Implementation research for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva infection prevention and control (IPC)-think tank (part 1)

Background Around 5–15% of all hospital patients worldwide suffer from healthcare-associated infections (HAIs), and years of excessive antimicrobial use in human and animal medicine have created emerging antimicrobial resistance (AMR). A considerable amount of evidence-based measures have been published to address these challenges, but the largest challenge seems to be their implementation. Methods In June 2017, a total of 42 experts convened at the Geneva IPC-Think Tank to discuss four domains in implementation science: 1) teaching implementation skills; 2) fostering implementation of IPC and antimicrobial stewardship (AMS) by policy making; 3) national/international actions to foster implementation skills; and 4) translational research bridging social sciences and clinical research in infection prevention and control (IPC) and AMR. Results Although neglected in the past, implementation skills have become a priority in IPC and AMS. They should now be part of any curriculum in health care, and IPC career paths should be created. Guidelines and policies should be aligned with each other and evidence-based, each document providing a section on implementing elements of IPC and AMS in patient care. International organisations should be advocates for IPC and AMS, framing them as patient safety issues and emphasizing the importance of implementation skills. Healthcare authorities at the national level should adopt a similar approach and provide legal frameworks, guidelines, and resources to allow better implementation of patient safety measures in IPC and AMS. Rather than repeating effectiveness studies in every setting, we should invest in methods to improve the implementation of evidence-based measures in different healthcare contexts. For this, we need to encourage and financially support collaborations between social sciences and clinical IPC research. Conclusions Experts of the 2017 Geneva Think Tank on IPC and AMS, CDC, and WHO agreed that sustained efforts on implementation of IPC and AMS strategies are required at international, country, and hospital management levels, to provide an adequate multimodal framework that addresses (not exclusively) leadership, resources, education and training for implementing IPC and AMS. Future strategies can build on this agreement to make strategies on IPC and AMS more effective

Transverse oscillations of two parallel coronal loops

Context. Collective oscillations of two or more coronal magnetic loops are observed very often. Aims. We study the eigenmodes of oscillations of a system consisting of two parallel magnetic loops. Methods. The linearised MHD equations for a cold plasma are solved analytically in bicylindrical coordinates using the longwavelength approximation. A dispersion equation determining the frequencies of eigenmodes is derived and solved analytically. Results. Two solutions of the dispersion relation were found. The higher frequency corresponds to the antisymmetric mode polarised in the direction parallel to the line connecting the loop centres, and the symmetric mode polarised in the perpendicular direction. Depending on the polarisation of modes corresponding to the lower frequency, the systems of two parallel loops are classified as standard and anomalous. In standard systems the lower frequency corresponds to the symmetric mode polarised in the direction parallel to the line connecting the loop centres, and the antisymmetric mode polarised in the perpendicular direction. In anomalous systems the lower frequency corresponds to the antisymmetric mode polarised in the direction parallel to the line connecting the loop centres, and the symmetric mode polarised in the perpendicular direction. The limiting case of two identical loops is studied. The results for this case are compared with recent numerical results

Signatures of Alfven waves in the polar coronal holes as seen by EIS/Hinode

Context. We diagnose the properties of the plume and interplume regions in a polar coronal hole and the role of waves in the acceleration of the solar wind. Aims. We attempt to detect whether Alfven waves are present in the polar coronal holes through variations in EUV line widths. Methods. Using spectral observations performed over a polar coronal hole region with the EIS spectrometer on Hinode, we study the variation in the line width and electron density as a function of height. We use the density sensitive line pairs of Fe xii 186.88 A & 195.119 A and Fe xiii 203.82 A & 202.04 A . Results. For the polar region, the line width data show that the nonthermal line-of-sight velocity increases from 26 km/s at 1000 above the limb to 42 km/s some 15000 (i.e. 110,000 km) above the limb. The electron density shows a decrease from 3:3 10^9 cm^-3 to 1:9 10^8 cm^-3 over the same distance. Conclusions. These results imply that the nonthermal velocity is inversely proportional to the quadratic root of the electron density, in excellent agreement with what is predicted for undamped radially propagating linear Alfven waves. Our data provide signatures of Alfven waves in the polar coronal hole regions, which could be important for the acceleration of the solar wind.Comment: 5 pages, 11 figures. Astronomy and Astrophysics Letters (accepted) http://www.aanda.org/articles/aa/pdf/forth/aa12242-09.pd

Epigenome-wide association study reveals decreased average methylation levels years before breast cancer diagnosis

Interest in the potential of DNA methylation in peripheral blood as a biomarker of cancer risk is increasing. We aimed to assess whether epigenome-wide DNA methylation measured in peripheral blood samples obtained before onset of the disease is associated with increased risk of breast cancer. We report on three independent prospective nested case-control studies from the European Prospective Investigation into Cancer and Nutrition (EPIC-Italy; n = 162 matched case-control pairs), the Norwegian Women and Cancer study (NOWAC; n = 168 matched pairs), and the Breakthrough Generations Study (BGS; n = 548 matched pairs). We used the Illumina 450k array to measure methylation in the EPIC and NOWAC cohorts. Whole-genome bisulphite sequencing (WGBS) was performed on the BGS cohort using pooled DNA samples, combined to reach 50× coverage across ~16 million CpG sites in the genome including 450k array CpG sites. Mean β values over all probes were calculated as a measurement for epigenome-wide methylation

