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Van Arkel A, Willemsen I, Kilsdonk-Bode L, Vlamings-Wagenaars S, Van Oudheusden A, De Waegemaeker P, Leroux-Roels I, Verelst M, Maas E, Van Oosten A, Willemse P, Van Asselen E, Klomp-Berens E, Franssen K, Van Cauwenberg E, Schweitzer V, Kluytmans J. Feedback of ATP measurement as a tool for reducing environmental contamination in hospitals in the Dutch/Belgian border area. Int J Qual Health Care 2021; 33:6430447. [PMID: 34791294 DOI: 10.1093/intqhc/mzab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
DESIGN A two-phase prospective intervention study. OBJECTIVE The objective of this study was to determine if feedback of adenosine triphosphate (ATP) measurements decreases environmental contamination within hospitals in the Dutch/Belgian border area. METHODS Standardized ATP measurements were conducted in nine hospitals on pre-defined fomites. Four different fomite groups were defined: medical devices, patient-bound materials, ward-bound materials and sanitary items. ATP results were reported in relative light unit (RLU), RLU >1000 was considered as 'not clean.' Two rounds of ATP measurements were conducted. After the first round of ATP measurements, results were provided to the wards and cleaning staff. The second round of ATP measurements was performed one year later. The amount of surface contamination before and after the feedback was compared. RESULTS In total 1923 ATP measurements were performed. Before feedback 960 ATP measurements were conducted and after feedback 963 were conducted. The overall median reduction in RLU was 381 (P < 0.001), from 568 before feedback to 187 afterward. In each hospital there was a reduction of the median RLU after feedback. CONCLUSIONS Substantial reductions in RLU values were found after feedback of ATP measurements. Feedback of ATP measurement in itself was associated with a major reduction of surface contamination in hospitals.
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Affiliation(s)
- Andreas Van Arkel
- Department of Infection Control, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands.,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, Tilburg 5022 GC, The Netherlands
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands
| | - Linda Kilsdonk-Bode
- Department of Infection Control, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands
| | - Sindy Vlamings-Wagenaars
- Department of Infection Control, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, Tilburg 5022 GC, The Netherlands
| | - Anne Van Oudheusden
- Department of Infection Control, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, Tilburg 5022 GC, The Netherlands
| | - Pascal De Waegemaeker
- Department of Infection Control, Ghent University Hospital, Comeel Heymanslaan 10, Ghent 9000, Belgium
| | - Isabel Leroux-Roels
- Department of Infection Control, Ghent University Hospital, Comeel Heymanslaan 10, Ghent 9000, Belgium.,Laboratory for Microbiology, Ghent University Hospital, Comeel Heymanslaan 10, Ghent 9000, Belgium.,Department of Diagnostic Sciences, University Hospital Ghent, Comeel Heymanslaan 10, Ghent 9000, Belgium
| | - Martine Verelst
- Department of Infection Control, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Evelien Maas
- Department of Infection Control, ZorgSaam Hospital, Wielingenlaan 2, Terneuzen 4535 PA, The Netherlands
| | - Anita Van Oosten
- Department of Infection Control, Admiraal de Ruyter Hospital, 's-Gravenpolderseweg 114, Goes 4462 RA, The Netherlands
| | - Patricia Willemse
- Department of Infection Control, Elkerliek Hospital, Wesselmanlaan 25, Helmond 5707 HA, The Netherlands
| | - Esther Van Asselen
- Department of Infection Control, Elkerliek Hospital, Wesselmanlaan 25, Helmond 5707 HA, The Netherlands
| | - Ella Klomp-Berens
- Department of Infection Control, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Karen Franssen
- Department of Infection Control, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Elise Van Cauwenberg
- Department of Infection Control, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium
| | - Valentijn Schweitzer
- Laboratory for Microbiology, Utrecht University Hospital, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands.,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, Tilburg 5022 GC, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.,Microvida Laboratory for Microbiology, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands
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van Arkel A, Willemsen I, Kilsdonk-Bode L, Vlamings-Wagenaars S, van Oudheusden A, Waegemaeker PD, Leroux-Roels I, Verelst M, Maas E, van Oosten A, Willemse P, van Asselen E, Klomp-Berens E, Franssen K, Van Cauwenberg E, Kluytmans J. ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch/Belgian border area. Antimicrob Resist Infect Control 2020; 9:77. [PMID: 32466792 PMCID: PMC7254657 DOI: 10.1186/s13756-020-00730-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements. Design A cross-sectional observational survey. Methods Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as “not clean.” Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties. Results A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3–277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups. Conclusion ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.
