Silver Iodate

InChI = 1S/Ag.HIO3/c;2-1(3)4/h;(H,2,3,4)/q+1;/p-1 InChIKey = YSVXTGDPTJIEIX-UHFFFAOYSA-M (reagent used as a versatile oxidative amidation and cyclization component) Physical Data: mp >200 °C; d 5.53 g cm^(−3). Solubility: soluble in aqueous ammonia; practically insoluble in water (0.3 g L^(−1) at 10 °C). Form Supplied in: white crystalline powder; commercially available. Handling, Storage, and Precautions: irritant; light sensitive; causes ignition with reducing agents or combustibles; store in cool and dry conditions in well-sealed containers; handle in fume hood

Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a study protocol for a randomised controlled trial

© 2016 Lee et al. Background: Urinary tract infections [UTIs] are very common in people with Spinal Cord Injury [SCI]. UTIs are increasingly difficult and expensive to treat as the organisms that cause them become more antibiotic resistant. Among the SCI population, there is a high rate of multi-resistant organism [MRO] colonisation. Non-antibiotic prevention strategies are needed to prevent UTI without increasing resistance. Probiotics have been reported to be beneficial in preventing UTIs in post-menopausal women in several in vivo and in vitro studies. The main aim of this study is to determine whether probiotic therapy with combinations of Lactobacillus reuteri RC-14 + Lactobacillus rhamnosus GR-1 [RC14-GR1] and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 [LGG-BB12] are effective in preventing UTI in people with SCI compared to placebo. Method: This is a multi-site randomised double-blind double-dummy placebo-controlled factorial design study conducted in New South Wales, Australia. All participants have a neurogenic bladder as a result of spinal injury. Recruitment started in April 2011. Participants are randomised to one of four arms, designed for factorial analysis of LGG-BB12 and/or RC14-GR1 v Placebo. This involves 24 weeks of daily oral treatment with RC14-GR1 + LGG-BB12, RC14-GR1 + placebo, LGG-BB12 + placebo or two placebo capsules. Randomisation is stratified by bladder management type and inpatient status. Participants are assessed at baseline, three months and six months for Short Form Health Survey [SF-36], microbiological swabs of rectum, nose and groin; urine culture and urinary catheters for subjects with indwelling catheters. A bowel questionnaire is administered at baseline and three months to assess effect of probiotics on bowel function. The primary outcome is time from randomisation to occurrence of symptomatic UTI. The secondary outcomes are change of MRO status and bowel function, quality of life and cost-effectiveness of probiotics in persons with SCI. The primary outcome will be analysed using survival analysis of factorial groups, with Cox regression modelling to test the effect of each treatment while allowing for the other, assuming no interaction effect. Hazard ratios and Kaplan-Meier survival curves will be used to summarise results. Discussion: If these probiotics are shown to be effective in preventing UTI and MRO colonisation, they would be a very attractive alternative for UTI prophylaxis and for combating the increasing rate of antibiotic resistance after SCI. Trial registration: Australian New Zealand Clinical Trials Registry [ ACTRN 12610000512022 ]. Date of registration: 21 June 2010

The behavioural effects of supplementing diets with synthetic and naturally sourced astaxanthin in an ornamental fish (Puntius titteya)

