voltage decay measurements were used to determine the voltage-dependent lifetime of injected electrons in TiO2 in the presence of each complex. To further characterize the rates of electronic recombination, density functional theory was used to calculate the inner-sphere and outer-sphere reorganization energy for each complex. These calculations were then combined with classical Marcus theory to determine the theoretical rate of back-electron transfer from the TiO2 conduction band. These results show that, in model complexes, a significant reduction in the recombination rate constant is achieved for complexes possessing a significant inner-sphere reorganization energy.

Deprivation and child dental attendance in England: exploring the shape and moderators.

OBJECTIVE: To describe the shape of the relationship between area deprivation and dental attendance (DA) in children aged 5 years and under in England and the modifying effect of caries prevalence, ethnicity, family profile and dentist-to-population ratio. BASIC RESEARCH DESIGN: DA rates were calculated at lower-tier local authority level (LA, n=326) using NHS data for the year to March 2017. LA deprivation was determined by Index of Multiple Deprivation 2015. Caries prevalence was retrieved from the 2016/17 National Dental Epidemiology Programme; ethnicity and family profile from Census 2011 and dentist-to-population ratio from NHS statistics. Fractional polynomial (FP) models explored the shape of the relationship. Multivariable regression models were adjusted for covariates. The effect of moderators was estimated by adjusted marginal effects. CLINICAL SETTING: English Lower-tier LAs. MAIN OUTCOME MEASURE: Shape of the relationship between DA and deprivation and its moderators. RESULTS: Best-fitting second-order FP model (p=0.582) did not provide a better fit for the relationship than the linear model. Therefore, the linear model was selected for final analysis. Deprivation was associated with decreased DA rates (Coefficient=-0.39, 95%CI=-0.53,-0.24; p=⟨0.001); while White ethnicity (Coefficient=0.35, 95%CI=0.29, 0.41; p=⟨0.001), single parenthood (Coefficient = 2.21, 95%CI=0.91,3.51; p=0.001) and caries prevalence (Coefficient =0.34, 95%CI=0.25,0.44; p=⟨0.001) with increased rates. These moderated the relationship. CONCLUSIONS: We hypothesised that the shape of the relationship between deprivation and DA could be curvilinear with higher rates in the extreme ends of deprivation. However, the analysis showed a linear association, moderated by the effect of ethnicity, single parenthood and disease level.

Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance.

INTRODUCTION: Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. METHODS: We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. RESULTS: We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. CONCLUSIONS: The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. KNOWLEDGE TRANSFER STATEMENT: While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.

Inequalities in orthodontic outcomes in England: treatment utilisation, subjective and normative need.

OBJECTIVE: To investigate inequalities in three aspects of access to orthodontic care: uptake of orthodontic treatment, normative need and subjective need in England. METHODS: We used data from two surveys in England: 12 and 15-year-olds from the 2013 Child Dental Health Survey (CDHS 2013) and 12-year-olds from the 2008/2009 NHS Dental Epidemiology Programme for England (NDEP 2008/2009). Summary variables representing orthodontic status were calculated. Two regression-based summary measures of inequalities were used to investigate the relationship between deprivation level and orthodontic outcomes: Slope and Relative indices of Inequality. RESULTS: There were significant absolute and relative inequalities in uptake of orthodontic treatment. The least deprived were 1.9 times more likely to have received orthodontic treatment compared to the most deprived in both surveys. Normative need was not associated with deprivation in either the analyses of CDHS 2013 (SII= 0.03, 95% CI: -0.04, 0.1; RII=1.06, 95% CI: 0.91, 1.24) or the NDEP 2007/2008 (SII= 0.03, 95% CI: -0.02, 0.07; RII=1.06, 95% CI: 0.96, 1.18). There was greater willingness to have teeth straightened in more deprived children from CDHS 2013 (SII=-0.09, 95% CI: -0.16, -0.03; RII=0.85, 95% CI: 0.75, 0.96) but not in NDEP 2007/2008 (SII=0.03, 95% CI: 0, 0.06; RII=1.07, 95% CI: 0.99, 1.15). CONCLUSIONS: Being deprived was associated with lower uptake of orthodontic treatment. Normative need was not related to deprivation. The association between deprivation and subjective need was only partly established, with poorer children showing a greater desire to have their teeth straightened in one survey.

Hypergolic zeolitic imidazolate frameworks (ZIFs) as next-generation solid fuels: Unlocking the latent energetic behavior of ZIFs.

