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Chronically ill patients may be at risk of re-hospitalization or even death if their care transitions are poorly coordinated. Transitions of care create challenges for care coordination, such as in...

Summary Background Pseudomonas aeruginosa is a common opportunistic pathogen and molecular typing in outbreaks has linked patient acquisition to contaminated hospital water systems. Aim To elucidate the role of P. aeruginosa transmission rates in non-outbreak augmented care settings in the UK. Methods Over a 16-week period, all water outlets in augmented care units of four hospitals were sampled for P. aeruginosa and clinical isolates were collected. Outlet and clinical P. aeruginosa isolates underwent whole-genome sequencing (WGS), which with epidemiological data identified acquisition from water as definite (level 1), probable (level 2), possible (level 3), and no evidence (level 4). Findings Outlets were positive in each hospital on all three occasions: W (16%), X (2.5%), Y (0.9%) and Z (2%); and there were 51 persistently positive outlets in total. WGS identified likely transmission (at levels 1, 2 and 3) from outlets to patients in three hospitals for P. aeruginosa positive patients: W (63%), X (54.5%) and Z (26%). According to the criteria (intimate epidemiological link and no phylogenetic distance), approximately 5% of patients in the study ‘definitely’ acquired their P. aeruginosa from their water outlets in the intensive care unit. This study found extensive evidence of transmission from the outlet to the patients particularly in the newest hospital (W), which had the highest rate of positive outlets. Conclusions The overall findings suggest that water outlets are the most likely source of P. aeruginosa nosocomial infections in some settings, and that widespread introduction of control measures would have a substantial impact on infections.

While the purpose of academic research is to obtain new knowledge and understanding, there is an increasing concern that many scholars value work based upon where it is published rather than on its intrinsic quality. We argue that the degree to which journal ranking lists affect research has an important field-specific component. Using a large-scale survey of UK business academics and underpinned with a conceptual framework inspired by Bourdieu, we examine the attitudes towards journal ranking lists of individuals working within 22 ‘fields’ operating under the umbrella of business and management in the Academic Journal Guide (AJG). We show that scholars in economics and finance at one end of the spectrum, and in organisational studies at the other, systematically differ from accounting scholars in how they relate to the list. While the empirical evidence suggests that finance and economics are more insular than other fields, members of these two fields are the ones who are significantly less likely to consider that journal lists create a ‘research monoculture’, foster ‘technically well-executed but boring research’, or ‘encourage work that is not of interest to practitioners/policy makers’. On the other hand, scholars in organisational studies show the highest agreement with these concerns about journal ranking lists. Our findings have important implications for the evolution of accounting as a field that spans both a critical, interpretive paradigm with a strong focus on organisational context as well as a positivist, financial and capital markets-based research paradigm. If accounting scholars of these two approaches attach different authority to journal ranking lists and the value of publications in highly ranked journals, these perception differences could lead to tensions within the field and could have distortive effects on resource allocations and the career prospects of accounting scholars working in the respective sub-fields.

To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.

Wage inequality has increased across most developed nations; this has been manifested in a wide range of organisations and sectors, with implications for well‐being and sustainability; within UK universities, this has become increasingly visible. There is increasing pressure on universities to deliver social and economic impact in an increasingly market‐driven and metric‐driven environment. In the UK context, increasing financial pressure has led to both an escalation of student fees and constrained wage growth for faculty. In contrast, most Vice Chancellors have secured substantive pay packages raising concerns that regulatory failures may be contributing to the rise. We show that Vice Chancellors use their internal power within organisations to extract a disproportionate amount of the value created by the institution. However, we encountered much diversity according to the quality of governance, highlighting the extent to which not only contextual but also internal dynamics drive wage inequality.

Academics often judge themselves and are judged by others according to the status of the journals in which they publish. Little is known about whether individual scholars would choose to publish an article in a high-status journal if it would garner similar or lower levels of scholarly impact than an article published in a lower-status journal. Drawing upon status theory, we explore whether and how much business school academics are willing to ‘pay’, as captured by a hypothetical level of ‘forfeited’ citations, to publish in high-status 4* journals rather than leading specialized 4-rated journals. Using choice-set design and survey data from UK business and management scholars, we suggest and empirically demonstrate that the willingness to forgo citations to publish in 4* journals is strongest among academics who have already published in 4* and/or 4-rated journals. Contrary to our expectations, we find that an individual’s existing scholarly impact, as captured by prior citations, has no effect on this preference. We also show that academics working in high-ranked institutions would give up more citations for 4* journal publication than those working at lower-ranked institutions. We explore the implications of these findings for theories of academic status, journal rankings and research assessment systems.

