OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) ...by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)-producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 13.2% vs 197 of 600 32.8%; P<.001) and CRA (56 of 600 9.3% vs 94 of 600 15.7%; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol 2018;39:571-577.
School‐aged children with autism spectrum disorders (ASDs) have delayed gestural development, in comparison with age‐matched typically developing children. In this study, an intervention program ...taught children with low‐functioning ASD gestural comprehension and production using video modelling (VM) by a computer‐generated robot animation. Six to 12‐year‐old children with ASD (N = 20; IQ < 70) were taught to recognize 20 gestures produced by the robot animation (phase I), to imitate these gestures (phase II) and to produce them in appropriate social contexts (phase III). Across the three phases, significant differences were found between the results of the pretest and the immediate and follow‐up posttests; the results of both posttests were comparable, after controlling for the children's motor and visual memory skills. The children generalized their acquired gestural skills to a novel setting with a human researcher. These results suggest that VM by a robot animation is effective in teaching children with low‐functioning ASD to recognize and produce gestures.
Lay Description
What is already known about this topic:
Children with autism spectrum disorders (ASDs) have difficulties with nonverbal communication.
Children with ASD have difficulties in recognizing and producing gestures.
What this paper adds:
A multiphase therapeutic intervention program using video modelling (VM) of robot animation is effective to promoting the gestural communication skills, both recognition and production, in children with low‐functioning ASD.
Children with ASD have improved their skills to recognize the taught gestures (phase I), imitate them (phase II) and produce them in appropriate social contexts (phase III).
Children with ASD are able to generalize the acquired skills to human‐to‐human interactions after the intervention program.
Implications for practice and/or policy:
VM of a robot animation is effective in teaching children with low‐functioning ASD both gesture recognition and gesture production.
The multiphase therapeutic intervention protocol can be recommended for clinicians or teachers in special schools to teach children with low‐functioning ASD gestural communication skills.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
In this paper, a fundamental study of energy efficiency (EE) optimization for coordinated multi-point (CoMP) simultaneous wireless information and power transfer (SWIPT) heterogeneous networks ...(HetNets) is provided. We aim to optimize the EE while satisfying certain quality-of-service requirements in regard to transmission rate and energy harvesting at both the macro cell and small cells. The corresponding joint beamforming and power allocation in the presence of intra- and inter-cell interference constitutes an EE maximization problem that is non-convex, and hence, very challenging to solve. In order to solve this problem, we propose to separate the beamforming design and power allocation processes. First, we adopt linear zero-forcing (ZF) beamforming to suppress the multi-user interference from both the energy harvesting users (EH-UEs) as well as the information decoding UEs (ID-UEs), thus transforming the HetNet under consideration to a virtual point-to-point system. An efficient power allocation algorithm is then developed to maximize the corresponding EE. On the other hand, the ZF strategy does not utilize the notion that interference benefits the EH-UEs. As a result, we propose a partial ZF approach by differentiating the EH-UEs and ID-UEs in order to further improve the EE. Our findings show that the EE can be significantly improved through the integration of CoMP-SWIPT in HetNets.
Purpose: To determine mortality and outcomes of patients diagnosed with fracture-related infections (FRIs).
Methods: FRI patients treated at a trauma centre between 2001 and 2020 were analysed. The ...primary outcome was 1-year mortality; mortality associations with FRI organism, depth of involvement, and temporality were investigated with multivariable survival analysis. Healthcare-associated and serological outcomes were reported as secondary outcomes. Results: 311 FRIs with mean age of 67.0 and median Charlson comorbidity index of 0 were analysed. Methicillin-sensitive Staphylococcus aureus (MSSA) (29.9%) was the most frequently implicated organism. The majority of FRIs were deep infections (62.7%). FRIs were diagnosed at a median of 40 (IQR 15–200) days post index surgery. The mean follow-up was 5.9 years. One-year mortality amounted to 17.7%. MSSA FRIs were associated with better survival (adj HR 0.34, 95%CI 0.15–0.76, p = 0.008). There was no difference in survivorship between deep or superficial FRI (adj HR 0.86, 95%CI 0.62–1.19, p = 0.353) or in relation to onset time (adj HR 1.0, 95%CI 0.99–1.00, p = 0.943). Implant removal or debridement alone was performed in 61.7% and 17% respectively. Antibiotics was prescribed for 53 (IQR 23–110) days, and patients were hospitalised for 39 (IQR 19–78) days. CRP and ESR normalised in 70.3% (median 46 days) and 53.8% (median 86 days) patients respectively. Conclusion: Fracture-related infections are associated with significant mortality and morbidity regardless of depth and temporality. Non-MSSA FRIs are associated with inferior survival.
