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In national surveys of infection preventionists in Israel (n = 15), the United States (n = 415), and Thailand (n = 100), we found that views of organizational culture track well with these countries' cultural dimension scores of power distance and individualism. Our findings highlight the importance of considering cultural dimensions when implementing infection prevention efforts. • Organizational culture can influence infection prevention and infection rates. • Infection preventionist organizational views align with national culture scores. • Consider cultural dimensions when implementing infection prevention efforts. [ABSTRACT FROM AUTHOR]

Introduction: Despite the perception that meticillin-resistant Staphylococcus aureus (MRSA) is now under control in high-income countries, global prevalence remains high, even increasing in some regions. Universal admission screening and decolonization has been instituted in some hospitals to attempt control but the practice remains controversial.Methods: In 2014, Mater Dei Hospital in Malta introduced a universal admission screening policy, utilizing a novel, centralized and customized approach to achieve high compliance and low cost. Admissions are screened nasally by designated staff using chromogenic media, irrespective of risk factors. Carriers are decolonized without concurrent isolation or contact precautions. In this study, longitudinal, quasi-experimental evaluation was undertaken using time series analysis to analyse the impact of the intervention on the proportion of MRSA among clinical S. aureus isolates (%MRSA) and incidence per 1000 bed-days. A cost-utility analysis was also attempted to identify approximate quality-adjusted life years (QALYs) gained.Results: A transfer function model approach concluded that the intervention had a significant effect on both %MRSA and incidence. Six years following its introduction, the screening programme had led to an overall 43% long-term reduction in %MRSA from pre-screening levels [R2=0.687; Bayesian information criterion (BIC)=4.063], translating to a decrease in incidence of approximately 0.56 cases/1000 bed-days (R2=0.633, BIC=-3.063). No correlation was identified with consumption of antibiotics or alcohol hand rub. The annual cost-benefit of the programme was calculated at €1058 per QALY gain per year.Conclusion: The universal admission screening and decolonization intervention was successful and cost-effective in this high-endemicity setting. It facilitated improvement in the prevalence of MRSA, achieving reduction levels rarely reported by Mediterranean hospitals. [ABSTRACT FROM AUTHOR]

This paper presents the experiences and challenges with concurrently carrying out numerical model development, integrated simulations and design of a novel floating vertical axis wind turbine, the DeepWind concept. The floating VAWT modelling capabilities of the aero-hydro-elastic HAWC2 simulation tool are briefly described and the design approach adopted for such a challenging project was to independently design subsystems in parallel, apart from essential design specifications. Instability issues encountered when integrating all subsystems in the unified numerical model, in particular blade edgewise and controller instabilities, are presented and efforts to alleviate such issues are detailed. A multidisciplinary design and optimization approach is proposed to eliminate these issues and accelerate future design cycles. [ABSTRACT FROM AUTHOR]

DeepWind has been presented as a novel floating offshore wind turbine concept with cost reduction potentials. Twelve international partners developed a Darrieus type floating turbine with new materials and technologies for deep-sea offshore environment. This paper summarizes results of the 5 MW DeepWind conceptual design. The concept was evaluated at the Hywind test site, described on its few components, in particular on the modified Troposkien blade shape and airfoil design. The feasibility of upscaling from 5 MW to 20 MW is discussed, taking into account the results from testing the Deepwind floating 1 kW demonstrator. The 5 MW simulation results, loading and performance are compared to the OC3-NREL 5 MW wind turbine. Finally the paper elaborates the conceptual design on cost modelling. [ABSTRACT FROM AUTHOR]

The need to further exploit offshore wind resources has pushed offshore wind farms into deeper waters, requiring the use of floating support structures to be economically sustainable. The use of conventional wind turbines may not continue to be the optimal design for floating applications. Therefore it is important to assess other alternative configurations in this context. Vertical axis wind turbines (VAWTs) are one promising configuration, and it is important to first understand the coupled and relatively complex dynamics of floating VAWTs to assess the technical feasibility. As part of this task, a series of articles have been developed to present a comprehensive literature review covering the various areas of engineering expertise required to understand the coupled dynamics involved in floating VAWTs. This third article focuses on approaches to develop an efficient coupled model of dynamics (considering aerodynamics, hydrodynamics, structural and mooring line dynamics, and control dynamics) for floating VAWTs, as well as suitable ‘semi-analytical’ hydrodynamic models for this type of coupled dynamics models. Emphasis is also placed on utilising computationally efficient models and programming strategies. A comparison of the various forces acting on a floating VAWT with the three main floating support structure (spar, semi-submersible and tension-leg-platform) is also presented to highlight the relative dominant forces and hence importance of model accuracy representing these forces. Lastly a concise summary covering this series of articles is presented to give the reader an overview of this interdisciplinary research area. This article has been written both for researchers new to this research area, outlining underlying theory whilst providing a comprehensive review of the latest work, and for experts in this area, providing a comprehensive list of the relevant references where the details of modelling approaches may be found. [ABSTRACT FROM AUTHOR]