Background: Many countries re-opened schools after national lockdown but little is known about the risk of SARS-CoV-2 infection and transmission in educational settings. Public Health England conducted six-month prospective surveillance in primary schools across England. Methods: The COVID-19 Surveillance in School KIDs (sKIDs) study included two arms: weekly nasal swabs for ≥4 weeks following partial reopening during the summer half-term (June to mid-July 2020) and blood sampling with nasal and throat swabs at the beginning and end of the summer half-term, and, following full reopening in September 2020, at the end of the autumn term (end-November 2020). Results: In round 1, 12,026 participants (59.1% students, 40.9% staff) in 131 schools had 43,091 swabs taken. Weekly SARS-CoV-2 infection rates were 3.9 (1/25,537; 95% CI, 0.10-21.8) and 11.3 (2/17,554; 95% CI, 1.4-41.2) per 100,000 students and staff. At recruitment, N-antibody positivity in 45 schools was 11.1% (91/817; 95%CI, 9.2-13.5%) in students and 15.1% (209/1381; 95%CI, 13.3-17.1%) in staff, similar to local community seroprevalence. Seropositivity was not associated with school attendance during lockdown or staff contact with students. Round 2 participation was 73.7% (1,619/2,198) and only five (4 students, 1 staff) seroconverted. In round 3, when 61.9% (1,361/2,198) of round 1 participants were re-tested, seroconversion rates were 3.4% (19/562; 95%CI, 2.0-5.2) in students and 3.9% (36/930; 95%CI, 2.7-5.3) in staff. Conclusions: SARS-CoV-2 infection rates, assessed using nasal swabs for acute infection and serum antibodies for prior infection, were low following partial and full reopening of primary schools in England. Funding Statement: This surveillance was funded by the Department of Health and Social Care (DHSC). Declaration of Interests: None to declare. Ethics Approval Statement: The surveillance protocol was approved by the Public Health England Research Ethics Governance Group (R&D REGG Ref: NR0209, 16 May 2020).

The quantity of finance research has grown enormously over the past two decades, yet questions remain over its breadth and ability to benefit the economy and society beyond academia. Using multisource data, we argue that individual and institutional incentives have fostered insularity and a consequent homogeneity in the discipline. We examine the characteristics of research that is published and cited in the leading field journals in finance, arguing that the work has become abstract and unrelated to real world issues. The work published in the ‘top’ journals makes increasing use of US data, even where the researchers are drawn from different countries. Using information from impact assessment, publication patterns, and grant capture, we illustrate that this narrow agenda lacks relevance to the financial services sector, the economy or wider society compared to other areas of business and management research. In particular, we highlight the relative absence of research on ethics in academic finance and discuss the likely consequences for the discipline including its relevance to society.

A tin-loaded liquid scintillator has been developed for gamma spectroscopy and neutron detection. The scintillator was characterized in regard to energy resolution, pulse shape discrimination, neutron light output function, and timing resolution. The loading of tin into scintillators with low effective atomic number was demonstrated to provide photopeaks with acceptable energy resolution. The scintillator was shown to have reasonable neutron/gamma discrimination capability based on the charge comparison method. The effect on the discrimination quality of the total charge integration time and the initial delay time for tail charge integration was studied. To obtain the neutron light output function, the time-of-flight technique was utilized with a 252Cf source. The light output function was validated with the MCNPX-PoliMi code by comparing the measured and simulated pule height spectra. The timing resolution of the developed scintillator was also evaluated. The tin-loading was found to have negligible impact on the scintillation decay times. However, a relatively large degradation of timing resolution was observed due to the reduced light yield.

From the mid-1950s to the early 1980s the Treasury and Bank of England successfully advocated a policy of restricting both private and public sector house-building, as a key but covert instrument of their wider ‘stop-go’ macroeconomic policy framework. While the intensity of restrictions varied over the economic cycle, private house-building was restricted (through limiting mortgage availability) for almost all this period. This was achieved by keeping building society interest rates low relative to other interest rates and thus starving the building society movement of mortgage funds. Mortgage restriction was never publicly discussed and sometimes operated alongside ambitious housing targets and well-publicised policy initiatives to boost housing demand. This paper outlines the evolution of house-building restriction, together with its impacts on the housing sector and the wider economy. We review the evolution of the policy framework and its consequences, compare the level and stability of British house-building during this period - historically and relative to other countries, and undertake time-series econometric analysis of its impacts on both house-building and house prices. Finally, implications for debates regarding stop-go policy, Britain’s housing problem, and the distributional consequences of government macroeconomic policy are discussed.

The development of the Association of Business Schools’ (ABS) list in 2007 and its rapid adoption by UK business schools has had a profound effect on the nature of business and management academics’ ways of working. Using a large-scale survey of UK business academics, we assess the extent to which individuals use the Academic Journal Guide (AJG/ABS) list in their day-to-day professional activities. In particular, we explore how their perceptions of the list, the academic influence of their research, academic rank and organizational context drive the varied use. Building on prior research on the importance of univalent attitudes in predicting behaviour, we find those who have either strong positive or negative views of the list are more extensive users than those who are ambivalent. We also find that the extent of use of the AJG/ABS list is greatest among those academics who have lower academic influence, in the middle or junior ranks within Business Schools and in middle and low-status universities. We explore the implications of these findings for the value of journal rankings and for the management of business schools.

Research about the Covid-19 pandemic has taken centre stage in shaping the work of many scholars, inter alia highlighting the importance of research in addressing the grand challenges humanity faces. However, the pandemic has also ushered in increased administrative, teaching and out of work commitments for many researchers, leading to concerns that academics will become less willing to invest time in obtaining resources to undertake non-Covid-related projects. Using a large-scale survey of business, economics and management researchers, coupled with their publication histories and additional institutional data, we examine how far individuals experienced the focus on the pandemic as ‘crowding out’ interest in, and undermining their confidence in applying for grants for work not focused on the pandemic. We found 40% of the sample agree that the pandemic has impaired their confidence in applying for non-pandemic-related grants and ‘crowded out’ other projects. Researchers with current and prior grants, particularly those with the most experience of holding grants, scholars whose work ‘impacted’ beyond academia, and early career researchers, disproportionately considered themselves to be most affected. We also found that researchers’ perceptions differed based on institutional characteristics. We discuss the implications of these findings for grant providers and national research agencies as well as for individual academic researchers and the institutions in which they work.

