Mass spectrometry analysis of gut tissue in acute SIV-infection in rhesus macaques identifies early proteome alterations preceding the interferon inflammatory response.

HIV infection damages the gut mucosa leading to chronic immune activation, increased morbidities and mortality, and antiretroviral therapies, do not completely ameliorate mucosal dysfunction. Understanding early molecular changes in acute infection may identify new biomarkers underlying gut dysfunction. Here we utilized a proteomics approach, coupled with flow cytometry, to characterize early molecular and immunological alterations during acute SIV infection in gut tissue of rhesus macaques. Gut tissue biopsies were obtained at 2 times pre-infection and 4 times post-infection from 6 macaques. The tissue proteome was analyzed by mass spectrometry, and immune cell populations in tissue and blood by flow cytometry. Significant proteome changes (p < 0.05) occurred at 3 days post-infection (dpi) (13.0%), 14 dpi (13.7%), 28 dpi (16.9%) and 63 dpi (14.8%). At 3 dpi, proteome changes included cellular structural activity, barrier integrity, and activation of epithelial to mesenchymal transition (EMT) (FDR < 0.0001) prior to the antiviral response at 14 dpi (IFNa/g pathways, p < 0.001). Novel EMT proteomic biomarkers (keratins 2, 6A and 20, collagen 12A1, desmoplakin) and inflammatory biomarkers (PSMB9, FGL2) were associated with early infection and barrier dysfunction. These findings identify new biomarkers preceding inflammation in SIV infection involved with EMT activation. This warrants further investigation of the role of these biomarkers in chronic infection, mucosal inflammation, and disease pathogenesis of HIV.

Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disorders.

BACKGROUND: To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). METHODS: A mixed methods feasibility study. RESULTS: Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. CONCLUSIONS: The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.

Use of diamond sensors for a high-flux, high-rate X-ray pass-through diagnostic.

X-ray free-electron lasers (XFELs) deliver pulses of coherent X-rays on the femtosecond time scale, with potentially high repetition rates. While XFELs provide high peak intensities, both the intensity and the centroid of the beam fluctuate strongly on a pulse-to-pulse basis, motivating high-rate beam diagnostics that operate over a large dynamic range. The fast drift velocity, low X-ray absorption and high radiation tolerance properties of chemical vapour deposition diamonds make these crystals a promising candidate material for developing a fast (multi-GHz) pass-through diagnostic for the next generation of XFELs. A new approach to the design of a diamond sensor signal path is presented, along with associated characterization studies performed in the XPP endstation of the LINAC Coherent Light Source (LCLS) at SLAC. Qualitative charge collection profiles (collected charge versus time) are presented and compared with those from a commercially available detector. Quantitative results on the charge collection efficiency and signal collection times are presented over a range of approximately four orders of magnitude in the generated electron-hole plasma density.

A behaviour change package to prevent hand dermatitis in nurses working in the National Health Service: results of a cluster randomized controlled trial.

BACKGROUND: Occupational hand dermatitis poses a serious risk for nurses. OBJECTIVES: To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171. RESULTS: Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported. CONCLUSIONS: There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.

Managing common mental health disorders in healthcare workers.

BACKGROUND: Approximately a quarter of sickness absence in the UK National Health Service (NHS) is attributed to common mental health disorders (CMHDs). This is costly to the NHS and impacts on patient care and staff morale. Little is known about the occupational health (OH) management of NHS staff who take sick leave for CMHDs. AIMS: To explore the current OH management of NHS staff on sick leave for CMHDs. METHODS: We invited providers of NHS OH services identified from the NHS Health at Work Network and Commercial OH Providers Association to complete a survey on the management of employees off work because of CMHDs. Analysis involved descriptive statistics and content analysis. RESULTS: Forty-nine (39%) of the 126 OH departments approached responded. The majority (98%) had an organizational sickness absence policy that included triggers for referral for staff absent with CMHDs. In 63%, referral occurred 8-28 days after the onset of absence; in 92%, the consultation was completed by an OH nurse or OH physician. Content of the first consultation often included assessment of symptoms and medication for CMHDs. Case management and regular reviews were least commonly used despite evidence on their effectiveness in supporting return to work. All providers offered some support for managers of staff with CMHDs. CONCLUSION: Variation existed between providers of NHS OH services in the timing of referrals, use of case management and regular reviews for staff with CMHDs. Our findings suggest that current evidence-based guidance on interventions to improve return to work is not being implemented consistently.