The need to further exploit offshore wind resources has pushed offshore wind farms into deeper waters, requiring the use of floating support structures to be economically sustainable. The use of conventional wind turbines may not continue to be the optimal design for floating applications. Therefore it is important to assess other alternative concepts in this context. Vertical axis wind turbines (VAWTs) are one promising concept, and it is important to first understand the coupled and relatively complex dynamics of floating VAWTs to assess their technical feasibility. A comprehensive review detailing the areas of engineering expertise utilised in developing an understanding of the coupled dynamics of floating VAWTs has been developed through a series of articles. This first article details the aerodynamic modelling of VAWTs, providing a review of available models, discussing their applicability to floating VAWTs and current implementations by researchers in this field. A concise comparison between conventional horizontal axis wind turbines and VAWTs is also presented, outlining the advantages and disadvantages of these technologies for the floating wind industry. This article has been written both for researchers new to this research area, outlining underlying theory whilst providing a comprehensive review of the latest work, and for experts in this area, providing a comprehensive list of the relevant references where the details of modelling approaches may be found. [ABSTRACT FROM AUTHOR]

The need to exploit enhanced wind resources far offshore as well as in deep waters requires the use of floating support structures to become economically viable. The conventional three-bladed horizontal axis wind turbine may not continue to be the optimal design for floating applications. Therefore it is important to assess alternative concepts in this context that may be more suitable. Vertical axis wind turbines (VAWTs) are a promising concept, and it is important to first understand the coupled and relatively complex dynamics of floating VAWTs to assess their technical feasibility. As part of this task, a series of articles have been developed to present a comprehensive literature review covering the various areas of engineering expertise required to understand the coupled dynamics involved in floating VAWTs. This second article focuses on the modelling of mooring systems and structural behaviour of floating VAWTs, discussing various mathematical models and their suitability within the context of developing a model of coupled dynamics. Emphasis is placed on computational aspects of model selection and development as computational efficiency is an important aspect during preliminary design stages. This paper has been written both for researchers new to this research area, outlining underlying theory whilst providing a comprehensive review of the latest work, and for experts in this area, providing a comprehensive list of the relevant references where the details of modelling approaches may be found. [ABSTRACT FROM AUTHOR]

Abstract: Floating offshore wind turbines (FOWTs) are subjected to large amplitude motions that induce greater loads on components and reduce aerodynamic performance. One approach to counteract this has been to use passive damping systems for FOWTs to dissipate the wave-induced energy and therefore reduce the global platform motions. This paper proposes that rather than discard this energy, a wave energy converter (WEC) is utilized on the floating platform to absorb it. A study is carried out on a floating vertical axis wind turbine (VAWT) combined with WEC moving in heave. A range of damping and stiffness coefficients are applied between the FOWT and WEC to establish strategies for two cases: maximum motion reduction and maximum energy extraction. The results and conclusions obtained are presented in terms of modifying the WEC natural frequency, damping and stiffness values. [Copyright &y& Elsevier]

Background: One commonly cited reason for inadequate hand hygiene (HH) in health care facilities is lack of handwashing sinks and alcohol hand rub (AHR). Methods: Using the World Health Organization (WHO) direct observation method, we studied HH compliance after migration from an old hospital having 1 HH station (sink and AHR) per 6 beds to a new institution with 1 per 0.85 beds. We then introduced the other WHO strategy components in a sequential manner—posters, active education, and performance feedback—and assessed the impact of the various elements over time. Results: Migration from the old to the new hospital was actually accompanied by a reduction in HH from 27.3% to 14.5% (P < .01), with a 52% decline in handwashing (P = .01) after patient contact. Small group interactive teaching improved HH compliance but only reached a maximum of 33.1%. No change was seen where only posters and leaflets (without educational sessions) were adopted. Significant improvement was only obtained after a performance feedback campaign coupled with increased staff accountability, reaching an overall average of 63% (P < .001). Conclusion: Our results suggest that, on their own, better resources do not offer any guarantees of improved HH practices. However, once in place, audit and feedback—coupled with genuine administrative support and fostering of individual accountability—appear to be effective change tools to increase HH compliance. [Copyright &y& Elsevier]

