Handrub Consumption Mirrors Hand Hygiene Compliance

We assessed handrub consumption as a surrogate marker for hand hygiene compliance from 2007 to 2014. Handrub consumption varied substantially between departments but correlated in a mixed effects regression model with the number of patient-days and the observed hand hygiene compliance. Handrub consumption may supplement traditional hand hygiene observations. Infect. Control Hosp. Epidemiol. 2016;1-4.

Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.

OBJECTIVE To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B'). DESIGN Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. METHODS Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B. RESULTS During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. CONCLUSION Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.

Non-sexual household transmission of HCV infection: A cohort study

Objective. This study was designed to determine the prevalence and incidence of HCV infection among non-sexual household contacts of HCV-infected women and to describe the association between HCV infection and potential household risk factors in order to examine whether non-sexual household contact is a route of transmission for HCV infection. ^ Methods. A baseline prevalence survey included 409 non-sexual household contacts of 241 HCV-infected index women in the Houston area from 1994 to 1997. A total of 470 non-sexual household contacts with no evidence of HCV infection at baseline investigation were re-assessed approximately three years after baseline enrollment. Information on potential risk factors was collected through face to face interviews and blood samples were tested for anti-HCV with ELISA-2 and Matrix/RIBA-2. The relationships between HCV infection and potential risk factors were examined by using univariate and multivariate logistic regression analyses. ^ Results. The overall prevalence of anti-HCV positivity among 409 non-sexual household contacts was 4.4%. The highest prevalence of anti-HCV was found in parents (19.5%), followed by siblings (8.1%) and other relatives (5.6%); the children had the lowest prevalence of anti-HCV (1.2%). The univariate analysis showed that IDU, blood transfusion, tattoos, sexual contact with injecting drug users, more than 3 sexual partners in a lifetime, history of a STD, incarceration, previous hepatitis, and contact with hepatitis patients were significantly associated with HCV infection, however, sharing razors, nail clippers, toothbrushes, gum, food or beds with HCV-infected women, and history of dialysis, health care job, body piercing, and homosexual activities were not. Multivariate analysis found that IDU (OR = 221.7 with 95% CI of 22.8 to 2155.7) and history of a STD (OR = 11.7 with 95% CI of 1.2 to 113.1) were the only variables significantly associated with HCV infection. No such associations remained for other risk factors. The three-year cumulative incidence of anti-HCV among 352 non-sexual household contacts of HCV-infected women was zero. ^ Conclusion. This study has provided no evidence that non-sexual household contact is a likely route of transmission for HCV infection. The risk of sharing razors, nail clippers, toothbrushes, gum, food and/or beds with HCV-infected women is not evident and has not been shown to be the likely mode for HCV spread among family members. This study does suggest that IDU is the likely route of transmission for most HCV infection. Association also has been shown independently with a history of STD. The prevalence of anti-HCV among non-sexual household contacts was low. Exposure to common parenteral risk factors and sexual transmission between sexual partners may account for HCV spread among household members of HCV-infected persons. ^

Retrospective study of prevalence of Community Associated Methicillin Resistant Staphylococcus Aureus (CA-MRSA) seen in Texas MedClinics, San Antonio, TX from April 2006-August 2009