Diamond sensors and polycapillary lenses for X-ray absorption spectroscopy.

Diamond sensors are evaluated as incident beam monitors for X-ray absorption spectroscopy experiments. These single crystal devices pose a challenge for an energy-scanning experiment using hard X-rays due to the effect of diffraction from the crystalline sensor at energies which meet the Bragg condition. This problem is eliminated by combination with polycapillary lenses. The convergence angle of the beam exiting the lens is large compared to rocking curve widths of the diamond. A ray exiting one capillary from the lens meets the Bragg condition for any reflection at a different energy from the rays exiting adjacent capillaries. This serves to broaden each diffraction peak over a wide energy range, allowing linear measurement of incident intensity over the range of the energy scan. Extended X-ray absorption fine structure data are measured with a combination of a polycapillary lens and a diamond incident beam monitor. These data are of comparable quality to data measured without a lens and with an ionization chamber monitoring the incident beam intensity.

Evaluation of a case management service to reduce sickness absence.

BACKGROUND: It is unclear whether and to what extent intensive case management is more effective than standard occupational health services in reducing sickness absence in the health care sector. AIMS: To evaluate a new return to work service at an English hospital trust. METHODS: The new service entailed intensive case management for staff who had been absent sick for longer than 4 weeks, aiming to restore function through a goal-directed and enabling approach based on a bio-psycho-social model. Assessment of the intervention was by controlled before and after comparison with a neighbouring hospital trust at which there were no major changes in the management of sickness absence. Data on outcome measures were abstracted from electronic databases held by the two trusts. RESULTS: At the intervention trust, the proportion of 4-week absences that continued beyond 8 weeks fell from 51.7% in 2008 to 49.1% in 2009 and 45.9% in 2010. The reduction from 2008 to 2010 contrasted with an increase at the control trust from 51.2% to 56.1%-a difference in change of 10.7% (95% CI 1.5-20.0%). There was also a differential improvement in mean days of absence beyond 4 weeks, but this was not statistically significant (1.6 days per absence; 95% CI -7.2 to 10.3 days). CONCLUSIONS: Our findings suggest that the intervention was effective, and calculations based on an annual running cost of £57 000 suggest that it was also cost-effective. A similar intervention should now be evaluated at a larger number of hospital trusts.

Management of occupational dermatitis in healthcare workers: a systematic review.

OBJECTIVES: This systematic review informed evidence-based guidelines for the management of occupational dermatitis, with a particular focus on healthcare workers. METHODS: A multidisciplinary guideline group formulated questions about the management of healthcare workers with dermatitis. Keywords derived from these questions were used in literature searches. We appraised papers and developed recommendations using the Scottish Intercollegiate Guideline Network (SIGN) methodology. RESULTS: Literature searches identified 1677 papers; 11 met the quality standard (SIGN grading ++ or +). A small body of evidence indicated that dermatitis is more likely to be colonised with micro-organisms than normal skin, but there was insufficient evidence about the risk of transmission to patients. There was limited evidence that using alcohol gel for hand decontamination is less damaging to skin than antiseptics or soap. A small body of evidence showed that conditioning creams improve dermatitis, but are not more effective than their inactive vehicle. A small inconsistent body of evidence showed that workplace skin care programmes improve dermatitis. CONCLUSIONS: Healthcare workers should seek early treatment for dermatitis and should be advised about the risk of bacterial colonisation. Work adjustments should be considered for those with severe or acute dermatitis who work with patients at high risk of hospital-acquired infection. Healthcare workers with dermatitis should follow skin care programmes, and use alcohol gel where appropriate for hand decontamination. Further research should explore whether healthcare workers with dermatitis are more likely to transmit infection to their patients, and whether health surveillance is effective at reducing dermatitis.

