Improving healthcare worker adherence to the use of transmission-based precautions through application of human factors design: a prospective multi-centre study

A key component of transmission-based precautions (TBPs) is the use of personal protective equipment (PPE) but healthcare worker (HCW) adherence remains suboptimal. A human factors-based intervention was implemented to improve adherence to TBPs including (i) improved signage, (ii) standardized placement of signage, (iii) introduction of a mask with integrated face shield, and (iv) improvement in PPE availability. Donning of the correct PPE by HCWs improved significantly (79.7 vs 56.4%; P < 0.001). This approach may be more effective than education alone, but further study is required to determine sustainability and subsequent impact on transmission of healthcare-associated infections.

Prenatal brain imaging for predicting need for postnatal hydrocephalus treatment in fetuses that had neural tube defect repair in utero

OBJECTIVE

To determine if brain imaging in fetuses that underwent prenatal repair of neural tube defect (NTD) can predict the need for postnatal hydrocephalus treatment (HT) in the first year postpartum.

METHODS

This was a retrospective study of fetuses diagnosed with open NTD that had in-utero myelomeningocele repair between April 2014 and April 2016. Independent variables were collected from four chronological sets of fetal images: presurgery ultrasound, presurgery magnetic resonance imaging (MRI), 6-week postsurgery MRI and predelivery ultrasound. The following independent variables were collected from all image sets unless otherwise noted: gestational age, head circumference, mean ventricular width, ventricular volume (MRI only), hindbrain herniation (HBH) score (MRI only), and level of lesion (LOL), defined as the upper bony spinal defect (presurgery ultrasound only). Based on these measurements, additional variables were defined and calculated including change in degree of HBH, ventricular width growth (mm/week) and ventricular volume growth (mL/week). The need for HT (by either ventriculoperitoneal shunt or endoscopic third ventriculostomy with choroid plexus cauterization) was determined by a pediatric neurosurgeon using clinical and radiographic criteria; a secondary analysis was performed using the MOMS trial criteria for hydrocephalus. The predictive value of each parameter was assessed by receiver-operating characteristics curve and logistic regression analyses.

RESULTS

Fifty affected fetuses were included in the study, of which 32 underwent open hysterotomy and 18 fetoscopic repair. Two neonates from the open hysterotomy group died and were excluded from the analysis. The mean gestational ages for the presurgery ultrasound, presurgery MRI, postsurgery MRI and predelivery ultrasound were 21.8 ± 2.1, 22.0 ± 1.8, 30.4 ± 1.6 and 31.0 ± 4.9 weeks, respectively. A total of 16 subjects required HT. The area under the curve (AUC) of predictive accuracy for HT showed that HBH grading on postsurgery MRI had the strongest predictive value (0.86; P < 0.01), outperforming other predictors such as postsurgery MRI ventricular volume (0.73; P = 0.03), MRI ventricular volume growth (0.79; P = 0.01), change in HBH (0.82; P = 0.01), and mean ventricular width on predelivery ultrasound (0.73; P = 0.01). Other variables, such as LOL, mean ventricular width on presurgery ultrasound, mean ventricular width on presurgery and postsurgery MRI, and ventricular growth assessment by MRI or ultrasound, had AUCs < 0.7. Optimal cut-offs of the variables with the highest AUC were evaluated to improve prediction. A combination of ventricular volume growth ≥ 2.02 mL/week and/or HBH of 3 on postsurgery MRI were the optimal cut-offs for the best prediction (odds ratio (OR), 42 (95% CI, 4-431); accuracy, 84%). Logistic regression analyses showed that persistence of severe HBH 6 weeks after surgery by MRI is one of the best predictors for HT (OR, 39 (95% CI, 4-369); accuracy, 84%). There was no significant change in the results when the MOMS trial criteria for hydrocephalus were used as the dependent variable.

CONCLUSIONS

Persistence of HBH on MRI 6 weeks after prenatal NTD repair independently predicted the need for postnatal HT better than any ultrasound- or other MRI-derived measurements of ventricular characteristics. These results should aid in prenatal counseling and add support to the hypothesis that HBH is a significant driver of hydrocephalus in myelomeningocele patients. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Does fetoscopic or open repair for spina bifida affect fetal and postnatal growth?