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Affiliation(s)
- Andreas van Arkel
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands. .,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | | | - Anne van Oudheusden
- Department of Infection Control, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Isabel Leroux-Roels
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium.,Laboratory for Microbiology, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, University hospital Ghent, Ghent, Belgium
| | - Martine Verelst
- Department of Infection Control, University Hospitals Leuven, Leuven, Belgium
| | - Evelien Maas
- Department of Infection Control, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Anita van Oosten
- Department of Infection Control, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Patricia Willemse
- Department of Infection Control, Elkerliek Hospital, Helmond, The Netherlands
| | - Esther van Asselen
- Department of Infection Control, Elkerliek Hospital, Helmond, The Netherlands
| | - Ella Klomp-Berens
- Department of Infection Control, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Karen Franssen
- Department of Infection Control, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Laboratory for Microbiology and Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.,Microvida Laboratory for Microbiology, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
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Maas E, Skoberne T, Werner A, Braun S, Jackisch C. Paraneoplastic Neurological Syndrome in Fallopian Tube Cancer. Geburtshilfe Frauenheilkd 2014; 74:950-953. [PMID: 25364036 DOI: 10.1055/s-0034-1383041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/07/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022] Open
Abstract
We report on a rare case of paraneoplastic syndrome (PS) that was discovered on completion of diagnostic work-up to be an undifferentiated fallopian tube carcinoma. A 49-year-old Caucasian woman was admitted to neurology with vertigo, gait ataxia and dysarthria, transient ischaemic attack (TIA) and stroke were quickly excluded. Indicative for the further diagnosis of a paraneoplastic syndrome was the identification of onconeuronal antibodies the detection of which can be associated with certain tumour entities. The strongly positive anti-Yo antibody that is formed above all by breast and lung cancers as well as ovarian cancer led to a corresponding staging. The tumour markers CEA, CA 125 and CA 15-3 were in the normal ranges. Mammography and thorax CT were also unremarkable; on transvaginal sonography the internal genitals were inconspicuous except for a follicular cyst on the left. On abdominal CT the only conspicuous finding was a 1.5 cm ovarian cyst. After consensual agreement a bilateral laparoscopic adenexectomy was performed but with unremarkable abdominal findings. The histological examination confirmed a right-sided undifferentiated tubal carcinoma with the provisional classification FIGO IIA. After a stage-related staging operation, the final classification was found to be the FIGO-IIIC stage on account of positive retroperitoneal lymph nodes. Thus adjuvant chemotherapy with 6 cycles of carboplatin and paclitaxel was performed. By means of a timely, guideline-conform therapy for tubal carcinoma, the neurological symptoms and, above all, the dysarthria could be improved after 10 months.