Summary Background Pseudomonas aeruginosa infections have been linked to contaminated hospital taps, highlighting the potential for tap outlet fittings (OF) to harbour biofilm. P. aeruginosa may be transferred to OFs via contaminated cleaning cloths. Suggested interventions include flushing regimens and alternative OF designs. Aim To investigate the transfer of P. aeruginosa from a contaminated cleaning cloth to conventional and ‘antimicrobial/antibiofilm' OFs and to determine whether this contamination persists and/or leads to contamination of tap water. Methods Microfibre cloths contaminated with P. aeruginosa (10 8 cfu/mL) were used to wipe four different types of OF [one of conventional design (OF-A) and three marketed as ‘antimicrobial' and/or ‘antibiofilm' (OF- B, -C and -D)]. OFs were inserted into an experimental water distribution system for up to 24 h. Survival was assessed by culture. Single and multiple water samples were collected and cultured for P. aeruginosa . Findings The median number of P. aeruginosa transferred from cloth to OF was 5.7 × 10 5 cfu (OF-A), 1.9 × 10 6 cfu (OF-B), 1.4 × 10 5 cfu (OF-C) and 2.9 × 10 6 cfu (OF-D). Numbers declined on all OFs during the 24 h period with log reductions ranging from 3.5 (OF-C) to 5.2 (OF-B; P > 0.05). All water samples delivered immediately after OF contamination contained P. aeruginosa at ≥10 cfu per 100 mL. Contamination of water delivered from OF-A persisted despite continued flushing. Water delivered from OF-B did not contain P. aeruginosa beyond the first flush. Conclusion Contaminated cleaning cloths may transfer P. aeruginosa to OFs, leading to contamination of tap water. Although not removing the potential for contamination, ‘antimicrobial/antibiofilm' OFs may prevent P. aeruginosa from continually contaminating water delivered from the outlet.

The global outbreak of COVID-19 led to a rapid shift to Working from Home (WFH). In Universities and other of the education sector, on-line teaching and assessment becoming mandatory. We use research from a representative large-scale (n=2,287) survey of business, management and economics academics in the UK to examine how prior on-line experience, learning during the ‘lockdown’, and work engagement, impacted their perceptions of on-line education. Results show that: (1)experience of on-line activity prior to the lockdown was substantially positively related to perceptions of working virtually, though perceptions differed by seniority; (2) While experience of working on-line during lockdown did not enhance academic’s views of on-line delivery or any bias against on-line delivery, it did increase positive attitudes towards on-line marking; (3) Those able to maintain mental resilience and energy are considerably more likely to perceive on-line activity positively; but being more ‘dedicated’ or more ‘ensconced in work’ did not play a role. We explore the implications of these findings for the future of on-line work.

Pseudomonas aeruginosa is a ubiquitous and important opportunistic pathogen in immunocompromised or critically ill patients. Nosocomial P. aeruginosa outbreaks have been associated with hospital water sources. In the UK, high profile incidents, specifically those in Northern Ireland, highlighted the link between P. aeruginosa, tap water and clinical infection. Water sampling undertaken on augmented care areas has reported up to 30% of tap outlets being positive for P. aeruginosa at any one time. Molecular typing of patient and water isolates have suggested high transmission rates of P. aeruginosa from the water to patients on the ICU (up to 30%–50% in some cases). As a consequence, there is a plethora of guidance available related to the sampling and testing of P. aeruginosa in healthcare premises, with advice on interventions to stop transmission of P. aeruginosa. In this book chapter we describe the clinical setting and patient populations affected by P. aeruginosa. We also discuss the waterborne sources and potential transmission routes of P. aeruginosa. Finally we give examples of the Infection Prevention measures used to control P. aeruginosa waterborne transmission including both engineering interventions and holistic human factors to minimize contamination of water outlets and the subsequent clinical impact to patients. The role of waterborne transmission of P. aeruginosa in augmented care areas cannot be overlooked. We suggest reducing the transmission of waterborne P. aeruginosa involves both holistic and engineering factors.

AimTo present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations.MethodsAn SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018).ResultsWhile most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved.ConclusionEvidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.

The marked increase in the use of metrics, such as journal lists, to assess research has had a profound effect on academics’ working lives. While some view the diffusion of rankings as beneficial, others consider their diffusion as a malicious development, which further acerbates a tendency towards managerialism in academia, and undermine the integrity and diversity of academic research. Using data from a large-scale survey and a re-grading of journals in a ranking used by Business and Management UK scholars—the Academic Journal Guide—as a pseudo-experiment, we examine what determines negative and positive perceptions of rankings. We find that the individuals who published in outlets that were upgraded were less hostile to the ranking than those who did not benefit from these changes, and that individuals were also less hostile to the ranking if outlets in their field had benefited from re-grading in the new list. We also find that the individuals who published in outlets that were upgraded were more positive to the ranking than those who did not benefit from these changes, and that individuals were also more positive to the ranking if outlets in their field had benefited from re-grading in the new list.

