Purpose: This study identifies the relative importance of reasons for institutionalization endorsed by caregivers of patients with dementia; examines the relationship between caregivers' reasons for ...institutionalization and indicators of caregiver and patient physical and emotional functioning measured in the prior year; and compares, on these indicators, caregivers who institutionalized their care recipients with caregivers who did not. Design and Methods: Participants were 2,200 caregivers from the National Longitudinal Caregiver Study, including 580 who institutionalized their care recipient during the 3-year interval. Caregivers' reason(s) for institutionalization were examined and correlated with indicators of caregiver and patient physical and emotional functioning. These indicators were used in a proportional hazards model to determine independent predictors. Results: Caregivers' reasons for placement included (a) the need for more skilled care (65%); (b) the caregivers' health (49%); (c) the patients' dementia-related behaviors (46%); and (d) the need for more assistance (23%). Each of these reasons was significantly associated with indicators in the prior year's survey. This study uniquely demonstrates that caregiving task demand and a single-item measure of caregiver life satisfaction significantly predict placement. Implications: These findings emphasize that caregivers' reasons have valid underpinnings and that institutionalization of dementia patients results from caregiver and patient factors evident in the year prior to placement. In routine office visits, caregivers should be systematically screened; accounts of low life satisfaction, dementia problem behaviors, or high task demand should cue clinicians that discussions of nursing home placement would be timely and appropriate.
AIM: The aim of the study was to develop test methods and evaluate survival of Francisella philomiragia cells and MS2 bacteriophage after exposure to PES‐Solid (a solid source of peracetic acid) ...formulations with or without surfactants. METHODS AND RESULTS: Francisella philomiragia cells (≥7·6 log₁₀CFU) or MS2 bacteriophage (≥6·8 log₁₀PFU) were deposited on seven different test materials and treated with three different PES‐Solid formulations, three different preneutralized samples and filter controls at room temperature for 15 min. There were 0–1·3 log₁₀CFU (<20 cells) of cell survival, or 0–1·7 log₁₀(<51 PFU) of bacteriophage survival in all 21 test combinations (organism, formulation and substrate) containing reactive PES‐Solid. In addition, the microemulsion (Dahlgren Surfactant System) showed ≤2 log₁₀(100 cells) of viable F. philomiragia cells, indicating the microemulsion achieved <2 log₁₀CFU on its own. CONCLUSIONS: Three PES‐Solid formulations and one microemulsion system (DSS) inactivated F. philomiragia cells and/or MS2 bacteriophage that were deposited on seven different materials. SIGNIFICANCE AND IMPACT OF THE STUDY: A test method was developed to show that reactive PES‐Solid formulations and a microemulsion system (DSS) inactivated >6 log₁₀CFU/PFU F. philomiragia cells and/or MS2 bacteriophage on different materials.
AIMS: To develop test methods and evaluate survival of Bacillus anthracis ∆Sterne or Bacillus thuringiensis Al Hakam on materials contaminated with dirty spore preparations after exposure to hot, ...humid air using response surface modelling. METHODS AND RESULTS: Spores (>7 log₁₀) were mixed with humic acid + spent sporulation medium (organic debris) or kaolin (dirt debris). Spore samples were then dried on five different test materials (wiring insulation, aircraft performance coating, anti‐skid, polypropylene, and nylon). Inoculated materials were tested with 19 test combinations of temperature (55, 65, 75°C), relative humidity (70, 80, 90%) and time (1, 2, 3 days). The slowest spore inactivation kinetics was on nylon webbing and/or after addition of organic debris. CONCLUSIONS: Hot, humid air effectively decontaminates materials contaminated with dirty Bacillus spore preparations; debris and material interactions create complex decontamination kinetic patterns; and B. thuringiensis Al Hakam is a realistic surrogate for B. anthracis. SIGNIFICANCE AND IMPACT OF THE STUDY: Response surface models of hot, humid air decontamination were developed which may be used to select decontamination parameters for contamination scenarios including aircraft.
Aims
To add a spore germination step in order to reduce decontamination temperature and time requirements compared to the current hot, humid air decontamination parameters, which are 75–80°C, ≥72 h, ...70–90% RH, down to ≤60°C and ≤24 h total decontamination time.
Methods and Results
Bacillus anthracis spore germination with l‐alanine+inosine+calcium dipicolinate (CaDPA) was quantified at 0–40°C, several time points and spore concentrations of 5–9 log10 per ml. Germination efficiency at 0–40°C was >99% at <8 log10 spores per ml. The temperature optimum was 20°C. Germination efficiency was significantly higher but slower at 0°C compared to ≥30°C at ≥8 log10 spores per ml. A single germinant application followed by 60°C, 1‐h treatment consistently inactivated >2 log10 (>99%) of spores. However, a repeat application of germinant was needed to achieve the objective of ≥6 log10 spore inactivation out of a 7 log10 challenge (≥99·9999%) for ≤24 h total decontamination time for nylon and aircraft performance coating.
Conclusions
l‐alanine+inosine+CaDPA stimulated germination across wide temperature and spore concentration ranges.
Significance and Impact of the Study
Germination expands the scope of spore decontamination to include materials from any industry sector that can be sprayed with an aqueous germinant solution.