Hypergolic materials, capable of spontaneous ignition upon contact with an external oxidizer, are of critical importance as fuels and propellants in aerospace applications (e.g., rockets and spacecraft). Currently used hypergolic fuels are highly energetic, toxic, and carcinogenic hydrazine derivatives, inspiring the search for cleaner and safer hypergols. Here, we demonstrate the first strategy to design hypergolic behavior within a metal-organic framework (MOF) platform, by using simple "trigger" functionalities to unlock the latent and generally not recognized energetic properties of zeolitic imidazolate frameworks, a popular class of MOFs. The herein presented six hypergolic MOFs, based on zinc, cobalt, and cadmium, illustrate a uniquely modular platform to develop hypergols free of highly energetic or carcinogenic components, in which varying the metal and linker components enables the modulation of ignition and combustion properties, resulting in excellent hypergolic response evident by ultrashort ignition delays as low as 2 ms.

Low rates of dental attendance by the age of one and inequality between local government administrative areas in England.

OBJECTIVE: To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN: Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING: Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE: Attending an NHS primary care dental service. RESULTS: DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS: DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

Socioeconomic Variation in the association between Malocclusion and Oral Health Related Quality of Life.

OBJECTIVES: Oral health related quality of life (OHRQoL) has been linked to malocclusion. We aimed (a) to investigate the association between malocclusion and OHRQoL among children, and (b) to examine whether this association varied by socioeconomic status. METHODS: Cross-sectional analysis of data for 4,217 children aged 12 & 15 years, who participated in the 2013 Children Dental Health Survey (CDHS); a nationally representative survey of children in England, Wales, and Northern Ireland. Malocclusion was determined using the modified Index of Orthodontic Treatment Need (IOTN). OHRQoL was measured using the Child Oral Impacts on Daily Performance (Child-OIDP). For socioeconomic status, we used the pupils' eligibility for free school meals (FSM) and Index of Multiple Deprivation (IMD). Adjusted marginal effects were estimated controlling for confounding variables. Separate analyses were carried out for the two age groups. RESULTS: Malocclusion was associated with 6% and 15% increases in the probability of reporting negative impact of OHRQoL for 12- and 15-year olds respectively, which was significant for 15-year olds (marginal effect=0.15, 95% CI=0.08-0.22). Malocclusion was associated with the prevalence of oral impacts for 12 year olds (marginal effect=0.1, 95% CI=0.02-0.17) and 15-year olds (marginal effect=0.2, 95% CI 95%=0.13-0.28) not eligible for FSM and for 15-year olds in the most (marginal effect=0.2, 95% CI=0.1-0.29) and least (marginal effect=0.26, 95% CI=0.13-0.4) deprived IMD quintiles. CONCLUSIONS: Malocclusion was associated with impacts on OHRQoL for 15-year olds. There was evidence of a relationship between SES, malocclusion and OHRQoL.

PLD Protein-Protein Interactions With Signaling Molecules and Modulation by PA.

We describe methods for studying phospholipase D (PLD) interactions with signaling proteins and modulation of these interactions by the PLD reaction product, phosphatidic acid (PA). PLD is fundamental to the physiological maintenance of cellular/intracellular membranes, protein trafficking, cytoskeletal dynamics, membrane remodeling, cell proliferation, meiotic division and sporulation. PA is an acidic phospholipid involved in the biosynthesis of many other lipids that affects the enzymatic activities of many different signaling proteins via protein-lipid interactions or as a substrate. The involvement of PLD as an effector of protein-protein interactions and downstream signaling via PA-mediated processes has led to the investigation of PA-binding domains in target protein partners. We present here data and protocols detailing the interaction between PLD2-Rac2 interaction and modulation of this interaction by PA. We describe biochemical techniques to measure interactions between PLD, PA, and the small GTPase Rac2, which are associated in the cell. We found two maxima concentrations of PA that contributed to association or dissociation of Rac2 with PLD2, as well as the PLD2 lipase and guanine nucleotide exchange factor (GEF) activities. Fluctuations in the Rac2-PLD2 protein-protein binding interaction facilitate shuttling of Rac2 and/or PLD2 within the cell dependent on local cellular PA concentration. Fluorescence resonance emission transfer stoichiometry for PLD2 and Rac2 binding yielded a 3:1 ratio of Rac2:PLD2. Detection of PA in mammalian cells with a new biosensor showed colocalization in and around the nucleus. We also described methods for quantitation of PA in biological materials by HPLC electrospray ionization tandem mass spectrometry.