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Affiliation(s)
- E Maas
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
| | - T Skoberne
- Neurologie, SanaKlinikum Offenbach, Offenbach
| | - A Werner
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
| | - S Braun
- Pathologie, SanaKlinikum Offenbach, Offenbach
| | - C Jackisch
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
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Bobholz JA, Rao SM, Lobeck L, Elsinger C, Gleason A, Kanz J, Durgerian S, Maas E. fMRI study of episodic memory in relapsing-remitting MS: correlation with T2 lesion volume. Neurology 2006; 67:1640-5. [PMID: 17101897 DOI: 10.1212/01.wnl.0000242885.71725.76] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether memory loss in patients with multiple sclerosis (MS) results from faulty encoding or retrieval, we correlated extent of T2-weighted lesion involvement with brain activation patterns on fMRI scans obtained while patients performed a verbal episodic memory task. METHODS We performed a neurologic examination, neuropsychological testing, and an event-related fMRI scan on 36 patients with relapsing-remitting MS. In addition, we obtained T2-weighted structural MRI scans to measure lesion volume. We performed a regression analysis to examine the association between lesion volume and regional brain activation. RESULTS Increasing lesion volume correlated with increasing magnitude of brain activation, primarily in the left frontal and parietal association cortices. Significant correlations of function with lesion volume were primarily observed during the memory retrieval phase of the task. CONCLUSIONS These results extend previous fMRI studies in multiple sclerosis (MS) by demonstrating an association between greater disease burden and increased neural recruitment during episodic memory. In addition, the stronger correlations observed between lesion volume and brain activation during retrieval than encoding would suggest that retrieval processes are more affected by MS-related cerebral pathology.
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Affiliation(s)
- J A Bobholz
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Affiliation(s)
- F Jung
- Department of General and Thoracic Surgery, Justus Liebig University, Giessen, Germany
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Korom S, De Meester I, Maas E, Stein A, Wilker S, Jung F, Weimer R, Brendel MD, Ernst W, Friemann S, Linder R, Grimm H, Padberg W, Scharpé S, Kupiec-Weglinski JW, Schwemmle K. CD26 expression and enzymatic activity in recipients of kidney allografts. Transplant Proc 2002; 34:1753-4. [PMID: 12176563 DOI: 10.1016/s0041-1345(02)03054-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Korom
- Department of General and Thoracic Surgery, University Hospital, Justus Liebig University, Giessen, Germany.
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Maas E, Barlow J, Robin D, Shapiro L. Treatment of sound errors in aphasia and apraxia of speech: Effects of phonological complexity. Aphasiology 2002; 16:609-622. [PMID: 22787286 PMCID: PMC3392129 DOI: 10.1080/02687030244000266] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND: Recent research suggests that the complexity of treatment stimuli influences the effectiveness of treatment. However, no studies have examined the role of complexity on sound production treatment in adult individuals with sound production impairments. AIMS: This study examines effects of syllable complexity on treatment outcome in two patients with acquired sound production problems. Complexity is defined in terms of syllable structure: clusters are more complex than singletons. Using a single-subject multiple-baseline design, we address the question: Is treatment of complex syllables more effective than treatment of simple syllables? METHODS #ENTITYSTARTX00026; PROCEDURES: Two patients with aphasia and apraxia of speech were trained to produce complex or simple syllables (using modelling). Improvement was measured by percent correct on a word and nonword repetition test. OUTCOMES #ENTITYSTARTX00026; RESULTS: We found that both treatment on simple syllables and treatment on complex syllables led to improved production of simple syllables, while treatment of complex syllables also led to improvement on some complex syllables for one of the two patients. CONCLUSIONS: These results suggests that training complex items is more effective than training simple items, at least for some patients. Possible reasons for lack of stronger effects are discussed, as well as directions for future research.