We examine the early marketing and distribution of entertainment radio sets. Manufacturers used distribution networks to both maximize profits and create barriers to entry. Lacking the market power of auto manufacturers, they developed cooperative strategies with authorized distributors and dealers. Dealers often complained about the costly activities manufacturers required of them. However, these underpinned the dominant quality and branding competition model of the 1920s, while the Depression-era switch to a simpler radio format, sold on price, proved catastrophic for the specialist retailer.

The rise in international markets of new, productive Japanese car manufacturers provoked intense world competition, which created serious doubts about the economic sustainability of an industry mostly dominated until the 1970s by European and North-American multinational companies. Ultimately, this crisis provoked a deep transformation of the industry, with consequences that had a permanent impact on European companies in the sector. American and later European manufacturers were successful in lobbying governments to provide protection. Using a rich source of data from the UK, I show that the ‘new trade policy’, voluntary export restraint (VER), placed on Japanese exports of new cars from 1977 to December 1999, was binding. This case study illustrates the strategies used by Japanese manufacturers to gain access to the European market through the UK market via strategic alliances and later through transplant production, against which continental European nation states were unable to fully insulate themselv...

Background Cancer and chronic disease are leading causes of death in the US with an estimated cost of $46 billion. Methods We analyzed 11 million cause-specific deaths of US workers age 18–64 years in 30 states during 1985–1999, 2003–2004, and 2007 by occupation, industry, race, gender, and Hispanic origin. Results The highest significantly elevated proportionate leukemia mortality was observed in engineers, protective service, and advertising sales manager occupations and in banks/savings l and wholesale farm supplies, agricultural chemical, synthetic rubber, and agricultural crop industries. Conclusions Significantly elevated risks for acute myocardial infarction and leukemia were observed across several occupations and industries that confirm existing reports and add new information. Interested investigators can access the NOMS website at http://www.cdc.gov/niosh/topics/NOMS/. Am. J. Ind. Med. 58:123–137, 2015. © 2015 Wiley Periodicals, Inc.

I evaluate the voluntary export restraint placed on Japanese automobile exports from 1977 to 1999 by the UK. I show that the policy failed to assist the British domestic car industry. Instead, UK-based US multi-nationals and Japanese manufacturers were the primary beneficiaries, at a substantial cost to UK consumers. Whilst there are a number of caveats, the policy was on balance damaging to the UK economy in welfare terms.

Academics are under increasing pressure to demonstrate the impact of their research with external actors. Some national research assessment systems have mandated academics to document their impact on non-academic actors, and linked research funding to assessments of these impacts. Although there has been considerable debate around the design of these systems, little is known about how academics perceive the value of impact against more conventional academic outputs, such as publications. Using multisource data, including a large-scale survey of UK business and management academics, this paper explores the individual and institutional factors that explain an individual’s preference for impact versus publication. The results show that academics display a preference for impact over publications, even when that impact is not associated with requirements of the assessment system in terms of rigour of the underpinning research. The preference for impact over publications is heightened by organization tenure, non-academic work experience, intrinsic career motivations and research-intensive contexts, while it is weakened by academic influence, extrinsic career motives and academic rank. We explore the implications of these findings for the design of research assessment systems and academics’ reactions to them.

Background Understanding Staphylococcus aureus dispersal from human carriers is vital for preventing transmission and colonization of this organism in health care settings. This study investigated the S aureus supershedder hypothesis in relation to attributes of healthy volunteers. Methods Microbial aerosol generation from volunteers was quantified within a controlled environmental chamber during walking or sitting activities. Biological air samplers were used to determine numbers of total S aureus colony-forming units disseminated during these activities. Results A total of 17 volunteers was sampled on 3 occasions. Hairstyle (long hair tied up or a shaved head) was the only significant predictor of dissemination of S aureus (5% significance level). No other significant effects were found at the 5% level. A negative binomial distribution provides the best fit with respect to S aureus . Conclusion We found that, in the context of our small sample size, hairstyle (long hair tied up or a shaved head) statistically affected levels of bacteria shed from volunteers. However, we found no evidence for "supershedders" or "cloud adults," suggesting they are at an extreme end of a continuous distribution.

ObjectivesThe aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.MethodsA literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.ResultsSixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.ConclusionCurrent evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

Much of what is currently documented in the electronic health record is in response toincreasingly complex and prescriptive medicolegal, reimbursement, and regulatory requirements. These requirements often result in redundant data capture and cumbersome documentation processes. AMIA's 2011 Health Policy Meeting examined key issues in this arena and envisioned changes to help move toward an ideal future state of clinical data capture and documentation. The consensus of the meeting was that, in the move to a technology-enabled healthcare environment, the main purpose of documentation should be to support patient care and improved outcomes for individuals and populations and that documentation for other purposes should be generated as a byproduct of care delivery. This paper summarizes meeting deliberations, and highlights policy recommendations and research priorities. The authors recommend development of a national strategy to review and amend public policies to better support technology-enabled data capture and documentation practices.