Purpose. To evaluate the presence of Community Associated–Methicillin Resistant Staphylococcus Aureus, CA-MRSA, in abscesses and skin and soft tissue infections presenting at 9 urgent care clinics in San Antonio, TX. ^ Methods. During the 40-month retrospective study (April 2006 to August 2009), wound cultures collected in 9 urgent care centers were evaluated for MRSA growth, antibiotics prescribed, follow up wound care, and antibiotic prescribing habits by physicians for all patients presenting with abscesses and skin/soft tissue infections. ^ Results. Across 9 urgent care centers in San Antonio, TX, 36,797 abscesses and cases of skin and soft tissue infections were treated during 40 months. Of the 36,797 cases, 9290 patients had wound cultures sent with 5,630 cultures sent to Texas MedClinic’s primary lab. Of the 5630 cultures sent to their primary lab, this reflected a prevalence of 4727 (84 %) cultures were positive for MRSA. Of the 9290 patients who had a wound culture sent (April 10th, 2006 to August 31st, 2009), a total of 4,307 antibiotics were prescribed. The top five antibiotics prescribed for CA-MRSA were Bactrim (55.5%), Clindamycin (18.4%), Bactroban (5%), Amoxicillin (3.5%), and Doxycycline (3%) representing 85.4% of the antibiotics prescribed. 8809/9290 (94.8%) of patients required no more than 3 follow up visits. Of the 33 physicians working full time during the entire study period, 29/33 (87.8%) of the physicians were family medicine physicians and represented varied prescribing rates of antibiotics between 11-76% with 26/33 (78.8%) of physicians prescribing antibiotics greater than 40% of the time.^ Conclusions. Abscesses and soft tissue infections are a common presenting complaint to urgent care centers. This study reveals that antibiotic-prescribing practices can be improved with physician education since this high prevalence was not known previously. Also, treating abscesses with limited packing has been shown to be a viable option in this particular circumstance and would be open field for additional clinical research. Due to the high prevalence of CA-MRSA skin and soft tissue infections among patients presenting to urgent care centers presumptive treatment for MRSA is indicated. Increasing levels of resistance to penicillin antibiotics is concerning and warrants alternative antibiotic management strategies.^

Statistical and methodological challenges for disaster preparedness and medical needs assessment in Rio Grande Valley of Texas

In recent years, disaster preparedness through assessment of medical and special needs persons (MSNP) has taken a center place in public eye in effect of frequent natural disasters such as hurricanes, storm surge or tsunami due to climate change and increased human activity on our planet. Statistical methods complex survey design and analysis have equally gained significance as a consequence. However, there exist many challenges still, to infer such assessments over the target population for policy level advocacy and implementation. ^ Objective. This study discusses the use of some of the statistical methods for disaster preparedness and medical needs assessment to facilitate local and state governments for its policy level decision making and logistic support to avoid any loss of life and property in future calamities. ^ Methods. In order to obtain precise and unbiased estimates for Medical Special Needs Persons (MSNP) and disaster preparedness for evacuation in Rio Grande Valley (RGV) of Texas, a stratified and cluster-randomized multi-stage sampling design was implemented. US School of Public Health, Brownsville surveyed 3088 households in three counties namely Cameron, Hidalgo, and Willacy. Multiple statistical methods were implemented and estimates were obtained taking into count probability of selection and clustering effects. Statistical methods for data analysis discussed were Multivariate Linear Regression (MLR), Survey Linear Regression (Svy-Reg), Generalized Estimation Equation (GEE) and Multilevel Mixed Models (MLM) all with and without sampling weights. ^ Results. Estimated population for RGV was 1,146,796. There were 51.5% female, 90% Hispanic, 73% married, 56% unemployed and 37% with their personal transport. 40% people attained education up to elementary school, another 42% reaching high school and only 18% went to college. Median household income is less than $15,000/year. MSNP estimated to be 44,196 (3.98%) [95% CI: 39,029; 51,123]. All statistical models are in concordance with MSNP estimates ranging from 44,000 to 48,000. MSNP estimates for statistical methods are: MLR (47,707; 95% CI: 42,462; 52,999), MLR with weights (45,882; 95% CI: 39,792; 51,972), Bootstrap Regression (47,730; 95% CI: 41,629; 53,785), GEE (47,649; 95% CI: 41,629; 53,670), GEE with weights (45,076; 95% CI: 39,029; 51,123), Svy-Reg (44,196; 95% CI: 40,004; 48,390) and MLM (46,513; 95% CI: 39,869; 53,157). ^ Conclusion. RGV is a flood zone, most susceptible to hurricanes and other natural disasters. People in the region are mostly Hispanic, under-educated with least income levels in the U.S. In case of any disaster people in large are incapacitated with only 37% have their personal transport to take care of MSNP. Local and state government’s intervention in terms of planning, preparation and support for evacuation is necessary in any such disaster to avoid loss of precious human life. ^ Key words: Complex Surveys, statistical methods, multilevel models, cluster randomized, sampling weights, raking, survey regression, generalized estimation equations (GEE), random effects, Intracluster correlation coefficient (ICC).^

