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Background: The hands of healthcare workers (HCWs) are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, both practising hand hygiene (HH) and adhering to HH guidelines are expected to decrease the risk of transmission. However, there is no consensus on the optimal hand hygiene compliance (HHC) rate for HCWs.Aim: To systematically review the published literature to determine an optimal threshold for the HCW HHC rate associated with the lowest HAI incidence rate.Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Online databases were searched using comprehensive search criteria for randomized controlled trials and non-randomized controlled studies, investigating the impact of the HCW HHC rate on HAI incidence rates in patients of all ages within healthcare facilities in high-income countries.Findings: Of the 8093 article titles and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60% and 70%. Lower HAI incidence rates seemed to be achieved with HHC rates of approximately 60%. The studies included in this review were not originally designed to assess the impact of HHC on HAI incidence rates, but risk of bias was assessed in accordance with the predetermined exposure and outcome criteria. Eleven (31%) studies were deemed to have low risk of bias.Conclusions: Although HHC is part of the HCW code of conduct, very high HHC rates are difficult to reach. In observational studies, HHC and HAIs had a negative relationship up to approximately 60% HHC. Due to flaws in the study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets for HHC rates. [ABSTRACT FROM AUTHOR]

Highlights • Histological characteristics of healthy equine temporomandibular joints (TMJs) were determined. • Articular surfaces of the equine TMJ are coated with fibrocartilage. • With the exception of the mandibular fossa, osseous aspects had a similar zonal pattern. • The lack of glycosaminoglycans in the mandibular fossa indicates low compressive loads in this area. • On the basis of similarities with human TMJs, the initial movement of the mandible in horses is likely to be translational. Abstract It has been assumed that dental conditions cause disorders of the equine temporomandibular joint (TMJ), due to biomechanical overload or aberrant loading. However, the incidence of published TMJ disorders in horses is low and this leads to the question whether the equine TMJ is adapted well to its biomechanical requirements or is able to remodel its articular surfaces in response to modified loading conditions. The aim of this study was to determine the histological characteristics of healthy equine TMJs. The tissue components of the articular surfaces of 10 TMJs obtained from horses without any clinical history of dental or TMJ disorders were analysed. Apart from the mandibular fossa of the temporal bone, the osseous aspects of the TMJ exhibited a uniform zoning pattern. The articular surfaces were composed of three tissue layers: (1) a superficial cell-rich dense connective tissue layer; (2) a middle fibrocartilage layer; and (3) a deep hyaline-like cartilage layer. The articular disc was composed of an inner core of fibrocartilage and hyaline-like cartilage meshwork covered with both cell-rich dense connective tissue and fibrocartilage at its dorsal and ventral aspects. In contrast, the mandibular fossa was only covered by a dense connective tissue, frequently supplemented by a synovial membrane, suggesting low biomechanical stress. Glycosaminoglycans, which are indicative of compressive loads, were predominantly present within the rostral part of the articular tubercle and the retroarticular process, the dorsal part of articular disc and the entire mandibular head, but were absent within the mandibular fossa. The results of this study suggest the presence of different biomechanical demands in the dorsal and ventral compartment of the equine TMJ. [ABSTRACT FROM AUTHOR]

In the last decade, the equine masticatory apparatus has received much attention. Numerous studies have emphasized the importance of the temporomandibular joint (TMJ) in the functional process of mastication. However, ultrastructural and histological data providing a basis for biomechanical and histopathological considerations are not available. The aim of the present study was to analyze the architecture of the collagen fiber apparatus in the articular surfaces of the equine TMJ to reveal typical morphological features indicating biomechanical adaptions. Therefore, the collagen fiber alignment was visualized using the split-line technique in 16 adult warmblood horses without any history of TMJ disorders. Within the central two-thirds of the articular surfaces of the articular tubercle, the articular disc and the mandibular head, split-lines ran in a correspondent rostrocaudal direction. In the lateral and medial aspects of these articular surfaces, the split-line pattern varied, displaying curved arrangements in the articular disc and punctual split-lines in the bony components. Mediolateral orientated split-lines were found in the rostral and caudal border of the articular disc and in the mandibular fossa. The complex movements during the equine chewing cycle are likely assigned to different areas of the TMJ. The split-line pattern of the equine TMJ is indicative of a relative movement of the joint components in a preferential rostrocaudal direction which is consigned to the central aspects of the TMJ. The lateral and medial aspects of the articular surfaces provide split-line patterns that indicate movements particularly around a dorsoventral axis. [ABSTRACT FROM AUTHOR]