Minimalist running is increasing in popularity based upon a concept that it can reduce impact forces and decrease injury rates. The purpose of this investigation is to identify the rate and severity of injuries in runners transitioning from traditional to minimalist footwear. The secondary aims were to identify factors correlated with injuries.Fourteen habitually shod (traditional running shoes) participants were enrolled for this prospective study investigating injury prevalence during transition from traditional running shoes to 5-toed minimalist shoes. Participants were uninjured, aged between 22-41 years, and ran at least twenty kilometers per week in traditional running shoes. Participants were given industry recommended guidelines for transition to minimalist footwear and fit with a 5-toed minimalist running shoe. They completed weekly logs for identification of injury, pain using Visual Analogue Scale (VAS), injury location, and severity. Foot strike pattern and impact forces were collected using 3D motion analysis at baseline, 4 weeks, and 12 weeks. Injuries were scored according to a modified Running Injury Severity Score (RISS).Fourteen runners completed weekly training and injury logs over an average of 30 weeks. Twelve of 14 (86%) runners sustained injuries. Average injury onset was 6 weeks (range 1-27 weeks). Average weekly mileage of 23.9 miles/week prior to transition declined to 18.3 miles/week after the transition. The magnitude of the baseline impact transient peak in traditional shoes and in minimalist shoes negatively correlated with RISS scores (r = -0.45, p = 0.055 and r = -0.53, p = 0.026, respectively).High injury rates occurred during the transition from traditional to minimalist footwear. Non-compliance to transition guidelines and high injury rates suggest the need for improved education. High impact transient forces unexpectedly predicted lower modified RISS scores in this population.

While care managers use multiple health IT applications to coordinate patient care across transitions of care, they experience challenges posed by these multiple health IT applications. We used a macroergonomic framework (i.e. the work system model), and conducted interviews and observations of care managers (inpatient, outpatient, transition of care) and a web-based survey to assess these challenges. The challenges were related to the care managers’ work system: technologies and tools (e.g., poor interface design of health IT), organization (e.g., no access to some health IT applications), and tasks (e.g., duplicate documentation). Care managers consider the following as major barriers: transferring patient-related information between multiple applications, finding correct information for medication reconciliation and other patient information (e.g., patient’s psychosocial background), and duplicate documentation and data entry. The next phase of the research focuses on how care managers deal with challenges posed by multiple health IT applications to perform their job of coordinating patient care across transitions of care.

Implementing large-scale complex health IT projects poses significant challenges to organizations. This paper discusses one Office of the National Coordinator for Health IT Beacon project aimed at implementing an IT-mediated care coordination model across multiple care settings in multiple communities. We posit that using participatory ergonomic methods to collect and promptly report findings to the project management team provides significant impetus for organizational learning and increases the likelihood of success of this large-scale health IT implementation project. We describe how we involve management team members in the ongoing regular evaluation of the project through short monthly Web-based surveys and semi-annual individual interviews. The goal of this process is to promote organizational learning and impact the success of this and future complex large-scale projects.

Summary Background Noroviruses are a leading cause of gastrointestinal disease and are of particular concern in healthcare settings such as hospitals. As the virus is reported to be environmentally stable, effective decontamination following an outbreak is required to prevent recurrent outbreaks. Aim To investigate the use of hydrogen peroxide vapour to decontaminate a number of surfaces that had been artificially contaminated with feline calicivirus (FCV), a surrogate for norovirus. The surfaces tested were representative of those found in hospital wards. Methods FCV was used to contaminate materials representative of a hospital setting (stainless steel, glass, vinyl flooring, ceramic tile and PVC plastic cornering). The carriers were exposed to 30% (w/w) hydrogen peroxide vapour at 5-min intervals over 20min, after which postexposure viral titres were measured. Findings Hydrogen peroxide vapour reduced the viral titre by 4 log 10 on all surfaces tested within 20min of exposure. The reduction in viral titre took longest to achieve on stainless steel (20min), and the quickest effect was seen on vinyl flooring (10min). For glass, plastic and ceramic tile surfaces, the desired reduction in viral titre was seen within 15min of exposure. Hydrogen peroxide vapour allows for large-scale decontamination of areas following outbreaks of infectious organisms. Conclusion Hydrogen peroxide vapour is effective against FCV and is active on a range of surfaces. Therefore, it may represent a suitable decontamination system for use following a hospital outbreak of norovirus.

The 1930s witnessed an intense struggle between gas and electricity suppliers for the working class market, where the incumbent utility--gas--was also a reasonably efficient (and cheaper) General Purpose Technology for most domestic uses. Local monopolies for each supplier boosted substitution effects between fuel types--as alternative fuels constituted the only local competition. Using newly-rediscovered returns from a major national household expenditure survey, we employ geographically-determined instrumental variables, more commonly used in the industrial organization literature, to show that gas provided a significant competitor, tempering electricity prices, while electricity demand was also responsive to marketing initiatives. Copyright 2011 Oxford University Press 2011 All rights reserved, Oxford University Press.

This study assessed the efficacy of two commonly used gaseous disinfection systems against high concentrations of a resistant viral surrogate in the presence and absence of soiling. MS2 bacteriophage suspensions were dried on to stainless steel carriers and exposed to hydrogen peroxide vapour (HPV) and vapour hydrogen peroxide (VHP) gaseous disinfection systems. The bacteriophages were also suspended and dried in 10% and 50% of horse blood to simulate the virus being present in a spill of blood/bodily fluids in a hospital ward environment. Carriers were removed from the gaseous disinfectant at regular intervals into phosphate-buffered saline, vortexed and assayed using a standard plaque assay. The effectiveness of both the HPV and VHP systems varied with the concentration of the bacteriophage with HPV resulting in a 6log(10) reduction in 10 min at the lowest viral concentration [10(7) plaque-forming units (pfu)/carrier] and requiring 45 min at the highest concentration (10(9) pfu/carrier). For the VHP system a 30 min exposure period was required to achieve a 6log(10) reduction at the lowest concentration and 60-90 min for the highest concentration. The addition of blood to the suspension greatly reduced the effectiveness of both disinfectants. This study demonstrates that the effectiveness of gaseous disinfectants against bacteriophage is a function of the viral concentration as well as the degree of soiling. It highlights the importance of effective cleaning prior to gaseous disinfection especially where high concentration agents are suspended in body fluids to ensure effective decontamination in hospitals.