El deporte en la Comunidad Japonesa de Colonia Urquiza : Béisbol

Este trabajo es parte de un seguimiento de la cultura y la actividad de la comunidad japonesa de Colonia Urquiza. Se han explorado temas relacionados con lo económico, cultural y social , y de estos últimos, haremos mención, de cómo el deporte tiene una importancia muy especial desde varios aspectos: como actividad física, sociabilidad, disciplina, solidaridad, trabajo en equipo, cooperación, etc. En la Argentina, el deporte más popular es el fútbol, practicado por todas las generaciones, en forma profesional o amateur, siendo común hacerlo como pasatiempo de una reunión o encuentro entre amigos. ;En Colonia Urquiza, los alumnos de la escuela japonesa, practican diversas actividades físicas como parte de la currícula y esparcimiento, lo que los lleva en algunos casos, a ver el deporte en forma profesional, como ocurre con el ping pong y el béisbol. El fútbol y el vóley, convocan a los adolescentes, mientras que el golf, park golf y pesca deportiva a los adultos. ;Focalizaremos nuestra atención en el béisbol (baseball), deporte que en esta comunidad, instalada en un mundo rural, a 20 km de la capital de la provincia de Bs. As., comenzó a tener impulso en la década del ´90, logrando conformar delegaciones nikkei de infantiles en Argentina, para medirse con sus pares en Japón. Cabe mencionar que en Argentina este deporte fue encausándose, logrando conformar la Liga Metropolitana de la Provincia de Buenos Aires, donde hay equipos formados solo por descendientes de japoneses y otros equipos mixtos, y se confrontan en torneos infantiles, prejunior, junior y adultos, con las ligas de las provincias a nivel nacional e internacional. Por lo tanto, pretendemos estudiar la relación de la comunidad con el ambiente y el deporte, los que consideramos vitales en el imaginario de la sociedad nipona

Part of the global DOC versus AOU (dissolved organic carbon/apparent oxygen utilization) data compilation, BATS

The contributions of total organic carbon and nitrogen to elemental cycling in the surface layer of the Sargasso Sea are evaluated using a 5-yr time-series data set (1994-1998). Surface-layer total organic carbon (TOC) and total organic nitrogen (TON) concentrations ranged from 60 to 70 µM C and 4 to 5.5 µM N seasonally, resulting in a mean C : N molar ratio of 14.4±2.2. The highest surface concentrations varied little during individual summer periods, indicating that net TOC production ceased during the highly oligotrophic summer season. Winter overturn and mixing of the water column were both the cause of concentration reductions and the trigger for net TOC production each year following nutrient entrainment and subsequent new production. The net production of TOC varied with the maximum in the winter mixed-layer depth (MLD), with greater mixing supporting the greatest net production of TOC. In winter 1995, the TOC stock increased by 1.4 mol C/m**2 in response to maximum mixing depths of 260 m. In subsequent years experiencing shallower maxima in MLD (<220 m), TOC stocks increased <0.7 mol C/m**2. Overturn of the water column served to export TOC to depth (>100 m), with the amount exported dependent on the depth of mixing (total export ranged from 0.4 to 1.4 mol C/m**2/yr). The exported TOC was comprised both of material resident in the surface layer during late summer (resident TOC) and material newly produced during the spring bloom period (fresh TOC). Export of resident TOC ranged from 0.5 to 0.8 mol C/m**2/yr, covarying with the maximum winter MLD. Export of fresh TOC varied from nil to 0.8 mol C/m**2/yr. Fresh TOC was exported only after a threshold maximum winter MLD of ~200 m was reached. In years with shallower mixing, fresh TOC export and net TOC production in the surface layer were greatly reduced. The decay rates of the exported TOC also covaried with maximum MLD. The year with deepest mixing resulted in the highest export and the highest decay rate (0.003 1/d) while shallow and low export resulted in low decay rates (0.0002 1/d), likely a consequence of the quality of material exported. The exported TOC supported oxygen utilization at dC : dO2 molar ratios ranging from 0.17 when TOC export was low to 0.47 when it was high. We estimate that exported TOC drove 15-41% of the annual oxygen utilization rates in the 100-400 m depth range. Finally, there was a lack of variability in the surface-layer TON signal during summer. The lack of a summer signal for net TON production suggests a small role for N2 fixation at the site. We hypothesize that if N2 fixation is responsible for elevated N : P ratios in the main thermocline of the Sargasso Sea, then the process must take place south of Bermuda and the signal transported north with the Gulf Stream system.