Excess cost associated with primary hip and knee joint arthroplasty surgical site infections: a driver to support investment in quality improvement strategies to reduce infection rates.

AIM: To determine the excess costs attributable to surgical site infections (SSI) following primary hip and knee joint arthroplasty at Auckland City Hospital. METHODS: A retrospective case-control study. Cases were patients who developed a SSI following primary hip (THA) and knee arthroplasty (TKA) surgery within 90 days of the procedure. Cases were matched 1:2 with controls; patients whose primary hip and knee arthroplasty procedures were not complicated by infection. Controls were matched for age, gender, date of surgery, type of surgery, and ASA category. The length of stay (LOS) and hospital costs for the initial admission and subsequent readmission for infection were calculated from the clinical costing system at Auckland District Health Board. RESULTS: Eleven cases were identified; 3 following TKA, 7 following THA, and 1 following hemiarthroplasty of the hip. Infections were classified as superficial, 1, joint space, 1, and deep incisional, 9. Five SSI were identified during the initial admission for joint arthroplasty and 6 patients were readmitted with an SSI. Compared to the control patients, SSIs were associated with an excess mean cost of $40,121 and an excess mean LOS of 42 days. CONCLUSIONS: There is a significant increase in LOS and cost associated with SSI following primary THA and TKA at Auckland City Hospital. In addition to the excess cost associated with SSI, there are also opportunity costs resulting from their impact on elective surgical waiting lists. This reinforces the significant positive economic impact a successful strategy to reduce SSIs associated with primary joint arthroplasty procedures will have.

Ruthenium(ii)-polypyridyl zirconium(iv) metal-organic frameworks as a new class of sensitized solar cells.

A series of Ru(ii)L2L' (L = 2,2'-bipyridyl, L' = 2,2'-bipyridine-5,5'-dicarboxylic acid), RuDCBPY, -containing zirconium(iv) coordination polymer thin films have been prepared as sensitizing materials for solar cell applications. These metal-organic framework (MOF) sensitized solar cells, MOFSCs, each are shown to generate photocurrent in response to simulated 1 sun illumination. Emission lifetime measurements indicate the excited state quenching of RuDCBPY at the MOF-TiO2 interface is extremely efficient (>90%), presumably due to electron injection into TiO2. A mechanism is proposed in which RuDCBPY-centers photo-excited within the MOF-bulk undergo isotropic energy migration up to 25 nm from the point of origin. This work represents the first example in which a MOFSC is directly compared to the constituent dye adsorbed on TiO2 (DSC). Importantly, the MOFSCs outperformed their RuDCBPY-TiO2 DSC counterpart under the conditions used here and, thus, are solidified as promising solar cell platforms.

West Midlands Care Home Dental Survey 2011: part 1. Results of questionnaire to care home managers.

AIM: To provide baseline data on dental issues affecting residents from the perspective of care home managers to inform oral health local needs assessments and commissioning decisions. METHODS: A pre-piloted postal questionnaire was sent to all identified managers of adult care homes (1,832) in the West Midlands between February and April 2011. Quantitative analysis was complemented by seeking the views of care home managers regarding training and experience of, and access to, dental services. RESULTS: The response rate to the study was 63.9% (1,170/1,832). There were 194 responding care homes who reported that residents had problems accessing dental services. Nearly double the proportion of nursing care homes and care homes with residents with elderly mental impairment (EMI) reported problems accessing dental services compared with care homes without nursing care and non-EMI care homes. Issues raised included patient safety concerns, reservations regarding expertise of dental staff, difficulties with transporting residents and waiting times for treatment. CONCLUSION: The survey provided a snapshot of dental issues as reported by care home managers, these results should help inform both the dental profession and those who commission services about issues affecting the oral health of patients living in care homes.

West Midlands Care Home Dental Survey 2011: part 2. Results of clinical survey of care home residents.