Understanding the antibiotic medication use process in the intensive care unit (ICU) is important for patient care outcomes. A system view of the medication use process facilitates understanding the role of communication between various disciplines in ensuring the timely administration of antibiotics. Antibiotic-related medication safety events (N = 312) were collected in two adult ICUs. We describe the information and communication flow in the medication use process and show the complexity of the process. An in-depth analysis of 101 (32%) events for late first-dose antibiotic identifies multiple factors contributing to the events.

Cleaning of dental instruments is the first line of control in reducing the adherent bioburden. The threat of vCJD and the difficulty in removing prion protein has provided a new challenge for cleaning surgical and dental instruments. Prion proteins are also more resistant to many disinfection and sterilisation techniques. A number of different methods are currently available in primary care for cleaning instruments including manual washing, ultrasonic cleaners and washer disinfectors. Manual cleaning of dental instruments is time-consuming, introduces operator error and the risk of puncture wounds, is not reproducible and does not completely remove debris from instruments. Ultrasonic baths are significantly more effective than hand cleaning alone and are currently used by the majority of dental surgeries (often as an adjunct to manual cleaning). Automated washer-disinfectors appear to provide a validated, reliable and reproducible procedure for disinfection and sterilisation of dental instruments to ensure both the safety of patients and dental staff. Dental instruments that are difficult to clean are frequently contaminated with tissue debris after routine reprocessing and cannot be excluded as a potential transmission risk for infectious agents, including prions. The transmission of vCJD via dentistry is considered to be low risk, however, the Department of Health (DoH) has recently advised dentists to ensure that endodontic reamers and files are treated as single-use as a precautionary basis in order to further reduce any risk of vCJD transmission.

New prion-related disorders have emerged over the past 20 years, of which the most notable in the human context is variant Creutzfeldt-Jakob disease (CJD). This disorder is a challenge to medical and public health professionals seeking early detection and diagnosis, provision of therapy, and support for persons affected and a better understanding of transmission risks. The risk of iatrogenic transmission of the disease remains a significant threat, given the well documented cases of CJD transmission via surgery, organ transplantation, and blood transfusion. This review discusses our current understanding of the prevalence of variant CJD, the distribution of tissue infectivity, and new methods for the decontamination of surgical instruments. A comparison of emerging technologies is provided on the basis of our current perception of surgical risk to identify methods that are likely to provide sufficient safety margins and to stimulate debate about the standards needed to protect against variant CJD and CJD transmission.

Summary The issues of cross-infection and the survival of variant Creutzfeldt Jakob disease (vCJD) on surgical instruments have highlighted the importance of cleanliness of multiple-use surgical instruments. The aim of this study was to assess the levels of total protein contamination on a wide range of surgical instruments as an indication of the effectiveness of routine cleaning and disinfection in hospitals. Anonymized trays of wrapped and autoclaved instruments were supplied to two laboratories for analysis at the stage where they would normally be returned to operating theatres. Instruments were assessed for residual protein and total organic matter. Laboratory A showed that 17% (35/206) of instruments were above a threshold that equated to 200 μg. The worst examples, a McIvor gag, a Draffin rod (child) and a Yankaur sucker, had 1.028, 1.286 and 2.228 mg of extractable protein, respectively. The median (25th, 75th percentiles) amount of protein from instruments from different hospitals assessed in Laboratory B ranged from 8 (3, 30) μg (Hospital C) to 91 (35, 213) μg (Hospital D) (P = 0.044). The residual matter washed from instruments varied from 0.62 (0.32, 0.81) mg (Hospital E) to 3.5 (3.5, 4.0) mg (Hospital A) (P = 0.0001). In one case, 45 mg of residual organic matter was washed from an instrument (split stem). In conclusion, this study demonstrated that a proportion of instruments at the point of use show levels of protein that could pose a direct cross-infection risk via prion agents and other organic contamination that may reduce the effectiveness of cleaning/disinfection strategies targeted against either prions or traditional infectious agents.

We show that hedonic price indices that omit model-specific unobservable product attributes are subject to considerable bias. We utilize a complete panel of new car versions marketed in the UK over 1971–98 which incorporates over 100 observable product characteristics, sales weighting to capture the distribution of purchases across models, and model-specific fixed effects to account for unobservable characteristics. We find that quality-adjusted prices obtained from hedonic regressions that do not account for unobservable characteristics exhibit a severe downward bias. We also show that quality-adjusted prices exhibit distinct sub-market differences having increased in ‘mass production’ segments and decreased in ‘specialized niches’.