OBJECTIVE

The effect of fetoscopic myelomeningocele (MMC) repair on fetal growth is unknown. Fetal surgery itself and/or exposure to a carbon dioxide (CO₂ ) environment during spina bifida repair may affect placental function and impair fetal growth. Our aim was to assess and compare growth in fetuses, neonates and infants who underwent prenatal fetoscopic or open MMC repair.

METHODS

Fetal biometrics were obtained serially using ultrasound after fetoscopic (n = 32) or open hysterotomy (n = 34) MMC repair in utero at a single institution between November 2011 and July 2017. Measurements obtained during growth scans on initial evaluation prior to surgery, and those taken at 6 weeks post-surgery, were transformed into percentiles and compared between groups. Additional neonatal and infant anthropometric measurements, including weight, length/height and head circumference, were also transformed into percentiles and compared between the groups. The proportions of cases in each group with estimated fetal weight (EFW) or postnatal weight < 10^th and < 3^rd percentiles were calculated and compared. A linear mixed model was used to analyze the serial fetal growth measurements of each parameter, and random intercepts and slopes were used to compare study variables between the study groups. The duration of surgery (skin-to-skin time at fetoscopic and open MMC repair) and duration of CO₂ exposure (fetoscopic repair) were evaluated for any effect on the fetal, neonatal or infant biometric percentiles.

RESULTS

Fetuses which underwent fetoscopic repair had a larger abdominal circumference percentile at referral (57 ± 21 vs 46 ± 23; P = 0.04). There were no other differences between the two groups in fetal biometric percentiles at the time of referral, 6 weeks post-surgery or at birth. There were no differences between groups in EFW percentile or in proportions of cases with birth weight < 10^th and < 3^rd percentiles. Linear mixed-model analysis did not show any significant differences in any fetal growth parameter between the groups over time. There were no significant correlations between duration of surgery or duration of CO₂ exposure and any of the biometric percentiles evaluated. Postnatal growth showed no significant differences between the groups in weight, height or head circumference percentiles, at 6-18, 18-30 or > 30 months of age.

CONCLUSIONS

Babies exposed to fetoscopic or open MMC repair in-utero did not show significant differences in fetal or postnatal growth parameters. These results support the safety of the use of CO₂ gas for fetoscopic surgery. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

OBJECTIVES

We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM.

METHODS

This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS).

RESULTS

The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not.

CONCLUSION

The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.

A large-aperture strip-grid beam splitter for partially combined two millimeter-wave diagnostics on Korea Superconducting Tokamak Advanced Research

A large-aperture beam splitter has been developed for simultaneous operation of two millimeter-wave diagnostics employing different probe beams in the frequency and polarization, microwave imaging reflectometer (∼85 GHz X-mode), and collective scattering system (300 GHz O-mode), on the Korea Superconducting Tokamak Advanced Research device. The beam splitter was designed based on a polarizer concept (i.e., grid of metal strips on a thin dielectric sheet), and this can be an optimal solution for these two diagnostics. Fabrication of the strips with uniform sub-millimeter width and spacing on a large dielectric sheet was achieved with an etching technique, and the laboratory test results on the reflection and transmission ratio are in good agreement with design values.

Never seen before? Opisthorchiasis and Clonorchiasis

Parasitic diseases are relatively rarely diagnosed and treated in Europe. Therefore, European clinicians are not familiar with their clinical and imaging features. In an era of increased human migration, it is fundamental for clinicians to be able to identify such diseases. We have recently described the features of cystic echinococcosis, schistosomiasis, fascioliasis and ascariasis. Here, we report on the clinical and imaging features as well as on the current therapy options of infections by the small liver flukes: Clonorchis sinensis, Opisthorchis viverrini (Southeast Asian liver fluke) and Opisthorchis felineus (cat liver fluke) and other Opisthorchis species prevalent in South Asia.

Electric field-controlled transformation of the eigenmodes in a twisted-nematic Fabry-Pérot cavity

The polarized optical states in the transmission spectrum of a twisted-nematic Fabry–Pérot cavity with the distinctly broken Mauguin’s waveguide regime have been theoretically and experimentally investigated. Specific features of the electric field-induced transformation of the polarization and spectral characteristics of eigenmodes of the neighboring series at the overlap resonant frequencies have been examined. It is demonstrated that the linear polarizations of eigenmodes at the cavity boundaries remain nearly orthogonal and their frequency trajectories reproduce the avoided crossing phenomenon. The experimental data are confirmed analytically and by the numerical simulation of light transmission through the investigated anisotropic multilayer with the use of a Berreman matrix method. The results obtained can be generalized to any materials with the helix response.