We describe a nosocomial outbreak of community-associated methicillin-resistant
Staphylococcus aureus
(CA-MRSA) ST59-SCC
mec
type V in a neonatal intensive care unit (NICU) in Hong Kong. In-depth ...epidemiological analysis was performed by whole-genome sequencing (WGS) of the CA-MRSA isolates collected from patients and environment during weekly surveillance and healthcare workers from the later phase of the outbreak. Case–control analysis was performed to analyze potential risk factors for the outbreak. The outbreak occurred from September 2017 to February 2018 involving 15 neonates and one healthcare worker. WGS analysis revealed complicated transmission dynamics between patients, healthcare worker, and environment, from an unrecognized source introduced into the NICU within 6 months before the outbreak. In addition to enforcement of directly observed hand hygiene, environmental disinfection, cohort nursing of colonized and infected patients, together with contact tracing for secondary patients, medical, nursing, and supporting staff were segregated where one team would care for CA-MRSA-confirmed/CA-MRSA-exposed patients and the other for newly admitted patients in the NICU only. Case–control analysis revealed use of cephalosporins odds ratio 49.84 (3.10–801.46),
p
= 0.006 and length of hospitalization odds ratio 1.02 (1.00–1.04),
p
= 0.013 as significant risk factors for nosocomial acquisition of CA-MRSA in NICU using multivariate analysis. WGS facilitates the understanding of transmission dynamics of an outbreak, providing insights for outbreak prevention.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Achieving efficient in vivo delivery of siRNA to the appropriate target cell would be a major advance in the use of RNAi in gene function studies and as a therapeutic modality. Hepatocytes, the key ...parenchymal cells of the liver, are a particularly attractive target cell type for siRNA delivery given their central role in several infectious and metabolic disorders. We have developed a vehicle for the delivery of siRNA to hepatocytes both in vitro and in vivo, which we have named siRNA Dynamic PolyConjugates. Key features of the Dynamic PolyConjugate technology include a membrane-active polymer, the ability to reversibly mask the activity of this polymer until it reaches the acidic environment of endosomes, and the ability to target this modified polymer and its siRNA cargo specifically to hepatocytes in vivo after simple, low-pressure i.v. injection. Using this delivery technology, we demonstrate effective knockdown of two endogenous genes in mouse liver: apolipoprotein B (apoB) and peroxisome proliferator-activated receptor alpha (ppara). Knockdown of apoB resulted in clear phenotypic changes that included a significant reduction in serum cholesterol and increased fat accumulation in the liver, consistent with the known functions of apoB. Knockdown of ppara also resulted in a phenotype consistent with its known function, although with less penetrance than observed in apoB knockdown mice. Analyses of serum liver enzyme and cytokine levels in treated mice indicated that the siRNA Dynamic PolyConjugate was nontoxic and well tolerated.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Suboptimal physical activity levels and tolerance, poor motor skills and poor physical health are demonstrated in children with Autism Spectrum Disorder (ASD). We speculate that social interaction ...and communication deficits in children with ASD are two major factors that hinder these children from actively participating in group physical activities. While previous studies have demonstrated that exercise intervention improves motor skills and behavioral outcomes in children with ASD, these programs tend to focus only on a single sport, which may not cater to the interests of different children with ASD. In this protocol, a game-based exercise training program designed by a multi-disciplinary team (pediatrics, physical education and psychology) will be implemented by front-line healthcare providers trained following the train-the-trainer (TTT) model and subjected to validation.
Using a randomized controlled trial design, the effectiveness of the game-based exercise program will be examined for 112 young children with ASD. These children were randomly assigned to two groups, which will be tested and trained in either one of the two arms of the waitlist conditions (control and intervention). The assessment of physical and psychological traits will be conducted at baseline (pre-test), at 16-weeks (post-treatment) and at 32-weeks (follow-up) of the program.