Background: This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions. Methods: MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions. Results: Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P =.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P =.002), combination penicillins (P =.018), and aminoglycosides (P =.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P =.005), but a negative association was evident for beta-lactamase–resistant penicillins (P =.010) and first-generation cephalosporins (P =.012). Conclusions: The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations. [Copyright &y& Elsevier]

Summary: Anecdotal data from the southern and eastern Mediterranean region suggests that self-medication with antibiotics is commonly practiced in many countries. In order to provide proper information on the situation, we undertook short structured interviews in out-patients clinics or primary health centres in Cyprus, Egypt, Jordan, Lebanon, Libya, Tunisia and Turkey. A total of 2109 interviews were undertaken of which 1705 completed the full questionnaire. Self-medication was reported by 19.1% (<0.1% in Cyprus to 37% in Lebanon) of respondents. Intended self-medication ranged from 1.3% (95% CI 0%, 3%) in Cyprus to 70.7% (95% CI 64%, 77%) in Jordan. Upper respiratory tract symptoms were the most frequent reasons for which respondents indicated they would self-medicate. 48.4% of the whole group replied that they kept antibiotics at home, being highest in Lebanon (60%, 95% CI 51%, 69%). We found a significant association between antibiotic hoarders and intended users of antibiotics for self-medication. Our data confirms that non-prescribed antibiotic use is high within ambulatory care in southern and eastern Mediterranean countries, being almost twice that reported in a similar European study. Corrective efforts are clearly required in the region to ensure proper use of antimicrobials so as to reduce pressure for antimicrobial resistance. [Copyright &y& Elsevier]

Few studies have studied the frequency of over-the-counter acquisition of antibiotics in western countries. In order to provide an insight into these practices in Malta, attitudes towards antibiotic use in the general public were researched through a structured interview. Nineteen percent admitted that they took antibiotics without prescription and 11% of parents replied that they had given antibiotics to their children without prescription. These antibiotics were mainly self-administered for upper respiratory tract symptoms, particularly sore throat, with community pharmacies being the major source in more than 85% of cases. The study indicates the need for an educational campaign on proper antibiotic use amongst the Maltese general public. [Copyright &y& Elsevier]

• The combination of histone variants greatly expands nucleosome diversity. • H2A and H2B variants occupy distinct chromatin landscapes. • Histone H3.1 controls epigenetic inheritance across the cell cycle. • Replacement and specialized H3 variants mediate epigenetic reprogramming. The dynamic properties of the nucleosome are central to genomic activity. Variants of the core histones that form the nucleosome play a pivotal role in modulating nucleosome structure and function. Despite often small differences in sequence, histone variants display remarkable diversity in genomic deposition and post-translational modification. Here, we summarize the roles played by histone variants in the establishment, maintenance and reprogramming of plant chromatin landscapes, with a focus on histone H3 variants. Deposition of replicative H3.1 during DNA replication controls epigenetic inheritance, while local replacement of H3.1 with H3.3 marks cells undergoing terminal differentiation. Deposition of specialized H3 variants in specific cell types is emerging as a novel mechanism of selective epigenetic reprogramming during the plant life cycle. [ABSTRACT FROM AUTHOR]

A structured self-assessment questionnaire was distributed to 8 southern and eastern Mediterranean hospitals to identify perceived obstacles to hand hygiene (HH). An insufficient number of sinks and alcohol handrub stations was rated by the vast majority of respondents as the most critical impediment, whereas improved availability of HH products was deemed the key intervention to increase compliance. The least importance and relevance were given to HH auditing and collegial reminders. While initiatives to improve HH compliance clearly must address infrastructural inadequacies, sociocultural issues also need to be considered when transposing initiatives found to be successful in Western countries to less-developed regions, to ensure that campaigns are not compromised by perceptual undercurrents. [Copyright &y& Elsevier]