Background: The role of infectious diseases (ID) and clinical microbiology (CM) in hospital settings has expanded in response to increasing antimicrobial resistance, leading to widespread development of hospital antimicrobial stewardship (AMS) programmes, the majority of which include antibiotic approval systems. However, inappropriate antibiotic use in hospitals continues, suggesting potential disjunctions between technical advice and the logics of antibiotic use within hospitals.Aim: To examine the experiences of doctors in a UK hospital with respect to AMS guidance of antibiotic prescribing, and experiences of a verbal postprescription antibiotic approval process.Methods: Twenty doctors in a teaching hospital in the UK participated in semi-structured interviews about their experiences of antibiotic use and governance. NVivo10 software was used to conduct a thematic content analysis systematically.Findings: This study identified three key themes regarding doctors' relationships with ID/CM clinicians that shaped their antibiotic practices: (1) competing hierarchical influences limiting active consultation with ID/CM; (2) non-ID/CM consultants' sense of ownership over clinical decision-making and concerns about challenges to clinical autonomy; and (3) tensions between evidence-based practice and experiential-style learning.Conclusions: This study illustrates the importance of examining relations between ID/CM and non-ID/CM clinicians in the hospital context, indicating that AMS models that focus exclusively on delivering advice rather than managing interprofessional relationships may be limited in their capacity to optimize antibiotic use. AMS and, specifically, antibiotic approval systems would likely be more effective if they incorporated time and resources for fostering and maintaining professional relationships. [ABSTRACT FROM AUTHOR]

A study was conducted to determine the impact of exposure to dust in the cattle load-out area in feedyards on pathogen contamination of cattle hides. A total of 250 cattle hides were sampled during summer and fall months, which are associated with elevated prevalence of Escherichia coli O157 in West Texas. Animals were removed from their home pens and restrained in a chute and sampled prior to exposure to dust generated as a result of a simulated loading exercise. The cattle hides were sampled again after exposure to the loading dust to determine total numbers of pathogens on cattle hides on leaving their home pen (before loading) and on cattle hides after exposure to the dust in the loading area. Air and dirt samples from the home pens and the cattle load-out area were also collected. The presence of E. coli O157 and Salmonella was determined in all the samples, and when a positive sample was identified, the total numbers of these bacteria present were enumerated. The total numbers of pathogens increased after dust exposure; Salmonella counts increased from 1.09 log most probable number (MPN)/cm² to 1.74 log MPN/cm² after exposure, and E. coli O157 counts increased from 0.80 to 2.35 log MPN/cm² after sampling. E. coli O157 and Salmonella were recovered from the air samples during dust generation at 6.66 and 11.1%, respectively. Salmonella and E. coli O157 prevalence was not changed and was not associated with the exposure to the dust. Results indicate airborne dust generated as a result of cattle movement and loading could be an important determining factor in total numbers of pathogens recovered on cattle hides. [ABSTRACT FROM AUTHOR]

Prevalences of Escherichia coli O157:H7, Salmonella, and total aerobic microorganisms were determined on the hides of beef feedlot cattle before and after transport from the feedyard to the harvest facility in clean and dirty trailers. Swab samples were taken from the midline and withers of 40 animals on each of 8 days before and after shipping. After samples were collected, animals were loaded in groups of 10 on upper and lower levels of clean and dirty trailers. Animals were unloaded at the harvest facility and kept in treatment groups for sample collection after exsanguination. Salmonella was found more often on hide swabs collected from the midline than on than samples collected from the withers from animals transported in both clean and dirty trailers. Salmonella was found on significantly more hide swabs collected at harvest from both sampling locations than on those collected at the feedyard, with no differences attributed to the type of trailer. At the feedyard, clean trucks had a lower percentage of Salmonella-positive samples than did dirty trucks before animals were loaded. However, after transport, both clean and dirty trucks had a similar prevalence of Salmonella. There were no differences in Salmonella prevalence on hides collected from animals transported on the top and bottom levels of clean and dirty trucks. E. coli O157:H7 was detected on less than 2% of the samples; therefore, no practical conclusions about prevalence could be drawn. Hides sampled at harvest had higher concentrations of aerobic microorganisms than did hides sampled at the feedyard, and concentrations were higher on the midline than on the withers. Although the prevalences of Salmonella and total aerobic microorganisms increased on hides after transport from the feedyard to the plant, this increase was not related to the cleanliness of the trailers or the location of the cattle in the trailers. [ABSTRACT FROM AUTHOR]

Increased dietary protein intake rapidly (3 h) decreases hepatic malic enzyme and increases hepatic histidase mRNA expression in broiler chicks. A series of experiments was conducted to determine the role that glucagon or a specific mixture of dietary amino acids might have in regulating the rapid changes in mRNA expression of these enzymes, when dietary protein intake is increased. Three hours after the injection of glucagon (240 μg/kg of BW) into the brachial vein of broiler chicks, hepatic malic enzyme mRNA expression was significantly lower and hepatic histidase mRNA expression was significantly greater than the level detected in saline-injected chicks. In addition, broiler chicks fed a high (40 g/100 g of diet) protein diet had significantly higher plasma glucagon levels at 1 and 3 h after initial access to this diet than broiler chicks fed a basal (22 g/100 g of diet) protein diet. The plasma glucagon concentration, however, was not different between the chicks fed the 2 dietary protein levels at 2 h after the initial access to the 2 diets. When a mixture of indispensable or dispensable amino acids was added to the basal diet to equal the concentrations of the individual indispensable or dispensable amino acids in the high protein diet, hepatic mRNA expression of malic enzyme and histidase were intermediate to the expression found in chicks fed the basal and high protein diet. The results indicate that glucagon may mediate the changes in the mRNA expression of malic enzyme and histidase in response to dietary protein intake and that total amino acid intake rather than the ingestion of specific amino acids regulates the mRNA expression of malic enzyme and histidase in chicks. [ABSTRACT FROM AUTHOR]

