Understanding routine (non-outbreak) respiratory protective equipment behaviour of hospital workers in different clinical settings - lessons for the future post-COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has drawn attention to the importance of facial (respiratory and eye) protective equipment (FPE). Optimal use of FPE in non-outbreak situations will enable front-line staff, such as emergency department (ED) clinicians, to adapt more rapidly and safely to the increased demands and skills required during an infectious disease outbreak. METHODS: A survey, designed to determine the attitudes, beliefs and knowledge of healthcare workers around the use of FPE for protection against respiratory infections, was distributed to staff in a respiratory ward, an adult ED and a paediatric ED in Sydney, Australia prior to COVID-19. RESULTS: The survey revealed differences between the respiratory ward and the EDs, and between professional groups. ED staff, particularly paediatric clinicians, were less likely than ward staff to use FPE appropriately during routine care. Medical staff were more likely to work outside of infection prevention and control policies. DISCUSSION: The busy, relatively chaotic ED environment presents unique challenges for optimal compliance with safe use of FPE when caring for patients with respiratory symptoms. CONCLUSIONS: Building upon the lessons of the pandemic, it is timely to address the specific infection prevention and control needs of the ED environment to improve compliance with the use of FPE during non-outbreak situations.

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.

Chaperone use amongst UK urological surgeons - an evaluation of current practice and opinion.

Introduction Intimate examinations are routinely performed by urologists as part of clinical practice. To protect patients and doctors, the General Medical Council offers guidance on the use of chaperones for intimate examinations. We assessed the opinions and use of chaperones amongst members of the British Association of Urological Surgeons (BAUS). Methods An online questionnaire comprising 12 questions on the use of chaperones in clinical practice was sent to all full, trainee and speciality doctor members of BAUS. Results The questionnaire had a response rate of 26% (n=331). The majority of respondents were consultant urologists, comprising 78.8% (n=261), with a wide range of years of experience. Of the respondents, 38.9% were not aware of the GMC guidance on chaperones. While 72.5% always used a chaperone., 22.9% never use a chaperone when the patient was of the same sex. Chaperones were most commonly used for intimate examinations (64.6%), and for examinations involving members of the opposite sex (77.3%). A majority of respondents felt that chaperones protect both the patient (77.3%), and the doctor (96.6%). However, 42.5% did not feel that using a chaperone assists the doctor's examination, and some (17.2%) participants felt that chaperones were unnecessary. Conclusions This study shows considerable variability amongst urologists in their use of chaperones. A significant proportion of respondents were not aware of the GMC guidelines and did not regularly use a chaperone during an intimate examination. In addition, practice appears to be gender biased. Further study and education is suggested.

Catalyzing the Critical Path Initiative: FDA's progress in drug development activities.

The US Food and Drug Administration (FDA) has directed considerable effort towards modernizing its regulatory processes over the past decade to address the challenges in the drug development sector. Through partnerships and input from stakeholders, multiple initiatives are under way, many projects have been launched, several have resulted in tangible results, and many are ongoing and under discussion. We are learning that collaborative efforts can better inform and leverage existing knowledge, that the challenges of data sharing and intellectual property can be overcome, and that there is wide interest in partnering to address key public health regulatory science issues. It is crucial that we continue to build on these initial efforts to facilitate drug development.

Application of metabolomics to understanding biofilms in water distribution systems: a pilot study.

Biofilms formed in pipes are known to contribute to waterborne diseases, accelerate corrosion and cause aesthetic taste and odour issues within the potable water supply network. This paper describes a pilot study, undertaken to assess the potential of using metabolomics to monitor bacterial activity in biofilms of an urban water network. Using samples from a water mains flushing programme, it was found that a profile of intracellular and extracellular metabolites associated with microbial activity could be obtained by analysing samples using gas chromatography mass spectrometry. Chemometric analysis of the chromatograms in conjunction with data from the mass spectrometer showed that it is possible to differentiate between biofilms from different pipe materials and planktonic bacteria. This research demonstrates that metabolomics has the potential for investigating biofilms and other microbial activity within water networks, and could provide a means for enhancing monitoring programmes, understanding the source of water quality complaints, and optimising water network management strategies.