Mineralogy and stable oxygen isotope ratios of the Cretaceous-Tertiary boundary

Results of detailed mineralogical, chemical, and oxygen isotope analyses of the clay minerals and zeolites from two Cretaceous-Tertiary (K/T) boundary regions, Stevns Klint, Denmark, and Deep Sea Drilling Project (DSDP) Hole 465A in the north central Pacific Ocean, are presented. In the central part of the Stevns Klint K/T boundary layer, the only clay mineral detected by x-ray diffraction is a pure smectite with > 95 percent expandable layers. No detrital clay minerals or quartz were observed in the clay size fraction in these beds, whereas the clay minerals above and below the boundary layer are illite and mixed-layer smectite-illite of detrital origin as well as quartz. The mineralogical purity of the clay fraction, the presence of smectite only at the boundary, and the d18O value of the smectite (27.2 ± 0.2 per mil) suggest that it formed in situ by alteration of glass. Formation from impact rather than from volcanic glass is supported by its major element chemistry. The high content of iridium and other siderophile elements is not due to the cessation of calcium carbonate deposition and resulting slow sedimentation rates. At DSDP Hole 465A, the principal clay mineral in the boundary zone (80 to 143 centimeters) is a mixed-layer smectite-illite with >=90 percent expandable layers, accompanied by some detrital quartz and small amounts of a euhedral authigenic zeolite (clinoptilolite). The mixed-layer smectite-illite from the interval 118 to 120 centimeters in the zone of high iridium abundance has a very low rare earth element content; the negative cerium anomaly indicates formation in the marine environment. This conclusion is corroborated by the d18O value of this clay mineral (27.1 ± 0.2 per mil). Thus, this mixed-layer smectite-illite formed possibly from the same glass as the K/T boundary smectite at Stevns Klint, Denmark.

Physiography of the Ampère Seamount in the Horseshoe Seamount chain off Gibraltar

The Ampère Seamount, 600 km west of Gibraltar, is one of nine inactive volcanoes along a bent chain, the so called Horseshoe Seamounts. All of them ascend from an abyssal plain of 4000 to 4800 m depth up to a few hundred meters below the sea surface, except two, which nearly reach the surface: the Ampère massif on the southern flank of the group and the summit of the Gorringe bank in the north. The horseshoe, serrated like a crown, opens towards Gibraltar and stands in the way of its outflow. These seamounts are part of the Azores-Gibraltar structure, which marks the boundary between two major tectonic plates: the Eurasian and the African plate. The submarine volcanism which formed the Horseshoe Seamounts belongs to the sea floor spread area of the Mid-Atlantic Ridge. The maximum activity was between 17 and 10 Million years ago and terminated thereafter. The volcanoes consist of basalts and tuffs. Most of their flanks and the abyssal plain around are covered by sediments of micro-organic origin. These sediments, in particular their partial absence on the upper flanks are a circumstantial proof and a kind of diary of the initial rise and subsequent subsidence of about 6oo m of these seamounts. The horizons of erosion where the basalt substrate is laid bare indicate the rise above sea level in the past. Since the Ampère summit is 60 m deep today, this volcano must have been an island 500 m high. The stratification of the sediments covering the surrounding abyssal plain reveals discrete events of downslope suspension flows, called turbidites, separated by tens of thousands of years and perhaps induced by changes in climate conditions. The Ampère sea mount of 4800 m height and a base diameter of 50 km exceeds the size of the Mont Blanc massif. Its southern and eastern flanks are steep with basalts cropping out, in parts with nearly vertical walls of some hundred meters. The west and north sides consist of terraces and plateaus covered with sediments at 140 m, 400 m, 2000 m, and 3500 m. The Horseshoe Seamount area is also remarkable as a kind of disturbed crossing of three major oceanic flow systems at different depths and directions with forced upwelling and partial mixing of the water masses. Most prominent is the Mediterranean Outflow Water (MOW) with its higher temperature and salinity between 900 to 1500 m depth. It enters the horseshoe unimpaired from the open eastern side but penetrates the seamount chain through its valleys on the west, thereafter diverging and crossing the entire Atlantic Ocean. Below the MOW is the North Atlantic Deep Water (NADW) between 2000 m to 3000 m depth flowing southward and finally there is the Antarctic Bottom Water (AABW) flowing northward below the two other systems.