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 48:63–77 (2005) Potential Occupational Risks for Neurodegenerative Diseases Robert M. Park, MS , 1 A Paul A. Schulte, PhD , 1 Joseph D. Bowman, PhD , CIH , 2 James T. Walker, PhD , 3 Stephen C. Bondy, MA , PhD , 4 Michael G. Yost, MS , PhD , 5 Jennifer A. Touchstone, MS , 5 and Mustafa Dosemeci, PhD6 Background Associations between occupations and neurodegenerative diseases (NDD) may be discernable in death certificate data. Methods Hypotheses generated from 1982 to 1991 study were tested in data from 22 states for the years 1992–1998. Specific occupations and exposures to pesticides, solvents, oxidative stressors, magnetic fields, and welding fumes were evaluated. Results About one third (26/87) of the occupations hypothesized with neurodegenerative associations had statistically significant elevated mortality odds ratios (MOR) for the same outcome. Occupations with the largest MORs were (a) for presenile dementia (PSD)— dentists, graders/sorters (non-agricultural), and clergy; (b) for Alzheimer’s disease (AD)—bank tellers, clergy, aircraft mechanics, and hairdressers; (c) for Parkinson’s disease (PD)—biological scientists, clergy, religious workers, and post-secondary teachers; and (d) for motor neuron disease (MND)—veterinarians, hairdressers, and graders and sorters (non-agricultural). Teachers had significantly elevated MORs for all four diseases, and hairdressers for three of the four. Non-horticultural farmers below age 65 had elevated PD (MOR ¼ 2.23, 95% CI ¼ 1.47–3.26), PSD (MOR ¼ 2.22, 95% CI ¼ 1.10–4.05), and AD (MOR ¼ 1.76, 95% CI ¼ 1.04–2.81). Sixty hertz magnetic fields exhibited significant exposure-response for AD and, below age 65, for PD (MOR ¼ 1.87, 95% CI ¼ 1.14–2.98) and MND (MOR ¼ 1.63, 95% CI ¼ 1.10–2.39). Welding had elevated PD mortality below age 65 (MOR ¼ 1.77, 95% CI ¼ 1.08–2.75). Conclusions Support was observed for hypothesized excess neurodegenerative disease associated with a variety of occupations, 60 Hz magnetic fields and welding. Am. J. Ind. Med. 48:63–77, 2005. Published 2005 Wiley-Liss, Inc. { KEY WORDS: Alzheimer’s disease; hairdresser; motor neuron disease; magnetic field; Parkinson’s disease; pesticide; welding Abbreviations: AD, Alzheimer’s disease; ALS, amyotrophic lateral sclerosis; BOC, Bureau of the Census; EMF, electromagnetic field; MND, motor neuron disease; MOR, mortality odds ratio; NDD, neurodegenerative disease; PD, Parkinson’s disease; PMR, proportionate mortal- ity ratios; PSD, presenile dementia. Education and Information Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, Ohio Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio Department of Community & Environmental Medicine, University of California, Irvine, California Published 2005 Wiley-Liss, Inc. This article is a US Government work and, as such, is in the public domain in the United States of America. Department of Environmental Health, University of Washington, Seattle,Washington Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland *Correspondence to: Robert M. Park, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Education and Information Division, MS C-15, 4676 Columbia Parkway, Cincinnati, OH 45226. E-mail: rhp9@cdc.gov Accepted 27 March 2005 DOI 10.1002/ajim.20178. Published online in Wiley InterScience (www.interscience.wiley.com)

Mycobacterium chimaera was present at high rates (80%) in heater-cooler units (HCUs) from all 5 thoracic surgery departments in Denmark. Isolates were clonal to HCU-associated isolates from the United States (including some from patients) and United Kingdom. However, M. chimaera from 2 brands of HCU were genetically distinct.

This study examines if and how gender relates to research evaluation via panel assessment and journal ratings lists. Using data from UK business schools we find no evidence that the proportion of women in a submission for panel assessment affected the score received by the submitting institution. However, we do find that women on average receive lower scores according to some journal ratings lists. There are important differences in the rated quality of journals that men and women publish in across the sub-disciplines with men publishing significantly more research in the highest rated accountancy, information management and strategy journals. In addition, women who are able to utilise networks to co-author with individuals outside their institution are able to publish in higher-rated journals, although the same is not true for men; women who are attributed with “individual staff circumstances” (e.g. maternity leave or part-time working) have lower scores according to journal ratings lists.

Water quality regulations require that potable water is supplied free of microbial pathogens. Although this is generally achieved, the incidence of waterborne outbreaks associated with potable water has been increasing over the last decade. Infection from pathogens such as Campylobacter spp., Salmonella spp., Cryptosporidium and Giardia and viral infections are on the increase, with the protozoans presenting their own particular problems due to chlorine resistance. Biofilm bacteria are generally more resistant to biocides than planktonic microorganisms. Thus, the water industry is presented with a problem, particularly with pathogens that enter the water system and become incorporated into biofilms. The presence of biofilms in potable water systems is discussed in terms of their development, structure, function and quantification on surfaces. Survival of specific water‐borne microbial pathogens is discussed in relation to their mode of growth in biofilms. Factors that influence growth such as nutrient ava...