Carotenoids are routinely incorporated into ornamental fish diets with the aim of enhancing companion fish colouration which may concomitantly affect fish behaviour. Previously, colour enhancement has typically been achieved using synthetic carotenoids, however, there is now growing public demand for food additives such as carotenoids to be derived from natural sources, which can be acquired from microalgae and cyanobacteria. There has been very little research into whether natural carotenoids alter fish behaviour in a similar way to synthetic carotenoids; the present study aimed to determine whether behavioural changes typically associated with increased carotenoid consumption differed according to carotenoid source in the cherry barb (Puntius titteya). Cherry barbs were fed one of four diets (carotenoid-free, 20 ppm synthetic astaxanthin (AX) sourced from Carophyll pink®, 20 or 40 ppm of natural-AX sourced from Panaferd) over a 12 week period and then observed for colour changes, mate-choice and aggressive behaviours. The diets containing 20 ppm synthetic-AX and natural-AX enhanced male red colouration of the anal fin and anterior dorsal area, via a reduction in hue, in comparison to the carotenoid-free control diet whereas only the 20 ppm natural-AX altered the hue of female colour. In the mate choice trials, males spent more time with females fed the 20 ppm synthetic-AX and 40 ppm natural-AX compared with the carotenoid-free control and 20 ppm natural AX. Experiments conducted under red-blocking and UV blocking conditions demonstrated an effect of red colouration and ultraviolet reflectance on mate discrimination. Interestingly, males fed both the synthetic and natural AX diets reduced aggressive interactions with a mirror image, even though they displayed enhanced red colouration, which is often used by fish as a signal of increased competitive ability. In conclusion, source of dietary AX affected the behaviour of cherry barbs, to the extent that synthetic AX exerted a stronger effect on mate-choice behaviour under full spectrum lighting in comparison to a similar concentration of natural AX. This therefore demonstrates that the behaviour of companion fish can be influenced by the source of carotenoids within their food

Infection Prevention and Control Response and Escalation Framework – evaluation and application beyond a pandemic

BACKGROUND The COVID-19 pandemic resulted in constant changes to Infection Prevention and Control (IPAC) recommendations, impacting clinician capacity to stay up to date. The COVID-19 IPAC Response and Escalation Framework (IPAC Framework), rarely reported or evaluated was developed to provide scalable IPAC guidance during the pandemic to health care in New South Wales (NSW), Australia. METHODS Using a thematic analysis approach, a qualitative study using an online, cross-sectional survey comprising 27 questions was sent to 248 key stakeholders. Participants were health workers with broad clinical and system representation with responsibilities for risk assessment, communicating, implementing, or monitoring the IPAC Framework. RESULTS The IPAC Framework provided a useful IPAC tool for the management of COVID-19 as perceived by 93 of respondents. The overwhelming majority (91 ) reported the Framework provided enough information on IPAC strategies needed for COVID-19 that were aligned with transmission risk. Resources supporting the IPAC Framework were reported by most respondents (84 ) as being widely accepted as the authoritative guidance. CONCLUSIONS An IPAC Framework is perceived as invaluable by clinicians and administrators to manage IPAC requirements in health care during a pandemic. The IPAC Framework can be applied more generally to support ongoing IPAC requirements

Esterification of hemins with trimethyloxonium tetrafluoroborate

A procedure has been developed for the methylation of hemins using trimethyloxonium tetrafluoroborate. The method is rapid and selective for carboxyl groups, and it can be used to methylate polar and nonpolar hemins under neutral and basic conditions. Esterifications of protohemin IX, hematohemin, and heme a have been accomplished in high yield.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21639/1/0000020.pd

Rectal screening displays high negative predictive value for bloodstream infections with (ESBL-producing) gram negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

Objectives We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. Methods We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. Results We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4–28.0%] and 20.6% (95% CI 16.0–26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. Conclusions The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile

Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial

© 2019, The Author(s). Study design: Randomised double-blind factorial-design placebo-controlled trial. Objective: Urinary tract infections (UTIs) are common in people with spinal cord injury (SCI). UTIs are increasingly difficult to treat due to emergence of multi-resistant organisms. Probiotics are efficacious in preventing UTIs in post-menopausal women. We aimed to determine whether probiotic therapy with Lactobacillus reuteri RC-14+Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG+Bifidobacterium BB-12 (LGG-BB12) are effective in preventing UTI in people with SCI. Setting: Spinal units in New South Wales, Australia with their rural affiliations. Methods: We recruited 207 eligible participants with SCI and stable neurogenic bladder management. They were randomised to one of four arms: RC14-GR1+LGG-BB12, RC14-GR1+placebo, LGG-BB12+ placebo or double placebos for 6 months. Randomisation was stratified by bladder management type and inpatient or outpatient status. The primary outcome was time to occurrence of symptomatic UTI. Results: Analysis was based on intention to treat. Participants randomised to RC14-GR1 had a similar risk of UTI as those not on RC14-GR1 (HR 0.67; 95% CI: 0.39–1.18; P = 0.17) after allowing for pre-specified covariates. Participants randomised to LGG-BB12 also had a similar risk of UTI as those not on LGG-BB12 (HR 1.29; 95% CI: 0.74–2.25; P = 0.37). Multivariable post hoc survival analysis for RC14-GR1 only vs. the other three groups showed a potential protective effect (HR 0.46; 95% CI: 0.21–0.99; P = 0.03), but this result would need to be confirmed before clinical application. Conclusion: In this RCT, there was no effect of RC14-GR1 or LGG-BB12 in preventing UTI in people with SCI

Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014–2018

In low-resource settings, detection of healthcare-acquired outbreaks in neonatal units relies on astute clinical staff to observe unusual morbidity or mortality from sepsis as microbiological diagnostics are often absent. We aimed to generate reliable (and automated) early warnings for potential clusters of neonatal late onset sepsis using retrospective data that could signal the start of an outbreak in an NCU in Port au Prince, Haiti, using routinely collected data on neonatal admissions. We constructed smoothed time series for late onset sepsis cases, late onset sepsis rates, neonatal care unit (NCU) mortality, maternal admissions, neonatal admissions and neonatal antibiotic consumption. An outbreak was defined as a statistical increase in any of these time series indicators. We created three outbreak alarm classes: 1) thresholds: weeks in which the late onset sepsis cases exceeded four, the late onset sepsis rates exceeded 10% of total NCU admissions and the NCU mortality exceeded 15%; 2) differential: late onset sepsis rates and NCU mortality were double the previous week; and 3) aberration: using the improved Farrington model for late onset sepsis rates and NCU mortality. We validated pairs of alarms by calculating the sensitivity and specificity of the weeks in which each alarm was launched and comparing each alarm to the weeks in which a single GNB positive blood culture was reported from a neonate. The threshold and aberration alarms were the strongest predictors for current and future NCU mortality and current LOS rates (p<0.0002). The aberration alarms were also those with the highest sensitivity, specificity, negative predictive value, and positive predictive value. Without microbiological diagnostics in NCUs in low-resource settings, applying these simple algorithms to routinely collected data show great potential to facilitate early warning for possible healthcare-acquired outbreaks of LOS in neonates. The methods used in this study require validation across other low-resource settings

Multi-drug resistance and high mortality associated with community-acquired bloodstream infections in children in conflict-affected northwest Nigeria

Pediatric community-acquired bloodstream infections (CA-BSIs) in sub Saharan African humanitarian contexts are rarely documented. Effective treatment of these infections is additionally complicated by increasing rates of antimicrobial resistance. We describe the findings from epidemiological and microbiological surveillance implemented in pediatric patients with suspected CA-BSIs presenting for care at a secondary hospital in the conflict affected area of Zamfara state, Nigeria. Any child (> 2 months of age) presenting to Anka General Hospital from November 2018 to August 2020 with clinical severe sepsis at admission had clinical and epidemiological information and a blood culture collected at admission. Bacterial isolates were tested for antibiotic susceptibility. We calculated frequencies of epidemiological, microbiological and clinical parameters. We explored risk factors for death amongst severe sepsis cases using univariable and multivariable Poisson regression, adjusting for time between admission and hospital exit. We included 234 severe sepsis patients with 195 blood culture results. There were 39 positive blood cultures. Of the bacterial isolates, 14 were Gram positive and 18 were Gram negative; 5 were resistant to empiric antibiotics: methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Extended Spectrum Beta-Lactamase positive enterobacterales (n = 3). We identified no significant association between sex, age-group, ward, CA-BSI, appropriate intravenous antibiotic, malaria positivity at admission, suspected focus of sepsis, clinical severity and death in the multivariable regression. There is an urgent need for access to good clinical microbiological services, including point of care methods, and awareness and practice around rational antibiotic in healthcare staff in humanitarian settings to reduce morbidity and mortality from sepsis in children