The critical path initiative: leveraging collaborations to enhance regulatory science.

Since 2004, the Critical Path Initiative has prompted industry, academia, and government agencies to work together to share the information, technology, and expertise critical to modernize and transform our approach to drug development and review. Various collaborations have been sharing data in a precompetitive space, establishing data standards, and facilitating collective tool development. As a result, the organization is making progress toward developing knowledge and tools that can reduce uncertainty in medical product development.

Use of sibutramine to assist obese women with weight loss can be successful in dietitian-led clinics: another tool in the dietitian's toolbox.

BACKGROUND: This study investigated differences in weight loss outcomes in obese women with Type 2 diabetes (T2D) compared to those without T2D attending a 6-month dietetic led 'Lifestyle' intervention. In those who had failed to reach weight loss goals using the 'Lifestyle' approach, the study further examined the effect on weight loss with the addition of sibutramine (Reductil, Abbott Laboratories, USA) over a 6-month period. METHODS: The study comprised a case-control analysis of data from 38 obese female patients (18 with T2D) from the 'Lifestyle' and 'Pharmacotherapy' clinics attending a tertiary hospital in the UK. RESULTS: In the 'Lifestyle' treatment groups, those with T2D lost significantly less body weight than those without T2D [5.26 kg (4.54%) versus 9.89 kg (9.55%), respectively]. For subjects who had failed to lose weight via the 'Lifestyle' intervention, the addition of sibutramine resulted in a similar weight loss compared to their pair-matched 'Lifestyle' only 'successful' counterparts (9.66% versus 9.55%). CONCLUSIONS: Not all obese women, and those with T2D in particular, will derive benefit from 'Lifestyle' advice and those who are resistant to this treatment approach may be assisted by pharmacotherapy. Dietitians can play a role in identifying those individuals who may benefit from the use of pharmacotherapy.

The analysis of flue gas treatment residues using non-destructive X-ray fluorescence as a regulatory compliance test.

Current and proposed European Union (EU) regulations require the residual material from municipal solid waste incineration to be characterised prior to disposal. X-Ray fluorescence (XRF) provides a rapid and non-destructive technique for analysing such materials.

Distributions of lead and cadmium in dust in the vicinity of a sewage sludge incinerator.

The content of lead and cadmium in surface dust within a 4 km radius of a sewage sludge incinerator has been investigated. Particular attention was given to Pb and Cd in different size fractions of dust, an aspect not explored in previous studies, and the differences between expressions of contamination as concentration or loading were examined. Despite suggestions from reports that sludge incinerators may have difficulty in complying with emission standards, the present investigation found little evidence for a major contribution to local pollution by the incinerator. Certainly, the highest Cd level was found some 2.2 km downwind of the prevailing wind direction from the incinerator, suggesting some resultant contamination, although the levels do not appear to be excessive. Similar observations apply to Pb contamination of the area. While data of the type produced in this study contribute to an understanding of environmental quality, both loadings and levels need to be considered, as the implications of only consideration one of these may be limited and even misleading.

The G2 block induced by DNA damage: a caffeine-resistant component independent of Cdc25C, MPM-2 phosphorylation, and H1 kinase activity.

Treatment of cells with agents that cause DNA damage often results in a delay in G2. There is convincing evidence showing that inhibition of p34cdc2 kinase activation is involved in the DNA damage-induced G2 delay. In this study, we have demonstrated the existence of an additional pathway, independent of the p34cdc2 kinase activation pathway, that leads to a G2 arrest in etoposide-treated cells. Both the X-ray-induced and the etoposide-induced G2 arrest were associated with inhibition of the p34cdc2 H1 kinase activation pathway as judged by p34cdc2 H1 kinase activity and phosphorylation of cdc25C. Caffeine treatment restored these activities after either of the treatments. However, the etoposide-treated cells did not resume cycling, revealing the presence of an alternative pathway leading to a G2 arrest. To explore the possibility that this additional pathway involved phosphorylation of the MPM-2 epitope that is shared by a large family of mitotic phosphoproteins, we monitored the phosphorylation status of the MPM-2 epitope after DNA damage and after treatment with caffeine. Phosphorylation of the MPM-2 epitope was depressed in both X-ray and etoposide-treated cells, and the depression was reversed by caffeine in both cases. The results indicate that the pathway affecting MPM-2 epitope phosphorylation is involved in the G2 delay caused by DNA damage. However, it is not part of the caffeine-insensitive pathway leading to a G2 block seen in etoposide-treated cells.