Objective: Prior studies have suggested that macrosomia is the only morbid condition associated with gestational diabetes and that this association is the result of confounding by maternal obesity rather than a result of gestational diabetes itself. We sought to determine whether unrecognized gestational diabetes is an independent predictor of macrosomia and other perinatal morbid conditions after controlling for confounding variables.Study Design: A retrospective analysis of 472 consecutive cases of gestational diabetes diagnosed between 24 and 30 weeks' gestation was undertaken including 16 prospectively identified but clinically unrecognized cases, 297 cases treated with diet alone, and 76 treated with diet plus insulin. Unrecognized cases were matched to 64 nondiabetic controls for race, age, body mass index, parity, pregnancy weight gain, and gestational age at delivery.Results: In the unrecognized gestational diabetes group versus the nondiabetic control versus gestational diabetes diet groups rates of large for gestational age infants (44% vs 5% vs 9%, p < 0.0005), macrosomia (44% vs 8% vs 15%, p < 0.01), shoulder dystocia (19% vs 3% vs 3%, p < 0.05), and birth trauma (25% vs 0% vs 0.3%, p < 0.001) were all significantly increased. These differences remained significant after controlling for maternal age, race, parity, body mass index, pregnancy weight gain, and gestational age at delivery.Conclusions: This study suggests that unrecognized gestational diabetes increases risks of large for gestational age infants, macrosomia, shoulder dystocia, and birth trauma independent of maternal obesity and other confounding variables. Clinical recognition and dietary control of gestational diabetes are associated with a reduction in these perinatal morbid conditions. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and exercise capacity in a large contemporary cohort of patients with chronic heart failure.Background: Natriuretic peptides such as NT-proBNP are important biomarkers in heart failure. The relationship between NT-proBNP and exercise capacity has not been well studied.Methods: We analyzed the relationship between baseline NT-proBNP and peak oxygen uptake (peak VO(2)) or distance in the 6-minute walk test in 1383 subjects enrolled in the HF-ACTION study. Linear regression models were used to analyze the relationship between NT-proBNP and peak Vo(2) or distance in the 6-minute walk test in the context of other clinical variables. Receiver operator curve analysis was used to evaluate the ability of NT-proBNP to accurately predict a peak VO(2) <12 mL/kg per minute.Results: NT-proBNP was the most powerful predictor of peak VO(2) (partial R(2) = 0.13, P < .0001) of 35 candidate variables. Although NT-proBNP was also a predictor of distance in the 6-minute walk test, this relationship was weaker than that for peak VO(2) (partial R(2) = 0.02, P < .0001). For both peak VO(2) and distance in the 6-minute walk test, much of the variability in exercise capacity remained unexplained by the variables tested. Receiver operator curve analysis suggested NT-proBNP had moderate ability to identify patients with peak VO(2) <12 mL/kg per minute (c-index, 0.69).Conclusions: In this analysis of baseline data from HF-ACTION, NT-proBNP was the strongest predictor of peak VO(2) and a significant predictor of distance in the 6-minute walk test. Despite these associations, NT-proBNP demonstrated only modest performance in identifying patients with a low peak VO(2) who might be considered for cardiac transplantation. These data suggest that, although hemodynamic factors are important determinants of exercise capacity, much of the variability in exercise performance in heart failure remains unexplained by traditional clinical and demographic variables. [ABSTRACT FROM AUTHOR]

Municipal solid waste (MSW) represents approximately 7% of the totalamount of waste produced annually in the UK and the statutory responsibilities for this waste lie with local authorities. The waste services provided by local authorities are mediated via contracts between the authority and service provider under the compulsory competitive tendering (CCT) regime. New regulations are now coming into place under the label of 'Best Value', whereby local authorities will be obliged by law to consult local people on their services, review and reporton how they have performed against targets, and embrace quality within their services. Best Value will impinge on the waste management industry by demanding the continuous improvement of their services in both quality and cost terms. This research has shown that there are eight key issues identified from a survey of different stakeholders forthe management of MSW, arising from the forthcoming Best Value legislation. In overall order, they are working arrangements (most important), investment and resources, performance and benchmarking, consultation, innovation, contractual terms, consolidation and finally diversification (least important): these are analysed from each stakeholder's standpoint. The research illustrates that new working arrangementsbetween the local authority and the contractor will be encouraged with contracts setting demanding targets for the management of MSW within a continuous improvement framework. Innovation and flexibility will be essential for contractors to reach these targets. There will be an increasing trend towards integrated waste management contracts, which will require substantial injections of capital and resources in order for local authorities to meet national and local targets for MSW. Diversification and consolidation will also affect sections of the waste management industry and company mergers will increase. Local authorities consider Best Value as a key driver for reaching targets toredu [ABSTRACT FROM AUTHOR]