Properties of hydrogen terminated diamond as a photocathode.

Electron emission from the negative electron affinity (NEA) surface of hydrogen terminated, boron doped diamond in the [100] orientation is investigated using angle resolved photoemission spectroscopy (ARPES). ARPES measurements using 16 eV synchrotron and 6 eV laser light are compared and found to show a catastrophic failure of the sudden approximation. While the high energy photoemission is found to yield little information regarding the NEA, low energy laser ARPES reveals for the first time that the NEA results from a novel Franck-Condon mechanism coupling electrons in the conduction band to the vacuum. The result opens the door to the development of a new class of NEA electron emitter based on this effect.

Assessing investment in manual handling risk controls: a scoring system for use in observational studies.

Most UK hospitals now have manual handling policies, but few studies have assessed their impact. To facilitate such research, a system for ranking the investment in manual handling risk controls was devised and applied to 109 acute hospitals in the UK. High scoring hospitals performed well on all aspects of manual handling risk management. Low scoring hospitals had a manual handling policy and recorded accidents and sickness absence, but had limited resource for expert manpower and equipment.

The enteric toxins of Clostridium perfringens.

The Gram-positive pathogen Clostridium perfringens is a major cause of human and veterinary enteric disease largely because this bacterium can produce several toxins when present inside the gastrointestinal tract. The enteric toxins of C. perfringens share two common features: (1) they are all single polypeptides of modest (approximately 25-35 kDa) size, although lacking in sequence homology, and (2) they generally act by forming pores or channels in plasma membranes of host cells. These enteric toxins include C. perfringens enterotoxin (CPE), which is responsible for the symptoms of a common human food poisoning and acts by forming pores after interacting with intestinal tight junction proteins. Two other C. perfringens enteric toxins, epsilon-toxin (a bioterrorism select agent) and beta-toxin, cause veterinary enterotoxemias when absorbed from the intestines; beta- and epsilon-toxins then apparently act by forming oligomeric pores in intestinal or extra-intestinal target tissues. The action of a newly discovered C. perfringens enteric toxin, beta2 toxin, has not yet been defined but precedent suggests it might also be a pore-former. Experience with other clostridial toxins certainly warrants continued research on these C. perfringens enteric toxins to develop their potential as therapeutic agents and tools for cellular biology.

Manual handling risk controls in hospitals (MARCH): a cross-sectional survey of UK hospitals.

Injury and ill health among healthcare staff associated with handling patients is an important area of risk for UK National Health Service (NHS) employers. Since the introduction of a specific legal duty to control this risk in 1992, many Trusts have developed manual handling risk management strategies. Anecdotally, however, practice varies between Trusts and there is no published description of common practice among NHS employers. The latter would be useful as a benchmark for risk managers. Therefore, we undertook a cross-sectional survey of 158 UK trusts (81% of those invited) using a structured interviewer-administered questionnaire to collect information about manual handling risk controls. Most Trusts had basic systems for risk management, including defined management accountability, written policies, provision of handling equipment, training, expert advice about manual handling and access to occupational health services and physiotherapy for injured employees. However, there was wide variation in important aspects, including the extent of expert manpower and criteria for referral to occupational health. Arrangements for monitoring risk controls were generally poor, and the variation in practice was a cause for concern. These data will help NHS employers by providing a benchmark against which to measure and develop risk management systems for manual handling. Future research should aim to develop standards through consensus opinion and ultimately evidence of effectiveness of risk controls.

Risk factors for incident neck and shoulder pain in hospital nurses.