Passive immunization of the vagina protects mice against vaginal transmission of genital herpes infections.

Vaginal application of human herpes simplex virus (HSV) antiserum, complement-inactivated antiserum, or IgG purified from antiserum protected mice (P < .001, P < .001, and P < .01, respectively) from visible signs of genital HSV-2 infection after subsequent vaginal inoculation with HSV-2 (10 ID50). Vaginal application of an anti-HSV-2 monoclonal antibody (MAb III-174) also protected mice against infection. This MAb, a neutralizing mouse IgG2A against glycoprotein D, prevented infection as determined by viral shedding from the vagina (P < .05), blocked 50% of visible signs of genital herpes infection at a vaginal dose of approximately 10 ng, and blocked 100% of visible signs of infection at a vaginal dose of 1 microgram (P < .001). These results suggest that vaginal applications of anti-HSV antibodies may help prevent sexual transmission of genital herpes infection.

Nonoxynol-9 protects mice against vaginal transmission of genital herpes infections.

A vaginal application of a commercially available contraceptive jelly containing nonoxynol-9 (N9) prevented vaginal transmission of herpes simplex virus type 2 (HSV-2) infections in the mouse. When N9 jelly was delivered to the vagina with the virus inoculum, 20 s before inoculum, or 5 min before inoculum, mice were completely protected from visible infection (P < .001). Protection lasted for at least 30 min (P < .03), and significant protection occurred even when the N9 jelly was delivered 15 min after the HSV-2 inoculum (P < .05). These results are consistent with results of studies using N9 products in other animal models and suggest that N9-based contraceptive products can provide significant protection against vaginal transmission of enveloped virus infections in animals.

Characteristics of air pollution in Birmingham, England. II. On the significance of sampling height.

Air quality data for "standard smoke" and for sulphur dioxide in central Birmingham are examined for the influence of sampling height. Data from two sites at the same location but separated vertically by about 30 m indicate that the effect of sampling height can change over a period of several years. For standard smoke the effect of height appears to be diminishing, whereas for sulphur dioxide the effect of sampling height appears to be increasing.

Characteristics of air pollution in Birmingham, England. I. Trends and triumphs.

Air quality data for "standard smoke" and for sulphur dioxide are presented for the period 1962-1982 to demonstrate the long-term trends in the centre of Birmingham. Little data have previously been published on this major urban area in the United Kingdom. Deviations from the long-term trends are related to meteorological conditions and the air quality is compared with standards. The improvements in air quality are considerable and are demonstrated in various ways. Changes in the urban environment had their impact on air quality in the city, but, as found elsewhere, once reductions in pollution have been achieved it is meteorological factors which influence concentrations from year to year. No effect of the nearby urban motorway on smoke stain measurements at the monitoring site was observed.

Kinetics of thiopentone in relation to the site of sampling.

Plasma concentrations of thiopentone were determined at frequent intervals over the first 12 min following injection i.v. in eight patients. Samples of arterial and peripheral venous blood were obtained in all subjects. In six, central venous and in two, internal jugular samples were obtained also. Thiopentone concentrations in arterial and central venous plasma did not differ significantly after 2 min. Differences between arterial and peripheral samples were significant for 2 min although, in some patients, considerable variability persisted for up to 9 min. In both patients from whom jugular venous samples were obtained, the difference between these and the peripheral plasma concentrations was marked. This difference may account for the appearance of acute tolerance. A computer model for this hypothesis is presented.