Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325​505

Social determinants of health and diabetic foot disease

Background Diabetic foot disease (DFD) is the leading cause of hospitalisation and lower extremity amputation (LEA) in people with diabetes. Many studies have established the relationship between DFD and clinical risk factors, such as peripheral neuropathy and peripheral arterial disease. Other studies have identified the relationship between diabetes and non-clinical risk factors termed social determinants of health (SDoH), such as socioeconomic status. However, it appears very few studies have investigated the relationship between DFD and SDoH. This paper aims to review the existing literature investigating the relationship between DFD and the SDoH factors socioeconomic status (SES), race and geographical remoteness (remoteness). Process Electronic databases (MEDLINE, CINAHL, and PubMed) were searched for studies reporting SES, race (including Aboriginal and Torres Strait Islander in Australia) and remoteness and their relationship to DFD and LEA. Exclusion criteria were studies conducted in developing countries and studies published prior to 2000. Findings Forty-eight studies met the inclusion criteria and were reviewed; 10 in Australia. Overall, 28 (58%) studies investigated LEA, 10 (21%) DFD, and 10 (21%) DFD and LEA as the DFD-related outcome. Thirty-six (75%) studies investigated the SDoH risk factor of race, 22 (46%) SES, and 20 (42%) remoteness. SES, race and remoteness were found to be individually associated with LEA and DFD in the majority of studies. Only four studies investigated interactions between SES, race and remoteness and DFD with contrasting findings. All four studies used only LEA as their investigated outcome. No Australian studies investigate the interaction of all three SDoH risk factors on DFD outcomes. Conclusions The SDoH risk factors of SES, race and GR appear to be individually associated with DFD. However, only few studies investigated the interaction of these three major SDoH risk factors and DFD outcomes with contrasting results. There is a clear gap in this area of DFD research and particularly in Australia. Until urgent future research is performed, current practice and policy does not adequately take into consideration the implication of SDoH on DFD.

Directional dominance on stature and cognition in diverse human populations

Homozygosity has long been associated with rare, often devastating, Mendelian disorders1, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness2. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power3, 4. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 × 10−300, 2.1 × 10−6, 2.5 × 10−10 and 1.8 × 10−10, respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months’ less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples5, 6, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection7, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.

Evaluation of polymeric nanomedicines targeted to PSMA: Effect of ligand on targeting efficiency

Targeted nanomedicines offer a strategy for greatly enhancing accumulation of a therapeutic within a specific tissue in animals. In this study, we report on the comparative targeting efficiency toward prostate-specific membrane antigen (PSMA) of a number of different ligands that are covalently attached by the same chemistry to a polymeric nanocarrier. The targeting ligands included a small molecule (glutamate urea), a peptide ligand, and a monoclonal antibody (J591). A hyperbranched polymer (HBP) was utilized as the nanocarrier and contained a fluorophore for tracking/analysis, whereas the pendant functional chain-ends provided a handle for ligand conjugation. Targeting efficiency of each ligand was assessed in vitro using flow cytometry and confocal microscopy to compare degree of binding and internalization of the HBPs by human prostate cancer (PCa) cell lines with different PSMA expression status (PC3-PIP (PSMA+) and PC3-FLU (PSMA−). The peptide ligand was further investigated in vivo, in which BALB/c nude mice bearing subcutaneous PC3-PIP and PC3-FLU PCa tumors were injected intravenously with the HBP-peptide conjugate and assessed by fluorescence imaging. Enhanced accumulation in the tumor tissue of PC3-PIP compared to PC3-FLU highlighted the applicability of this system as a future imaging and therapeutic delivery vehicle.

Caveolin-1 is required for lateral line neuromast and notochord development

Caveolae have been linked to diverse cellular functions and to many disease states. In this study we have used zebrafish to examine the role of caveolin-1 and caveolae during early embryonic development. During development, expression is apparent in a number of tissues including Kupffer's vesicle, tailbud, intersomite boundaries, heart, branchial arches, pronephric ducts and periderm. Particularly strong expression is observed in the sensory organs of the lateral line, the neuromasts and in the notochord where it overlaps with expression of caveolin-3. Morpholino-mediated downregulation of Cav1α caused a dramatic inhibition of neuromast formation. Detailed ultrastructural analysis, including electron tomography of the notochord, revealed that the central regions of the notochord has the highest density of caveolae of any embryonic tissue comparable to the highest density observed in any vertebrate tissue. In addition, Cav1α downregulation caused disruption of the notochord, an effect that was enhanced further by Cav3 knockdown. These results indicate an essential role for caveolin and caveolae in this vital structural and signalling component of the embryo.