Most of the interventions designed for ASD children target either their psychological traits or physical conditions, without bridging the two states. With the recognition of bidirectional relations between mental and physical health, the present game-based exercise program which includes multiple level of difficulties was developed to equip ASD children with the necessary skills for engaging in sustainable team sports or even professional sport training. The program, if effective, will provide an entertaining and engaging training for whole-person development among children with ASD.
This study is registered with the Chinese Clinical Trial Registry ( ChiCTR-IOR-17011898 ). Registered 6
July 2017.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The photocatalytic oxidation (PCO) of a monoazo dye Procion Red MX-5B under various physico-chemical conditions was investigated. Degradation of the dye by PCO was enhanced by augmentation in UV ...intensity, titanium dioxide and hydrogen peroxide concentrations but was inhibited by increase in initial dye concentration. The PCO process was affected by pH in a peculiar way. In the presence of 100 mg/l of TiO
2 and the absence of H
2O
2, the highest reaction rate was observed when the initial pH was 10. With 500 mg/l of TiO
2 and 10 mM of H
2O
2, the reaction was the fastest at initial pH of 3–5. The optimal conditions for the degradation of the dye, at an UV intensity of
17
mW/
cm
2
, were determined to be: TiO
2 concentration, 500 mg/l; initial H
2O
2 concentration, 10 mM; initial pH, 5.0. Monitoring of TOC loss showed that the dye was mineralized by 90% within 80 min under these conditions. Nevertheless, the persistence of a low level of TOC indicated that mineralization was not complete and dead-end product(s) which was (were) resistant to PCO might have accumulated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Meticillin-resistant Staphylococcus aureus (MRSA) has become endemic in many healthcare settings.
To analyse the incidence, risk factors, outcomes, and genomic relatedness of patients with newly ...diagnosed gastrointestinal colonization of MRSA.
Epidemiology and genetic analysis by whole-genome sequencing (WGS) in a hospital network in Hong Kong.
Between October 1st, 2015 and December 31st, 2018, a total of 919 (2.7%) of 34,667 patients had newly diagnosed gastrointestinal MRSA colonization by admission screening. The incidence was 0.67 ± 0.32 per 1000 patient-days per quarter. Including patients with gastrointestinal MRSA colonization, the overall burden of MRSA increased by 59.2%, with an addition of 4727 MRSA patient-days during the study period. Patients referred from residential care home for the elderly, with history of hospitalization in the past six months, and consumption of fluoroquinolones, cephalosporins, and proton-pump inhibitors in the preceding six months were found to be independent risk factors by multivariate analysis in the case–control analysis. The median survival of cases was significantly shorter than that of controls (860 vs 1507 days, P < 0.001). Of 919 patients, 127 (13.8%) developed symptomatic MRSA infection in a median of 112 days. Of 19 patients with paired MRSA faecal and blood culture isolates subjected to WGS, clonality was found in 16 (84.2%) pairs of MRSA isolates. MRSA ST45 constituted 44.7% (17/38) of MRSA isolates.
Gastrointestinal MRSA colonization may contribute to adverse clinical outcomes and pose an unrecognized burden upon hospital infection control.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
An increasing endemicity of multiple-drug-resistant
Acinetobacter baumannii
(MRAB) ST457 was noted in Hong Kong. The epidemiology, risk factors, and infection control measures to prevent nosocomial ...transmission of this epidemic clone were analyzed. A total of 5,058 patients cultured positive with
A. baumannii
between 1 January 2004 and 30 June 2014 were included, of which 297 (5.9 %) had bacteremia. The first case of MRAB bacteremia emerged in 2009, with an incidence that increased from 0.27 (one case) in 2009 to 1.86 (14 cases) per 100,000 patient-days in 2013 (
p
< 0.001). With the implementation of strict contact precautions and directly observed hand hygiene in conscious patients immediately before receiving meals and medications in July 2013, the incidence of MRAB bacteremia reduced from its peak to 0.77 (one case) per 100,000 patient-days in the first 6 months of 2014 (
p
< 0.001). Patients from long-term care facilities for the elderly odds ratio (OR) 18.6, confidence interval (CI) 2.1–162.4,
p
= 0.008 and history of carbapenem (OR 7.0, CI 1.7–28.0,
p
= 0.006) and beta-lactam/beta-lactamase use (OR 5.6, CI 1.1–28.7,
p
= 0.038) 90 days prior to admission were independent risk factors for MRAB bacteremia by logistic regression when compared with carbapenem-susceptible
A. baumannii
bacteremia.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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