Brewing of filter coffee

We report progress on mathematical modelling of coffee grounds in a drip filter coffee machine. The report focuses on the evolution of the shape of the bed of coffee grounds during extraction with some work also carried out on the chemistry of extraction. This work was sponsored by Philips who are interested in understanding an observed correlation between the final shape of the coffee grounds and the quality of the coffee. We used experimental data gathered by Philips and ourselves to identify regimes in the coffee brewing process and relevant regions of parameter space. Our work makes it clear that a number of separate processes define the shape of the coffee bed depending on the values of the parameters involved e.g. the size of the grains and the speed of fluid flow during extraction. We began work on constructing mathematical models of the redistribution of the coffee grounds specialised to each region and on a model of extraction. A variety of analytic and numerical tools were used. Furthermore our research has progressed far enough to allow us to begin to exploit connections between this problem and other areas of science, in particular the areas of sedimentology and geomorphology, where the processes we have observed in coffee brewing have been studied

Near-Limb Zeeman and Hanle Diagnostics

"Weak" magnetic-field diagnostics in faint objects near the bright solar disk are discussed in terms of the level of non-object signatures, in particular, of the stray light in telescopes. Calculated dependencies of the stray light caused by diffraction at the 0.5-, 1.6-, and 4-meter entrance aperture are presented. The requirements for micro-roughness of refractive and reflective primary optics are compared. Several methods for reducing the stray light (the Lyot coronagraphic technique, multiple stages of apodizing in the focal and exit pupil planes, apodizing in the entrance aperture plane with a special mask), and reducing the random and systematic errors are noted. An acceptable level of stray light in telescopes is estimated for the V-profile recording with a signal-to-noise ratio greater than three. Prospects for the limb chromosphere magnetic measurements are indicated.Comment: 11 pages, 3 figure

Polarimetric Properties of Flux-Ropes and Sheared Arcades in Coronal Prominence Cavities

The coronal magnetic field is the primary driver of solar dynamic events. Linear and circular polarization signals of certain infrared coronal emission lines contain information about the magnetic field, and to access this information, either a forward or an inversion method must be used. We study three coronal magnetic configurations that are applicable to polar-crown filament cavities by doing forward calculations to produce synthetic polarization data. We analyze these forward data to determine the distinguishing characteristics of each model. We conclude that it is possible to distinguish between cylindrical flux ropes, spheromak flux ropes, and sheared arcades using coronal polarization measurements. If one of these models is found to be consistent with observational measurements, it will mean positive identification of the magnetic morphology that surrounds certain quiescent filaments, which will lead to a greater understanding of how they form and why they erupt.Comment: 22 pages, 8 figures, Solar Physics topical issue: Coronal Magnetis

Nonlinear force-free and potential field models of active-region and global coronal fields during the Whole Heliospheric Interval

Between 2008/3/24 and 2008/4/2, the three active regions NOAA active regions 10987, 10988 and 10989 were observed daily by the Synoptic Optical Long-term Investigations of the Sun (SOLIS) Vector Spectro-Magnetograph (VSM) while they traversed the solar disk. We use these measurements and the nonlinear force-free magnetic field code XTRAPOL to reconstruct the coronal magnetic field for each active region and compare model field lines with images from the Solar Terrestrial RElations Observatory (STEREO) and Hinode X-ray Telescope (XRT) telescopes. Synoptic maps made from continuous, round-the-clock Global Oscillations Network Group (GONG) magnetograms provide information on the global photospheric field and potential-field source-surface models based on these maps describe the global coronal field during the Whole Heliospheric Interval (WHI) and its neighboring rotations. Features of the modeled global field, such as the coronal holes and streamer belt locations, are discussed in comparison with extreme ultra-violet and coronagraph observations from STEREO. The global field is found to be far from a minimum, dipolar state. From the nonlinear models we compute physical quantities for the active regions such as the photospheric magnetic and electric current fluxes, the free magnetic energy and the relative helicity for each region each day where observations permit. The interconnectivity of the three regions is addressed in the context of the potential-field source-surface model. Using local and global quantities derived from the models, we briefly discuss the different observed activity levels of the regions.Comment: Accepted for publication in the Solar Physics Whole Heliospheric Interval (WHI) topical issue. We had difficulty squeezing this paper into arXiv's 15 Mb limit. The full paper is available here ftp://gong2.nso.edu/dsds_user/petrie/PetrieCanouAmari.pd

Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis

BACKGROUND The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs. METHODOLOGY We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses. PRINCIPAL FINDINGS Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29), CLM (OR=0.24; 95% CI: 0.06-0.96), tungiasis (OR=0.42; 95% CI: 0.26-0.70), hookworm infection (OR=0.48; 95% CI: 0.37-0.61), any STH infection (OR=0.57; 95% CI: 0.39-0.84), strongyloidiasis (OR=0.56; 95% CI: 0.38-0.83), and leptospirosis (OR=0.59; 95% CI: 0.37-0.94). No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included. CONCLUSIONS/SIGNIFICANCE Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination. PROTOCOL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42012003338