El deporte en la Comunidad Japonesa de Colonia Urquiza : Béisbol

Este trabajo es parte de un seguimiento de la cultura y la actividad de la comunidad japonesa de Colonia Urquiza. Se han explorado temas relacionados con lo económico, cultural y social , y de estos últimos, haremos mención, de cómo el deporte tiene una importancia muy especial desde varios aspectos: como actividad física, sociabilidad, disciplina, solidaridad, trabajo en equipo, cooperación, etc. En la Argentina, el deporte más popular es el fútbol, practicado por todas las generaciones, en forma profesional o amateur, siendo común hacerlo como pasatiempo de una reunión o encuentro entre amigos. ;En Colonia Urquiza, los alumnos de la escuela japonesa, practican diversas actividades físicas como parte de la currícula y esparcimiento, lo que los lleva en algunos casos, a ver el deporte en forma profesional, como ocurre con el ping pong y el béisbol. El fútbol y el vóley, convocan a los adolescentes, mientras que el golf, park golf y pesca deportiva a los adultos. ;Focalizaremos nuestra atención en el béisbol (baseball), deporte que en esta comunidad, instalada en un mundo rural, a 20 km de la capital de la provincia de Bs. As., comenzó a tener impulso en la década del ´90, logrando conformar delegaciones nikkei de infantiles en Argentina, para medirse con sus pares en Japón. Cabe mencionar que en Argentina este deporte fue encausándose, logrando conformar la Liga Metropolitana de la Provincia de Buenos Aires, donde hay equipos formados solo por descendientes de japoneses y otros equipos mixtos, y se confrontan en torneos infantiles, prejunior, junior y adultos, con las ligas de las provincias a nivel nacional e internacional. Por lo tanto, pretendemos estudiar la relación de la comunidad con el ambiente y el deporte, los que consideramos vitales en el imaginario de la sociedad nipona

El deporte en la Comunidad Japonesa de Colonia Urquiza : Béisbol

Este trabajo es parte de un seguimiento de la cultura y la actividad de la comunidad japonesa de Colonia Urquiza. Se han explorado temas relacionados con lo económico, cultural y social , y de estos últimos, haremos mención, de cómo el deporte tiene una importancia muy especial desde varios aspectos: como actividad física, sociabilidad, disciplina, solidaridad, trabajo en equipo, cooperación, etc. En la Argentina, el deporte más popular es el fútbol, practicado por todas las generaciones, en forma profesional o amateur, siendo común hacerlo como pasatiempo de una reunión o encuentro entre amigos. ;En Colonia Urquiza, los alumnos de la escuela japonesa, practican diversas actividades físicas como parte de la currícula y esparcimiento, lo que los lleva en algunos casos, a ver el deporte en forma profesional, como ocurre con el ping pong y el béisbol. El fútbol y el vóley, convocan a los adolescentes, mientras que el golf, park golf y pesca deportiva a los adultos. ;Focalizaremos nuestra atención en el béisbol (baseball), deporte que en esta comunidad, instalada en un mundo rural, a 20 km de la capital de la provincia de Bs. As., comenzó a tener impulso en la década del ´90, logrando conformar delegaciones nikkei de infantiles en Argentina, para medirse con sus pares en Japón. Cabe mencionar que en Argentina este deporte fue encausándose, logrando conformar la Liga Metropolitana de la Provincia de Buenos Aires, donde hay equipos formados solo por descendientes de japoneses y otros equipos mixtos, y se confrontan en torneos infantiles, prejunior, junior y adultos, con las ligas de las provincias a nivel nacional e internacional. Por lo tanto, pretendemos estudiar la relación de la comunidad con el ambiente y el deporte, los que consideramos vitales en el imaginario de la sociedad nipona