Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration

Imaging through turbulence with a quadrature-phase optical interferometer

We present an improved technique for imaging through turbulence at visible wavelengths using a rotation shearing pupil-plane interferometer, intended for astronomical and terrestrial imaging applications. While previous astronomical rotation shearing interferometers have made only visibility modulus measurements, this interferometer makes four simultaneous measurements on each interferometric baseline, with phase differences of π/2 between each measurement, allowing complex visibility measurements (modulus and phase) across the entire input pupil in a single exposure. This technique offers excellent wavefront resolution, allowing operation at visible wavelengths on large apertures, is potentially immune to amplitude fluctuations (scintillation), and may offer superior calibration capabilities to other imaging techniques. The interferometer has been tested in the laboratory under weakly aberrating conditions and at Palomar Observatory under ordinary astronomical observing conditions. This research is based partly on observations obtained at the Hale Telescope

Design Within Complex Environments: Collaborative Engineering in the Aerospace Industry

The design and the industrialization of an aircraft, a major component, or an aerostructure is a complex process. An aircraft like the Airbus A400M is composed of about 700,000 parts (excluding standard parts). The parts are assembled into aerostructures and major components, which are designed and manufactured in several countries all over the world. The introduction of new Product Lifecycle Management (PLM) methodologies, procedures and tools, and the need to reduce time-to-market, led Airbus Military to pursue new working methods to deal with complexity. Collaborative Engineering promotes teamwork to develop product, processes and resources from the conceptual phase to the start of the serial production. This paper introduces the main concepts of Collaborative Engineering as a new methodology, procedures and tools to design and develop an aircraft, as Airbus Military is implementing. To make a Proof of Concept (PoC), a pilot project, CALIPSOneo, was launched to support the functional and industrial design process of a medium size aerostructure. The aim is to implement the industrial Digital Mock-Up (iDMU) concept and its exploitation to create shop fl oor documentation

21-cm synthesis observations of VIRGOHI 21 - a possible dark galaxy in the Virgo Cluster

Many observations indicate that dark matter dominates the extra-galactic Universe, yet no totally dark structure of galactic proportions has ever been convincingly identified. Previously we have suggested that VIRGOHI 21, a 21-cm source we found in the Virgo Cluster using Jodrell Bank, was a possible dark galaxy because of its broad line-width (~200 km/s) unaccompanied by any visible gravitational source to account for it. We have now imaged VIRGOHI 21 in the neutral-hydrogen line and find what could be a dark, edge-on, spinning disk with the mass and diameter of a typical spiral galaxy. Moreover, VIRGOHI 21 has unquestionably been involved in an interaction with NGC 4254, a luminous spiral with an odd one-armed morphology, but lacking the massive interactor normally linked with such a feature. Numerical models of NGC 4254 call for a close interaction ~10^8 years ago with a perturber of ~10^11 solar masses. This we take as additional evidence for the massive nature of VIRGOHI 21 as there does not appear to be any other viable candidate. We have also used the Hubble Space Telescope to search for stars associated with the HI and find none down to an I band surface brightness limit of 31.1 +/- 0.2 mag/sq. arcsec.Comment: 8 pages, accepted to ApJ, uses emulateapj.cls. Mpeg animation (Fig. 2) available at ftp://ftp.naic.edu/pub/publications/minchin/video2.mp

A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom.