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal. [ABSTRACT FROM AUTHOR]

Influenza spreads globally annually with significant paediatric and adult attack rates and considerable morbidity, mortality and the exacerbation of extant chronic disease. In the northern and southern hemispheres, outbreaks occur mainly in the respective winter seasons. Influenza vaccination is available but only partially effective. In the absence of a vaccine, in winter, novel coronavirus COVID-19 will also circulate in parallel with seasonal influenza. Thus far it appears that with the current strains of these two viruses, the clinical outcome of co-infection is not significantly worse than infection with COVID-19 alone. However, several strains of influenza circulate, including strains still to come. Similarly, COVID-19 has several strains, with probably more to come. This paper discusses these issues and estimates ideal minimum influenza vaccination coverage based on an estimated influenza Basic Reproduction Number (R0) of 0.9-2.1 so as to obtain herd immunity or approach it. There is a strong argument for attempting near universal population coverage with the annual influenza vaccine leading up to next winter. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety. [Copyright &y& Elsevier]

• A survey and webinar were used to study MRSA surveillance programmes. • Great diversity in MRSA surveillance programmes was observed. • Harmonisation of surveillance will improve epidemiological studies. • Several propositions are made to harmonise MRSA surveillance. Multinational surveillance programmes for methicillin-resistant Staphylococcus aureus (MRSA) are dependent on national structures for data collection. This study aimed to capture the diversity of national MRSA surveillance programmes and to propose a framework for harmonisation of MRSA surveillance. The International Society of Antimicrobial Chemotherapy (ISAC) MRSA Working Group conducted a structured survey on MRSA surveillance programmes and organised a webinar to discuss the programmes' strengths and challenges as well as guidelines for harmonisation. Completed surveys represented 24 MRSA surveillance programmes in 16 countries. Several countries reported separate epidemiological and microbiological surveillance. Informing clinicians and national policy-makers were the most common purposes of surveillance. Surveillance of bloodstream infections (BSIs) was present in all programmes. Other invasive infections were often included. Three countries reported active surveillance of MRSA carriage. Methodology and reporting of antimicrobial susceptibility, virulence factors, molecular genotyping and epidemiological metadata varied greatly. Current MRSA surveillance programmes rely upon heterogeneous data collection systems, which hampers international epidemiological monitoring and research. To harmonise MRSA surveillance, we suggest improving the integration of microbiological and epidemiological data, implementation of central biobanks for MRSA isolate collection, and inclusion of a representative sample of skin and soft-tissue infection cases in addition to all BSI cases. [ABSTRACT FROM AUTHOR]

The response from steep and breaking waves for a monopile structure is investigated by analysis of experimental results and by application of numerical models for six irregular sea states. The experimental monopile was designed to reproduce the first and second natural frequencies of the NREL 5 MW reference monopile wind turbine. The measured response is reproduced in a finite element model using the Morison equation extended to full Lagrangian acceleration with second-order wave kinematics, and with fully non-linear kinematics and the axial divergence term. For the fully nonlinear wave kinematics, the additional point forces of Rainey and Kristiansen & Faltinsen (KF) are further added. In the latter model, the kinematics at the still water level are obtained by Taylor expansion of the kinematics from the free surface. The shear force at the sea bed and the structural accelerations are next compared between the force models and the experimental data. Among the findings are that the extreme force events are generally smallest for the second-order Morison approach, followed by the extended Morison model, and then the Rainey and KF model which produce similar results. While the total accelerations are found to generally match the measurements with fair accuracy, a modal decomposition shows that all models overpredict the response at the first eigenfrequency and underpredict it at the second eigenfrequency for extreme events. The latter is linked to the missing description of slamming loads in the modelling approach. The point force models of Rainey and KF are found to give quite similar results for the extreme events, the reasons for which are demonstrated by regular wave analysis. • Experiments on a bottom-fixed offshore wind turbine in ULS conditions. • Rainey and KF (with fully non-linear irregular wave kinematics) compared to experiments. • KF model performs successfully when Taylor expanding the kinematics around z = 0. • Eightfold difference between Rainey and KF in small amplitude limit disappears for large waves. • The studied models are not generally conservative when estimating ULS response. [ABSTRACT FROM AUTHOR]