To develop test methods and evaluate the survival of Bacillus anthracis Delta Sterne and Bacillus thuringiensis Al Hakam spores after exposure to hot, humid air. Spores (>7 logs) of both strains were ...dried on six different test materials. Response surface methodology was employed to identify the limits of spore survival at optimal test combinations of temperature (60, 68, 77 degree C), relative humidity (60, 75, 90%) and time (1, 4, 7 days). No spores survived the harshest test run (77 degree C, 90% r.h., 7 days), while > 6.5 logs of spores survived the mildest test run (60 degree C, 60% r.h., 1 day). Spores of both strains inoculated on nylon webbing and polypropylene had greater survival rates at 68 degree C, 75% r.h., 4 days than spores on other materials. Electron microscopy showed no obvious physical damage to spores using hot, humid air, which contrasted with pH-adjusted bleach decontamination. Test methods were developed to show that hot, humid air effectively inactivates B. anthracis Delta Sterne and B. thuringiensis Al Hakam spores with similar kinetics. Hot, humid air is a potential alternative to conventional chemical decontamination.
Aims: To evaluate the inactivation of Bacillus anthracisΔSterne and Ames spores using electrochemically generated liquid‐phase chlorine dioxide (eClO2) and compare two sporulation and ...decontamination methods with regard to cost, safety and technical constraints.
Methods and Results: Spores were prepared via agar and broth methods and subsequently inoculated and dried onto clean, autoclave‐sterilized glass coupons. Bacillus anthracis spore inactivation efficacy was evaluated using the modified three‐step method (AOAC 2008.05) and a single‐tube extraction method. Spores (7·0 ± 0·5 logs) were inactivated within 1 min at room temperature using freshly prepared eClO2. Bacillus anthracisΔSterne spores decreased in size after eClO2 treatment as measured using a Beckman Coulter Multisizer.
Conclusions: eClO2 saturation of a hard surface was an effective B. anthracis sporicide. Broth sporulation and the single‐tube extraction method required less time and fewer steps, yielded a higher percentage of phase‐bright spores and showed higher spore recovery efficiency compared with AOAC 2008.05, making it more amenable to biosafety level 3 (BSL3) testing of virulent spores.
Significance and Impact of the Study: Two test methods demonstrated the sporicidal efficacy of eClO2. A new single‐tube extraction test protocol for decontaminants was introduced.
Aims To develop test methods and evaluate survival of Bacillus anthracis Delta Sterne or Bacillus thuringiensis Al Hakam on materials contaminated with dirty spore preparations after exposure to hot, ...humid air using response surface modelling. Methods and Results Spores (>7 log sub(10)) were mixed with humic acid + spent sporulation medium (organic debris) or kaolin (dirt debris). Spore samples were then dried on five different test materials (wiring insulation, aircraft performance coating, anti-skid, polypropylene, and nylon). Inoculated materials were tested with 19 test combinations of temperature (55, 65, 75 degree C), relative humidity (70, 80, 90%) and time (1, 2, 3 days). The slowest spore inactivation kinetics was on nylon webbing and/or after addition of organic debris. Conclusions Hot, humid air effectively decontaminates materials contaminated with dirty Bacillus spore preparations; debris and material interactions create complex decontamination kinetic patterns; and B. thuringiensis Al Hakam is a realistic surrogate for B. anthracis. Significance and Impact of the Study Response surface models of hot, humid air decontamination were developed which may be used to select decontamination parameters for contamination scenarios including aircraft.
Synopsis Photoprocesses of the endohedral fullerene ions Sc3N@C80+ and Sc3N@C80− in the gas phase have been experimentally investigated with emphasis on the specific effects of the encapsulated ...trimetallic nitride cluster Sc3N on the observed reaction yields. Clear evidence of photoexcitation near the Sc L edge is obtained with the dominating contributions visible in the one- and two-electron-removal channels. The experiments are accompanied by model calculations employing density functional theory (DFT).
Since many of the frailest and most vulnerable Americans reside in nursing homes, medical students need focused education and training pertaining to this setting. A unique cooperative learning ...experience utilizing the jigsaw method was developed to engage and expose students to the institutional long-term and postacute care (LTPAC) setting and the roles of personnel there. To accomplish these goals, small groups of medical students interviewed LTPAC personnel about their role, generally, and in relation to a specific patient case. These groups were then rearranged into new groups containing 1 student from each of the original groups plus a faculty facilitator. Each student in the new groups taught about the role of the LTPAC professional they interviewed. To assess the effectiveness of this learning experience, students and LTPAC personnel provided written feedback and rated the activity using a 5-point Likert scale (1 = worst; 5 = best). Students also took a knowledge test. The activity received ratings from students of 3.65 to 4.12 (mean = 3.91). The knowledge test results indicated that students understood the roles of the LTPAC personnel. In general, the jigsaw exercise was well-received by participants and provided an effective means of introducing medical students to the nursing home environment.
Aims
To develop test methods and evaluate survival of Bacillus anthracis Ames, B. anthracis ∆Sterne and B. thuringiensis Al Hakam spores after exposure to PES‐Solid (a solid source of peracetic ...acid), including PES‐Solid formulations with bacteriostatic surfactants.
Methods and Results
Spores (≥7 logs) were dried on seven different test materials and treated with three different PES‐Solid formulations (or preneutralized controls) at room temperature for 15 min. There was either no spore survival or less than 1 log (<10 spores) of spore survival in 56 of 63 test combinations (strain, formulation and substrate). Less than 2·7 logs (<180 spores) survived in the remaining seven test combinations. The highest spore survival rates were seen on water‐dispersible chemical agent resistant coating (CARC‐W) and Naval ship topcoat (NTC). Electron microscopy and Coulter analysis showed that all spore structures were intact after spore inactivation with PES‐Solid.
Conclusions
Three PES‐Solid formulations inactivated Bacillus spores that were dried on seven different materials.
Significance and Impact of the Study
A test method was developed to show that PES‐Solid formulations effectively inactivate Bacillus spores on different materials.
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