OBJECTIVE To evaluate the microbiologic effectiveness of the World Health Organization's 6-step and the Centers for Disease Control and Prevention's 3-step hand hygiene techniques using alcohol-based handrub. DESIGN A parallel group randomized controlled trial. SETTING An acute care inner-city teaching hospital (Glasgow). PARTICIPANTS Doctors (n=42) and nurses (n=78) undertaking direct patient care. INTERVENTION Random 1:1 allocation of the 6-step (n=60) or the 3-step (n=60) technique. RESULTS The 6-step technique was microbiologically more effective at reducing the median log10 bacterial count. The 6-step technique reduced the count from 3.28 CFU/mL (95% CI, 3.11-3.38 CFU/mL) to 2.58 CFU/mL (2.08-2.93 CFU/mL), whereas the 3-step reduced it from 3.08 CFU/mL (2.977-3.27 CFU/mL) to 2.88 CFU/mL (-2.58 to 3.15 CFU/mL) (P=.02). However, the 6-step technique did not increase the total hand coverage area (98.8% vs 99.0%, P=.15) and required 15% (95% CI, 6%-24%) more time (42.50 seconds vs 35.0 seconds, P=.002). Total hand coverage was not related to the reduction in bacterial count. CONCLUSIONS Two techniques for hand hygiene using alcohol-based handrub are promoted in international guidance, the 6-step by the World Health Organization and 3-step by the Centers for Disease Control and Prevention. The study provides the first evidence in a randomized controlled trial that the 6-step technique is superior, thus these international guidance documents should consider this evidence, as should healthcare organizations using the 3-step technique in practice. Infect Control Hosp Epidemiol 2016;37:661-666

Massive Black Hole Binary Inspirals: Results from the LISA Parameter Estimation Taskforce

The LISA Parameter Estimation (LISAPE) Taskforce was formed in September 2007 to provide the LISA Project with vetted codes, source distribution models, and results related to parameter estimation. The Taskforce's goal is to be able to quickly calculate the impact of any mission design changes on LISA's science capabilities, based on reasonable estimates of the distribution of astrophysical sources in the universe. This paper describes our Taskforce's work on massive black-hole binaries (MBHBs). Given present uncertainties in the formation history of MBHBs, we adopt four different population models, based on (i) whether the initial black-hole seeds are small or large, and (ii) whether accretion is efficient or inefficient at spinning up the holes. We compare four largely independent codes for calculating LISA's parameter-estimation capabilities. All codes are based on the Fisher-matrix approximation, but in the past they used somewhat different signal models, source parametrizations and noise curves. We show that once these differences are removed, the four codes give results in extremely close agreement with each other. Using a code that includes both spin precession and higher harmonics in the gravitational-wave signal, we carry out Monte Carlo simulations and determine the number of events that can be detected and accurately localized in our four population models.Comment: 14 pages, 2 figures, 5 tables, minor changes to match version to be published in the proceedings of the 7th LISA Symposium. For more information see the Taskforce's wiki at http://www.tapir.caltech.edu/dokuwiki/lisape:hom

Generalised Elliptic Functions

We consider multiply periodic functions, sometimes called Abelian functions, defined with respect to the period matrices associated with classes of algebraic curves. We realise them as generalisations of the Weierstras P-function using two different approaches. These functions arise naturally as solutions to some of the important equations of mathematical physics and their differential equations, addition formulae, and applications have all been recent topics of study. The first approach discussed sees the functions defined as logarithmic derivatives of the sigma-function, a modified Riemann theta-function. We can make use of known properties of the sigma function to derive power series expansions and in turn the properties mentioned above. This approach has been extended to a wide range of non hyperelliptic and higher genus curves and an overview of recent results is given. The second approach defines the functions algebraically, after first modifying the curve into its equivariant form. This approach allows the use of representation theory to derive a range of results at lower computational cost. We discuss the development of this theory for hyperelliptic curves and how it may be extended in the future.Comment: 16 page

Evaluation of the United Nations Mine Action Programme in the Democratic Republic of the Congo

The team found that mid to long term planning was insufficient to meet the changing context of the country. There team felt that there was a clear lack of congruence between mine action strategies and the countrywide priorities and strategic direction. The team believes that there is currently too much emphasis placed on creating a functional national mine action structure to the detriment to mid to long term planning for actual clearance activities in the country. The team also found that limited consideration has been placed on ensuring a long term solution to dealing with any residual mine and UXO remaining in the DRC after 2012