AIM: To determine the oral health status of a sample of care home residents and provide data to inform local needs assessments and commissioning decisions. METHODS: A stratified sampling methodology was used to sample care homes; residents were then selected at random and invited to participate. The survey consisted of a short questionnaire and a clinical examination; it attempted to capture data relating to current oral health status, treatment need and suitability for treatment. RESULTS: Of 1761 residents sampled, 848 residents (mean age: 80 years) were competent to and consented to participate in the survey. Of those who consented to a clinical examination, 56% were dentate and 43.6% edentate. Among dentate residents, there was a caries prevalence of 55.8%. Just over half of examined residents (52.7%) were thought to be in need of dental treatment, and potentially suitable to receive treatment. CONCLUSION: These findings document the current state of oral health of a sample of care home residents in the West Midlands and provide valuable data to help inform strategic commissioning decisions. The particular oral health needs of this population group must be considered.

Multicenter study of epidemiological cutoff values and detection of resistance in Candida spp. to anidulafungin, caspofungin, and micafungin using the Sensititre YeastOne colorimetric method.

Neither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candida spp. with anidulafungin, caspofungin, and micafungin when using the Sensititre YeastOne (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candida species wild-type (WT) MIC distributions (for microorganisms in a species/drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabrata complex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosis complex, and 1,016 C. tropicalis isolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO ECVs. ECVs for anidulafungin, caspofungin, and micafungin encompassing ≥97.5% of the statistically modeled population were, respectively, 0.12, 0.25, and 0.06 µg/ml for C. albicans, 0.12, 0.25, and 0.03 µg/ml for C. glabrata complex, 4, 2, and 4 µg/ml for C. parapsilosis complex, 0.5, 0.25, and 0.06 µg/ml for C. tropicalis, 0.25, 1, and 0.25 µg/ml for C. krusei, 0.25, 1, and 0.12 µg/ml for C. lusitaniae, 4, 2, and 2 µg/ml for C. guilliermondii, and 0.25, 0.25, and 0.12 µg/ml for C. dubliniensis. Species-specific SYO ECVs for anidulafungin, caspofungin, and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candida isolates with identified fks mutations. SYO ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin, and especially caspofungin, since testing the susceptibilities of Candida spp. to caspofungin by reference methodologies is not recommended.

An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study.

BACKGROUND: Contemporary evidence for the effectiveness of water fluoridation schemes in the U.K. is sparse. The utility of routinely collected data in providing evidence warrants further research. OBJECTIVES: To examine inpatient hospital episodes statistics for dental extractions as an alternative population marker for the effectiveness of water fluoridation by comparing hospital admissions between two major strategic health authority (SHA) areas, the West Midlands SHA-largely fluoridated--and the North West SHA--largely unfluoridated. METHOD: Hospital episodes statistics (HES) were interrogated to provide data on admissions for simple and surgical dental extractions, which had a primary diagnostic code of either dental caries or diseases of pulp and periapical tissues for financial years 2006/7, 2007/8 and 2008/9. Data was aggregated by SHA area and quinary age group. Directly standardised rates (DSR) of admissions purchased for each primary care trust (PCT) were calculated and ranked by index of multiple deprivation (IMD). RESULTS: A significant difference in DSRs of admission between PCTs in the West Midlands and North West was observed (Mann-Whitney U test [p <0.0001]) irrespective of IMD ranking. The difference in rates between the two most deprived PCTs was 27-fold. CONCLUSIONS: After ranking by IMD, DSRs of hospital admissions for the extraction of decayed or pulpally/periapically involved teeth is lower in areas with a fluoridated water supply. The analysis of routinely collected HES data may help identify the impact of water fluoridation schemes.

Revealing lithium-silicide phase transformations in nano-structured silicon-based lithium ion batteries via in situ NMR spectroscopy.

Nano-structured silicon anodes are attractive alternatives to graphitic carbons in rechargeable Li-ion batteries, owing to their extremely high capacities. Despite their advantages, numerous issues remain to be addressed, the most basic being to understand the complex kinetics and thermodynamics that control the reactions and structural rearrangements. Elucidating this necessitates real-time in situ metrologies, which are highly challenging, if the whole electrode structure is studied at an atomistic level for multiple cycles under realistic cycling conditions. Here we report that Si nanowires grown on a conducting carbon-fibre support provide a robust model battery system that can be studied by (7)Li in situ NMR spectroscopy. The method allows the (de)alloying reactions of the amorphous silicides to be followed in the 2nd cycle and beyond. In combination with density-functional theory calculations, the results provide insight into the amorphous and amorphous-to-crystalline lithium-silicide transformations, particularly those at low voltages, which are highly relevant to practical cycling strategies.

The use of hemospray in portal hypertensive bleeding; a case series.

Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.