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SUMMARY: An effective cleaning and sanitation protocol is important to mitigate disease outbreaks in poultry rearing facilities. This is especially important in cases of salmonellosis where there is a risk of disease transmission to humans. Compressed air foam systems (CAFS) may serve as an alternative carrier for foaming agents to clean and sanitize agricultural surfaces following an outbreak. The objective of this study was to evaluate the effects of a CAFS applied commercial firefighting foam (FF) and chlorine-based foaming cleaner (FC) in floor pen and caged quail rearing facilities with a history of salmonellosis. A firefighting foam concentrate (Phos-Chek WD881) and foaming cleaner (Chlor-A-Foam XL) were diluted in water and applied to floor pen and caged rearing facilities using a compressed air foam system. Total aerobes and cellular adenosine triphosphate (ATP) were quantified pre- and post-treatment using swabs. Both treatments significantly reduced aerobic bacteria in the floor pen and caged quail facilities (P < 0.05). The greatest reduction of 1.74 log10 CFU/mL was reported in the floor pen facility following FC treatment. Microbial ATP levels were also significantly reduced by both the CAFS applied FF and the FC in the floor pen and caged quail facilities (P < 0.05). Treatment of floor pen facilities with the FF resulted in the greatest ATP reduction of 4,201 RLU. These data summarize the efficacy of CAFS applied foaming agents suggesting that a compressed air foam system may serve as a practical method to clean quail rearing facilities.

We report a case of previously undescribed medial unicompartmental knee arthroplasty failure due to femoral component implant fracture. The patient experienced sudden pain and locking while ambulating 8 years postoperatively. Radiographs revealed catastrophic femoral component failure with a transverse break through the metal. The patient underwent revision to total knee arthroplasty. At 1-year follow-up, the patient had no pain and a range of motion of 130 degrees. Particular attention should be paid to obtaining adequate femoral component posterior flange fixation during unicompartmental knee arthroplasty. Patient education regarding maintaining a healthy weight is crucial to preventing this complication.

Biofilms are found in many infections in the forms of surface-adhering aggregates on medical devices, small clumps in tissues, or even in synovial fluid. Although antibiotic resistance genes are studied and monitored in the clinic, the structural and phenotypic changes that take place in biofilms can also lead to significant changes in how bacteria respond to antibiotics. Therefore, it is important to better understand the relationship between biofilm phenotypes and resistance and develop approaches that are compatible with clinical testing. Current methods for studying antimicrobial susceptibility are mostly planktonic or planar biofilm reactors. In this work, we develop a new type of biofilm reactor—three-dimensional (3D) microreactors—to recreate biofilms in a microenvironment that better mimics those in vivo where bacteria tend to form surface-independent biofilms in living tissues. The microreactors are formed on microplates, treated with antibiotics of 1000 times of the corresponding minimal inhibitory concentrations (1000 × MIC), and monitored spectroscopically with a microplate reader in a high-throughput manner. The hydrogels are dissolvable on demand without the need for manual scraping, thus enabling measurements of phenotypic changes. Bacteria inside the biofilm microreactors are found to survive exposure to 1000 × MIC of antibiotics, and subsequent comparison with plating results reveals no antibiotic resistance-associated phenotypes. The presented microreactor offers an attractive platform to study the tolerance and antibiotic resistance of surface-independent biofilms such as those found in tissues.

Introduction Chronic kidney disease (CKD) is a global-health problem. A significant proportion of referrals to nephrologists for CKD management are early and guideline-discordant, which may lead to an excess number of referrals and increased wait-times. Various initiatives have been tested to increase the proportion of guideline-concordant referrals and decrease wait times. This paper describes the protocol for a systematic review to study the impacts of quality improvement initiatives aimed at decreasing the number of non-guideline concordant referrals, increasing the number of guideline-concordant referrals and decreasing wait times for patients to access a nephrologist.Methods and analysis We developed this protocol by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (2015). We will search the following empirical electronic databases: MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO and grey literature for studies designed to improve guideline-concordant referrals or to reduce unnecessary referrals of patients with CKD from primary care to nephrology. Our search will include all studies published from database inception to April 2021 with no language restrictions. The studies will be limited to referrals for adult patients to nephrologists. Referrals of patients with CKD from non-nephrology specialists (eg, general internal medicine) will be excluded.Ethics and dissemination Ethics approval will not be required, as we will analyse data from studies that have already been published and are publicly accessible. We will share our findings using traditional approaches, including scientific presentations, open access peer-reviewed platforms, and appropriate government and public health agencies.PROSPERO registration number CRD42021247756.