Domestic violence on #qanda: The “Man” question in live Twitter discussion on the Australian Broadcasting Corporation's Q&A

Domestic violence is currently undergoing a period of heightened visibility in Australia. This article uses social media to analyze public discussions about this violence with respect to a specific theoretical frame, which Adrian Howe has called the “Man” question: where and how are men visible or invisible in narratives about their violence against women? The article presents a qualitative study of the Twitter conversation surrounding a special episode of the Australian Broadcasting Corporation's television program Q&A, themed around family violence, which aired in February 2015. We found that the place of men in this conversation was contested. Some tweets privileged men's voices and concerns, as did the organization and production of the program. However, feminist voices were also highly visible via presenting facts, legitimating survivor voices, and recuperating anti-feminist memes to challenge hegemonic patriarchal discourses on men's violence against women. La violence conjugale connait actuellement une visibilité accrue en Australie. Les auteures du présent article utilisent les réseaux sociaux pour analyser les débats publics sur cette violence selon un cadre théorique précis, qu'Adrian Howe a appelé la question de « l'homme » : où et comment les hommes sont-ils visibles ou invisibles dans les récits de leur violence envers les femmes? L'article présente une étude qualitative d'une conversation sur Twitter au sujet d'un épisode axé sur la famille diffusé en février 2015 dans le cadre de l'émission Q & A, à la télévision nationale d'Australie. Nous avons remarqué que dans cette conversation la place des hommes était remise en question. Certains tweets privilégiaient les voix et les craintes des hommes, comme l'ont fait les organisateurs et les producteurs de l'émission. Cependant, il y avait une forte présence de voix féministes dans la présentation des faits, légitimant le point de vue des survivantes et relevant des éléments culturels antiféministes afin de défier les discours hégémoniques et patriarcaux sur la violence des hommes envers les femmes.

Does gender moderate the relationship between polydrug use and sexual risk-taking among Australian secondary school students under 16 years of age?

Introduction and Aims This study examines the association of alcohol and polydrug use with risky sexual behaviour in adolescents under 16 years of age and if this association differs by gender. Design and Methods The sample consisted of 5412 secondary school students under 16 years of age from Victoria, Australia. Participants completed an anonymous and confidential survey during class time. The key measures were having had sex before legal age of consent (16 years), unprotected sex before 16 (no condom) and latent-class derived alcohol and polydrug use variables based on alcohol, tobacco, cannabis, inhalants and other illegal drug use in the past month. Results There were 7.52% and 2.55% of adolescents who reported having sex and having unprotected sex before 16 years of age, respectively. After adjusting for antisocial behaviours, peers' drug use and family and school risk factors, girls were less likely to have unprotected sex (odds ratio = 0.31, P = 0.003). However, the interaction of being female and polydrug use (odds ratio = 4.52, P = 0.004) was significant, indicating that girls who engaged in polydrug use were at higher risk of having unprotected sex. For boys, the effect of polydrug use was non-significant (odds ratio = 1.44, P = 0.310). Discussion and Conclusions For girls, polydrug use was significantly associated with unprotected sex after adjusting for a range of risk factors, and this relationship was non-significant for boys. Future prevention programs for adolescent risky sexual behaviour and polydrug use might benefit from a tailored approach to gender differences.

Post-transcriptional Repair of a Split Heat Shock Protein 90 Gene by mRNA trans-Splicing

Heat shock protein 90 participates in diverse biological processes ranging from protein folding, cell cycle, signal transduction and development to evolution in all eukaryotes. It is also critically involved in regulating growth of protozoa such as Dictyostelium discoideum, Leishmania donovani, Plasmodium falciparum, Trypanosoma cruzi, and Trypanosoma evansi. Selective inhibition of Hsp90 has also been explored as an intervention strategy against important human diseases such as cancer, malaria, or trypanosomiasis. Giardia lamblia, a simple protozoan parasite of humans and animals, is an important cause of diarrheal disease with significant morbidity and some mortality in tropical countries. Here we show that the G. lamblia cytosolic hsp90 ( glhsp90) is split in two similar sized fragments located 777 kb apart on the same scaffold. Intrigued by this unique arrangement, which appears to be specific for the Giardiinae, we have investigated the biosynthesis of GlHsp90. We used genome sequencing to confirm the split nature of the giardial hsp90. However, a specific antibody raised against the peptide detected a product with a mass of about 80 kDa, suggesting a post-transcriptional rescue of the genomic defect. We show evidence for the joining of the two independent Hsp90 transcripts in-trans to one long mature mRNA presumably by RNA splicing. The splicing junction carries hallmarks of classical cis-spliced introns, suggesting that the regular cis-splicing machinery may be sufficient for repair of the open reading frame. A complementary 26-nt sequence in the ``intron'' regions adjacent to the splice sites may assist in positioning the two pre-mRNAs for processing. This is the first example of post-transcriptional rescue of a split gene by trans-splicing.