Background Nearly one million U.S. women are employed as health or science technicians with various chemical and biological exposures, but few studies have looked at their health outcomes. Methods Using 1984–1995 mortality data with coded occupation information, we calculated race- and age-adjusted proportionate cancer mortality ratios (PCMRs) and 95% confidence intervals for two age groups for black and white women with occupations of clinical laboratory (CLT), radiologic, and science technician. Results For CLTs, the PCMRs for breast cancer were borderline significantly elevated. The PCMRs for leukemia were significantly elevated, particularly for myeloid leukemia. Radiologic technicians had no significantly elevated PCMRs. Science technicians had significantly elevated PCMRs for non-Hodgkin's lymphoma and multiple myeloma in the younger age group. Discussion The elevated risks for lymphatic and hematopoietic neoplasms in CLTs and science technicians may be associated with occupational exposures. Am. J. Ind. Med. 36:155–158, 1999. Published 1999 Wiley–Liss, Inc.

Our study examined cancer mortality before the age of 65 for women employed in the fastest growing and/or traditionally female occupations. Analysis of mortality data from 28 U.S. states for 1984-1995 revealed elevated proportionate cancer mortality ratios (PCMRs). The highest PCMRs observed were thyroid cancer among health aides, lymphatic and multiple myeloma among computer programmers, and brain cancer among actresses and directresses. Some of the excess mortality occurred for occupations that have been previously cited. These included elevated breast and ovarian cancer among teachers, Hodgkin's disease among hairdressers and cosmetologists, and thyroid cancer among health aides and therapists. A few of the associations were new, i.e., had not been previously observed. These included cancer of the connective tissue and lymphatic system among computer programmers, ovarian cancer and leukemia among secretaries, and lymphatic cancer and multiple myeloma among child care workers. These findings should be further investigated with epidemiologic and environmental studies.

The control of hospital-acquired infection (HAI) in the future will be challenging. As hospitals across the United Kingdom face increasing financial restrictions healthcare staff have to cope with a rising workload, fewer staff, higher throughput of patients, and high ward occupancy rates. Clinicians are beginning to make smarter choices based on the availability of up-to-date guidance that enables them to make risk assessment-based decisions at the local level. Healthcare professionals make choices in what disinfectants are used to control environmental microorganisms, and testing is required to allow them to make informed decisions on effective antimicrobial agents. Antimicrobial surfaces and nontouch gaseous decontamination technologies may have a role to play in decontamination of the built environment but the fundamentals of cleaning must not be forgotten if these technologies are really to make significant reductions in HAI. Decontamination guidance for surgical instruments has recently been updated and reverts to a Health Technical Memorandum. The decontamination of prions has driven improvements in central sterile services departments in the reprocessing of surgical instruments and endoscopes and healthcare professionals must be vigilant to prevent the potential for patient to patient transmission. Research is fundamental to the future of disinfection and decontamination in hospitals and both industry and research institutions must continue to development novel strategies.

Decontamination and disinfection are essential in hospitals to protect patients and control healthcare-acquired infections (HAIs). Historically, specialists such as Alexander Gordon, Ignaz Semmelweis, and Florence Nightingale recognized the importance of hand hygiene and cleanliness. Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile cause thousands of fatalities per year in our hospitals but strategies implemented by the Department of Health (England) have reduced HAI rates. The emergence of variant Creutzfeldt-Jakob disease (vCJD) prompted a reappraisal of the treatment of surgical instruments in contact with high-risk tissues to prevent transmission. Prions and emerging infections such as Ebola and Candida auris demonstrate that there are still major challenges in the world of decontamination and disinfection and as healthcare professionals it is our duty to remain vigilant against future disease threats. HAI and particularly antibiotic-resistant microorganisms will continue to be a major threat to patients in our hospitals.

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

In December 2011 and early 2012 four neonates died from Pseudomonas aeruginosa bacteraemia in hospitals in Northern Ireland.To assess whether P. aeruginosa was associated with the neonatal unit taps and whether waterborne isolates were consistent with patient isolates.Thirty taps and eight flow straighteners from the relevant hospitals were categorized and dismantled into 494 components and assessed for aerobic colony and P. aeruginosa counts using non-selective and selective agars. P. aeruginosa isolates were typed by variable number tandem repeat (VNTR) analysis. Selected tap components were subjected to epifluorescence and scanning electron microscopy to visualize biofilm.The highest P. aeruginosa counts were from the flow straighteners, metal support collars and the tap bodies surrounding these two components. Complex flow straighteners had a significantly higher P. aeruginosa count than other types of flow straighteners (P 0.05). Highest aerobic colony counts were associated with integrated mixers and solenoids (P 0.05), but there was not a strong correlation (r = 0.33) between the aerobic colony counts and P. aeruginosa counts. Representative P. aeruginosa tap isolates from two hospital neonatal units had VNTR profiles consistent with strains from the tap water and infected neonates.P. aeruginosa was predominantly found in biofilms in flow straighteners and associated components in the tap outlets and was a possible source of the infections observed. Healthcare providers should be aware that water outlets can be a source of P. aeruginosa contamination and should take steps to reduce such contamination, monitor it and have strategies to minimize risk to susceptible patients.

Urinary catheters and legs bags were simultaneously colonized by Escherichia coli and Proteus vulgaris using a model urinary drainage system. the system was continuously supplied with filter-sterilized artificial urine using a diurnal flow pattern. The extent of colonization was determined by assessment of both planktonic and biofilm formation over time. Contamination of the catheters resulted in rapid colonization of the whole system within a 24 h period. Contamination of the leg bags resulted in an ascending biofilm formation over a four-day period. Results indicated that infection risk could be minimized by changing the catheter and leg bags at least once a week. The design of the leg bags was not found to influence the rate or extent of biofilm formation.