AIM: To assess the incidence and risk factors for neck and shoulder pain in nurses. METHODS: A longitudinal study of neck and shoulder pain was carried out in female nurses at two hospitals in England. Personal and occupational risk factors were assessed at baseline. The self reported incidence of symptoms in the neck and shoulder region was ascertained at three-monthly intervals over two years. A Cox regression model was used to estimate hazard ratios (HRs) for incident neck/shoulder pain during follow up in nurses who had been pain free for at least one month at baseline. RESULTS: The baseline response rate was 56%. Of 903 women who were pain free at baseline, 587 (65%) completed at least one follow up while still in the same job. During an average of 13 months, 34% of these (202 women) reported at least one episode of neck/shoulder pain. The strongest predictor of pain in the neck/shoulder was previous history of the symptom (HRs up to 3.3). For physical exposures at work, the highest risks (HRs up to 1.7) were associated with specific patient handling tasks that involved reaching, pushing, and pulling. Nurses who reported low mood or stress at baseline were more likely to develop neck/shoulder pain later (HR 1.5). Workplace psychosocial factors (including job demands, satisfaction, and control) were not associated with incident neck/shoulder symptoms. CONCLUSIONS: Neck/shoulder pain is common among hospital nurses, and patient handling tasks that involve reaching and pulling are the most important target for risk reduction strategies.

Evaluation of a real-time PCR hybridization assay for rapid detection of Legionella pneumophila in hospital and environmental water samples.

A real-time LightCycler assay for Legionella pneumophila was evaluated with 120 water samples potentially contaminated with PCR inhibitors. Results were obtained within five hours, with a detection limit equivalent to 800 cells/L. However, 11 of 22 culture-positive samples containing < 100 CFU/L were also positive by LightCycler assay, indicating the presence of significant numbers of non-viable cells. Following extraction, amplification inhibitors remained in four culture-positive samples, but only one contained > 800 CFU/L. The assay seemed suitable for rapidly screening large sample numbers for heavy contamination with L. pneumophila, but conventional culture should continue to be used to detect low contamination levels.

Respiratory illness in agricultural workers.

Respiratory diseases have long been recognized in association with work in farming. Overall, only a small proportion of the population is employed in agriculture, so respiratory disease in farmers is not a major public health issue. However, farmers are known to have high morbidity and mortality from certain respiratory diseases, as shown by routinely collected statistics. Despite this, knowledge of the frequency, nature and risk factors for some respiratory disorders in agricultural workers is incomplete. Multiple exposures are common and some exposures can give rise to more than one specific disease. Moreover, the most common respiratory symptoms reported by farm workers (wheeze, dyspnoea and cough) are relatively non-specific and can be associated with several occupational respiratory disorders. This review describes the main occupational respiratory illnesses in farming and summarizes the current literature about epidemiology and prevention. The most important diseases are rhinitis and asthma, which, although common, are not usually fatal. Some non-allergic conditions, e.g. asthma-like syndrome and organic toxic dust syndrome, are not yet fully understood, but appear to be common among farm workers. The most serious respiratory diseases are hypersensitivity pneumonitis and respiratory infections, but these are rare. Most importantly, respiratory diseases are preventable by controlling harmful exposures to organic dust, toxic gases and chemicals on farms through improvements in animal rearing techniques, ventilation of animal accommodation, careful drying and storage of animal feed-stuffs, crops and other products, and use of personal protective equipment.

A survey of the delivery and uptake of influenza vaccine among health care workers.

During the 1990s, policies for immunizing fit health care workers against influenza varied between National Health Service (NHS) employers and the uptake of influenza vaccine by NHS staff was poor. In light of recent Department of Health recommendations to immunize key health care staff against influenza, we explored the possible reasons for poor uptake and assessed the impact of an intensive promotion campaign on vaccine acceptance. Among 290 doctors and nurses, the main perceived barriers to influenza immunization were difficulty with practical access to vaccine and lack of time to attend. Following intensive promotion and improved local access to influenza vaccine, the uptake among health care workers was approximately doubled. However, the overall proportion of staff immunized was low (5%) and the immunization rate among medical staff was particularly poor (2%). The practical implications for influenza immunization campaigns aimed at health care workers are discussed.

Estimating occupational health events in workers with asthma or diabetes: a comparison of diary and snapshot methods.