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Affiliation(s)
- E Maas
- San Diego State University, CA, USA
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Bates MN, Maas E, Martin T, Harte D, Grubner M, Margolin T. Investigation of the prevalence of Legionella species in domestic hot water systems. N Z Med J 2000; 113:218-20. [PMID: 10909936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
AIMS To investigate the prevalence of Legionella spp. in the hot water systems of a representative sample of Wellington domestic residences with electrically heated hot water systems, and to investigate risk factors (eg water temperature, plumbing materials) for such contamination. METHOD 100 households with electrically heated hot water systems in the Wellington area were investigated. Samples of hot water from several hot water outlets were collected, and characteristics of the plumbing system were recorded. Water samples and swabs were cultured and further examined by polymerase chain reaction (PCR) and direct fluorescence antibody (DFA) testing to identify Legionella spp. and serogroups. RESULTS No Legionella spp. were isolated by culture. PCR tested positive for Legionella in specimens from twelve residences. Six of these were also positive by DFA testing. The only environmental factor found to be associated with the presence of Legionella was recent plumbing work on the hot water system. Five of the twelve PCR-positive residences, and four of the six DFA-confirmed residences had hot water delivery temperatures in excess of 60 degrees C. CONCLUSIONS The results suggest that either Legionellae colonise domestic hot water reticulation systems and/or that the organisms are killed during passage through the hot water tank. Both possibilities may be correct. Further work to characterise the microbial ecology of Legionella-positive hot water distribution systems would be useful, as would the development of improved methods for culturing the organisms from potable water.
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Affiliation(s)
- M N Bates
- Epidemiology and Environmental Microbiology Groups, ESR, Kenepuru Science Centre, Porirua.
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Mark LP, Daniels DL, Naidich TP, Hendrix LE, Maas E. Anatomic moment. The septal area. AJNR Am J Neuroradiol 1994; 15:273-6. [PMID: 8192072 PMCID: PMC8334604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L P Mark
- Department of Diagnostic Radiology, Medical College of Wisconsin, Milwaukee 53226
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Maas E, Pospichal H, KOPlin R, Bisswanger H. Multi-enzyme complexes in thermophilic organisms: isolation and characterization of the pyruvate dehydrogenase complex from Thermus aquaticus AT62. ACTA ACUST UNITED AC 1992. [DOI: 10.1099/00221287-138-4-795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Bovine kidney mitochondria were separated into matrix and membrane fractions by treatment with digitonin and Lubrol PX. While malate dehydrogenase was found essentially in the matrix fraction, both the pyruvate and the alpha-oxoglutarate dehydrogenase multienzyme complexes remained bound to the inner membrane fraction and became solubilized only after repeated treatments with detergents. Thus both multienzyme complexes must be associated with the inner membrane rather than located within the matrix space.
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Affiliation(s)
- E Maas
- Physiologisch-chemisches Institut der Universität Tübingen, Germany
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Maas E, Adami P, Bisswanger H. Application of high-performance liquid chromatography to the purification, disintegration and molecular mass determination of pyruvate dehydrogenase multi-enzyme complexes from different sources. J Chromatogr A 1990; 521:169-78. [PMID: 2286634 DOI: 10.1016/0021-9673(90)85041-s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pyruvate dehydrogenase complex is associated with the inner mitochondrial membrane. A gentle and rapid purification procedure, especially for the very unstable pyruvate dehydrogenase complex from the extremely thermophilic organism Thermus aquaticus, is described. This procedure is based essentially on a combination of hydrophobic interaction and of adsorption chromatography by the rapid fast protein liquid chromatographic technique. Applying the same method, a relative molecular mass of 9.1 . 10(6) daltons was obtained by gel filtration on Superose 6 HR 10/30 for the pyruvate dehydrogenase complex from T. aquaticus. The same column served to resolve the pyruvate dehydrogenase complex into its enzyme components.
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Affiliation(s)
- E Maas
- Physiologisch-chemisches Institut der Universität Tübingen, F.R.G
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Affiliation(s)
- H J Kaminski
- Department of Neurology, Cleveland Veterans Affairs Medical Center, OH 44106
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Abstract
Thermal injuries in childhood occur mainly in the first three years of life and often lead to hospital admission: most are due to scalds in the home. The distress and anxiety of parents bears on the management of the young sick child in hospital, on his subsequent recovery at home and on the welfare of the whole family. To help parents, a weekly meeting was held with a small group of staff in the Burns Unit at which there was free and open discussion of all problems and worries connected with the child's accident. This paper describes the working of the group and the contribution it made to the care of 149 children admitted with burns and scalds during one year.
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