A model for heat transfer in a honey bee swarm

A swarm is a temporary structure formed when several thousand honey bees leave their hive and settle on some object such as the branch of a tree. They remain in this position until a suitable site for a new home is located by the scout bees. A continuum model based on heat conduction and heat generation is used to predict temperature profiles in swarms. Since internal convection is neglected, the model is applicable only at low values of the ambient temperature T-a. Guided by the experimental observations of Heinrich (1981a-c, J. Exp. Biol. 91, 25-55; Science 212, 565-566; Sci. Am. 244, 147-160), the analysis is carried out mainly for non-spherical swarms. The effective thermal conductivity is estimated using the data of Heinrich (1981a, J. Exp. Biol. 91, 25-55) for dead bees. For T-a = 5 and 9 degrees C, results based on a modified version of the heat generation function due to Southwick (1991, The Behaviour and Physiology of Bees, PP 28-47. C.A.B. International, London) are in reasonable agreement with measurements. Results obtained with the heat generation function of Myerscough (1993, J. Theor. Biol. 162, 381-393) are qualitatively similar to those obtained with Southwick's function, but the error is more in the former case. The results suggest that the bees near the periphery generate more heat than those near the core, in accord with the conjecture of Heinrich (1981c, Sci. Am. 244, 147-160). On the other hand, for T-a = 5 degrees C, the heat generation function of Omholt and Lonvik (1986, J. Theor. Biol. 120, 447-456) leads to a trivial steady state where the entire swarm is at the ambient temperature. Therefore an acceptable heat generation function must result in a steady state which is both non-trivial and stable with respect to small perturbations. Omholt and Lonvik's function satisfies the first requirement, but not the second. For T-a = 15 degrees C, there is a considerable difference between predicted and measured values, probably due to the neglect of internal convection in the model.

Process control of cantilever deflection for sensor application based on optical waveguides

This paper reports on the fabrication of cantilever silicon-on-insulator (SOI) optical waveguides and presents solutions to the challenges of using a very thin 260-nm active silicon layer in the SOI structure to enable single-transverse-mode operation of the waveguide with minimal optical transmission losses. In particular, to ameliorate the anchor effect caused by the mean stress difference between the active silicon layer and buried oxide layer, a cantilever flattening process based on Ar plasma treatment is developed and presented. Vertical deflections of 0.5 mu m for 70-mu m-long cantilevers are mitigated to within few nanometers. Experimental investigations of cantilever mechanical resonance characteristics confirm the absence of significant detrimental side effects. Optical and mechanical modeling is extensively used to supplement experimental observations. This approach can satisfy the requirements for on-chip simultaneous readout of many integrated cantilever sensors in which the displacement or resonant frequency changes induced by analyte absorption are measured using an optical-waveguide-based division multiplexed system.

Utilizacion del zumo de jicaro (Crescentia cujete) en el tratamiento de la dermatomicosis en terneros de la raza Reina en la Finca Santa Rosa de la UNA

El presente estudio se realizó con el objetivo de Determinar la efectividad fungicida del zumo de jícaro (Crescentia cujete) en el tratamiento de la Dermatomicosis en terneros de la raza Reina de la Finca Santa Rosa de la UNA. En el trabajo experimental se utilizó un diseño completamente al azar (D.C.A) el que estuvo compuesto por un lote de 15 terneros divididos en 3 grupos, cada grupo formado por 5 animales eleccionados al azar y sometidos a tratamientos distintos, aplicando una sola dosis cada 24 horas durante tres días. Tratamiento I: Tintura de yodo al 5%. Tratamiento II: Zumo de jícaro al 50%. Tratamiento III: Zumo jícaro al 100%. Obteniéndose los siguientes resultados, el microorganismos causantes de la Dermatomicosis en terneros de la raza Reina en la Finca Santa Rosa de la UNA es el Trichophyton verrucosum. Los tratamientos II y III tuvieron las mejores respuestas en el control, de la Dermatomicosis , con un porcentaje de efectividad del 82%, y 78% respectivamente y con un 40.% para el tratamiento I, se encontró diferencia significativa p< 0.05 entre los tratamientos, siendo el Zumo de jícaro al 50% tienden a curarse mejor los animales que con los otros tratamiento, seguido del Zumo jícaro al 100%).Según el análisis del costo de la dosis se puede decir que el zumo de jícaro es un funguicida económico para los productores.