The study was set up to assess the completeness of reporting different types of work-related health events through 6 month and 1 week diaries and telephone questionnaires relating to individual days. Subjects recruited from hospital asthma or diabetic clinics or from surgical day-case units were randomly assigned to either a full participation arm or to one completing only a 6 month diary. Of the 375 study participants, return rates were 68.8% for 6 month diaries, 81.9% for weekly diaries and 86.5% for researcher-administered questionnaires. Significantly higher rates of self-reported poor work performance, symptoms or changes in medication were estimated by snapshot methods (same-day telephone interviews or one-off weekly diaries) than from diaries completed over a 6 month period. Asthmatics and diabetics attending hospital outpatient clinics were no more likely, however, to report work-related health events in the following 6 months than those attending the same hospital for day surgery.

Health and exposures of United Kingdom Gulf war veterans. Part I: The pattern and extent of ill health.

OBJECTIVES: To assess the health of United Kingdom Gulf war veterans, to compare their health to that of similar personnel not deployed, to describe patterns of ill health in both groups, and to estimate their extent. METHODS: Main Gulf (n=4795) and validation Gulf (n=4793) cohorts were randomly selected within strata from the population deployed to the Gulf and a non-Gulf cohort (n=4790) from those who were not sent. Seven years after the war subjects completed a questionnaire about their health in the past month, including 95 symptom questions and two manikins on which to shade areas of pain or numbness and tingling. Responses were subjected to a principal component analysis with rotation and to a cluster analysis within each cohort. Mean symptom score was used as a measure of severity. Areas shaded on the manikins were coded to indicate widespread pain and possible toxic neuropathy. RESULTS: A response of 85.5% was achieved. Those who had been to the Gulf were more troubled by every symptom with a mean severity score (3.0) substantially greater than in the non-Gulf cohort (1.7). Seven factors were extracted accounting for 48% of the variance. The scores on five factors (labelled psychological, peripheral, respiratory, gastrointestinal, and concentration) were significantly worse in those who had been to the Gulf. Symptoms suggestive of peripheral neuropathy were found more often (12.5%) in the Gulf than the non-Gulf (6.8%) cohorts. Widespread pain was also found more often (12.2% Gulf; 6.5% non-Gulf). Those who had been to the Gulf were found disproportionately (23.8%) in three clusters with high mean severity scores; only 9.8% of non-Gulf respondents were in these clusters. There was no evidence of an important excess in the use of alcohol, tobacco, or referral to hospital specialists by those who had been to the Gulf. For the same level of reported ill health those who had been to the Gulf were less likely to be referred to specialists than non-Gulf veterans. CONCLUSION: 7 Years after the war, the Gulf war veterans were more troubled about their health than those who had not been sent, with a substantial subgroup reporting a pattern of symptoms suggestive of a significant decline in health.

Health and exposures of United Kingdom Gulf war veterans. Part II: The relation of health to exposure.

OBJECTIVES: To investigate whether, in personnel who served with the United Kingdom forces in the Gulf war, self reported exposures were related to symptoms in a way that was consistent, specific, and credible. METHODS: Responses to symptom and exposure questionnaires, completed 7 or more years after the war, were collected from 7971 subjects deployed in the Gulf, from two exposed cohorts, in a study with an overall response rate of 85.5%. Exposures were considered in three groups, those outside the control of the subjects, the use of prophylaxis, and indicators of susceptibility. Health indices derived from symptom questionnaires were related to reports of 14 exposures in these three groups in a series of multiple regression analyses to allow for confounding. The relation of exposure to complaints of widespread pain and to symptoms suggesting peripheral neuropathy were examined by logistic regression. RESULTS: Consistent but weak correlations between exposures and with health effects were found in independent analyses of the two (main and validation) cohorts. Three exposures outside the control of the subject, the number of inoculations, the number of days handling pesticides, and the days exposed to smoke from oil fires, were consistently and independently related to severity. The number of inoculations was also associated with higher scores on a factor weighted on symptoms associated with skin and musculoskeletal complaints. The number of days handling pesticides related particularly to scores on a neurological factor and to symptoms consistent with toxic neuropathy. CONCLUSION: The relations between exposures and ill health were generally weak. Consistent, specific, and credible relations, warranting further investigation, were found between health indices and two exposures, the reported number of inoculations and days handling pesticides.