Hepatitis B virus infection in Taiwan: The role of NTCP rs2296651 variant in relation to sex

Sodium taurocholate cotransporting polypeptide (NTCP) is a functional receptor for hepatitis B virus (HBV) infection. NTCP rs2296651 is believed to be an Asian-specific variant responsible for HBV susceptibility. We investigated the relationship between rs2296651 and HBV infection in Taiwan based on stratification by gender and menopausal status. We recruited 10 017 Taiwan Biobank participants aged 30-70 years with complete genetic data and sociodemographic information. Gender-stratified multivariate logistic regression models were used to determine the relationship between NTCP variant and HBV infection. Among individuals with HBV infection, the genotype frequencies of GG, AG and AA in women were 0.85, 0.15 and 0 while those in men were 0.82, 0.18 and 0, respectively. The multivariate-adjusted odds ratios (OR) of HBV infection were 0.77 (95% CI 0.59-0.99) in women and 0.98 (95% CI 0.79-1.20) in men. The adjusted OR was 0.87 (CI 0.63-1.19) in premenopausal and 0.59 (0.36-0.97) in postmenopausal women. We found that genetic variation in the HBV receptor gene (NTCP) was significantly associated with a decreased risk of HBV infection in Taiwanese women.

Hepatic steatosis is highly prevalent across the paediatric age spectrum, including in pre-school age children

BACKGROUND

The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is 8% in the general population, and 34% in the context of obesity. There is a paucity of data on the prevalence of hepatic steatosis in healthy children in Ontario.

AIMS

To determine the prevalence of hepatic steatosis using abdominal computed tomography (CT) scans in a cohort of previously healthy children across the paediatric age spectrum in Ontario, Canada, and to determine any association between measures of abdominal adiposity and hepatic steatosis.

METHODS

Retrospective review of the SickKids Trauma Database from 2004-2015. Previously healthy children ages 1-17 years having undergone an abdominal CT scan as a part of routine trauma assessment were included, and those with an intra-abdominal injury excluded. Steatosis was defined as a difference between liver and spleen attenuation ≤-25HU. The percentage of the total area occupied by abdominal subcutaneous adipose and visceral adipose tissue was measured. Anthropometrics and baseline demographics were collected.

RESULTS

A total of 503 (51% male) children with mean (±SD) age 9.5 ± 4.5 years and weight z-score of 0.37 ± 1.05 were studied. Seventy-seven (15%, 95% CI [12%-18%]) had hepatic steatosis; no differences found between sexes or across age quartiles. The abdominal subcutaneous adipose tissue area was greater in those with hepatic steatosis compared to those without (32% [22-42] vs 24% [17-36], P = 0.003). The visceral adipose tissue area was significantly greater in older children ≥9.8 years with hepatic steatosis (7.7% [5.1-10] vs 6.6% (4.9-8.5), P = 0.04).

CONCLUSION

Hepatic steatosis was highly prevalent in previously healthy children in Ontario, including children of pre-school age. We found an association between hepatic steatosis and abdominal subcutaneous adipose tissue, and in older children with visceral adipose tissue.

Measurement of the Effective Weak Mixing Angle in pp[over ¯]→Z/γ^{*}→ℓ^{+}ℓ^{-} Events

We present a measurement of the effective weak mixing angle parameter sin^{2}θ_{eff}^{ℓ} in pp[over ¯]→Z/γ^{*}→μ^{+}μ^{-} events at a center-of-mass energy of 1.96 TeV, collected by the D0 detector at the Fermilab Tevatron Collider and corresponding to 8.6  fb^{-1} of integrated luminosity. The measured value of sin^{2}θ_{eff}^{ℓ}[μμ]=0.23016±0.00064 is further combined with the result from the D0 measurement in pp[over ¯]→Z/γ^{*}→e^{+}e^{-} events, resulting in sin^{2}θ_{eff}^{ℓ}[comb]=0.23095±0.00040. This combined result is the most precise measurement from a single experiment at a hadron collider and is the most precise determination using the coupling of the Z/γ^{*} to light quarks.