The air traffic control industry is highly regulated, with stringent processes and procedures to ensure that IP (Intellectual Property) and workplaces are kept secure. The training of air traffic controllers (ATCs) and other roles relating to air traffic services is a lengthy and expensive process. The rate in which trainees can be trained is projected to fall significantly short of the demand for staff to work in the air traffic industry. This paper focuses on two prototype mobile training applications—Location Indicators (LI) and the Aircraft Control Positions Operator (ACPO) Starter Pack. LI and the ACPO Starter Pack have been produced to explore how air traffic control training could be improved and supported using digital applications. Each application explores a key learning area for trainees in the air traffic control industry and presents an alternative to the equivalent training that is currently in use. The two prototypes that have been designed focus on producing a succinct user experience alongside gamified elements to improve engagement. As part of this paper, usability testing has been undertaken with LI and the ACPO Starter Pack. A total of nine usability tests have been undertaken at four different locations. These usability tests consisted of participants from differing demographics, varying experience with the current training and differing amounts of time with both applications. The System Usability Scale (SUS) was adapted and used to quantify participant's reactions to the usability of each application. Usability scores for both applications were collected and then averaged to produce an overall score for each application. We can conclude from both usability scores and qualitative feedback that digital applications have the potential to engage future trainees in the air traffic services industry.

ObjectivesChronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network’s KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology.Design and settingThe study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph’s Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release.Primary and secondary outcome measuresThe primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria.ResultsThe proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form.ConclusionsWe did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.

Abstract The in situ determination of the size distribution of dispersed non-spherical nanoparticles is an essential characterization tool for the investigation and use of colloidal suspensions. In this work, we test a size characterization method based on the measurement of the transient behaviour of the birefringence induced in the dispersions by pulsed electric fields. The specific shape of such relaxations depends on the distribution of the rotational diffusion coefficient of the suspended particles. We analyse the measured transient birefringence with three approaches: the stretched-exponential, Watson-Jennings, and multi-exponential methods. These are applied to six different types of rod-like and planar particles: PTFE rods, goethite needles, single- and double-walled carbon nanotubes, sodium montmorillonite particles and gibbsite platelets. The results are compared to electron microscopy and dynamic light scattering measurements. The methods here considered provide good or excellent results in all cases, proving that the analysis of the transient birefringence is a powerful tool to obtain complete size distributions of non-spherical particles in suspension.

Pseudomonas aeruginosa is the most common Gram-negative pathogen causing nosocomial multidrug resistant infections. It is a good biofilm producer and has the potential for contaminating medical devices. Despite the widespread use of antibacterial-impregnated catheters, little is known about the impacts of antibacterial coating on the pathogenesis of P. aeruginosa. In this study, we investigated the adaptive resistance potential of P. aeruginosa strain PAO1 in response to continuous antibiotic exposure from clindamycin/rifampicin-impregnated catheters (CR-IC). During exposure for 144 h to clindamycin and rifampicin released from CR-IC, strain PAO1 formed biofilms featuring elongated and swollen cells. There were 545 and 372 differentially expressed proteins (DEPs) identified in the planktonic and biofilm cells, respectively, by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Both Cluster of Orthologous Groups (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the planktonic cells responded to the released antibiotics more actively than the biofilm cells, with metabolism and ribosomal biosynthesis-associated proteins being significantly over-expressed. Exposure to CR-IC increased the invasion capability of P. aeruginosa for Hela cells and upregulated the expression of certain groups of virulence proteins in both planktonic and biofilm cells, including the outer membrane associated (flagella, type IV pili and type III secretion system) and extracellular (pyoverdine) virulence proteins. Continuous exposure of P. aeruginosa to CR-IC also induced the overexpression of antibiotic resistance proteins, including porins, efflux pumps, translation and transcription proteins. However, these upregulations did not change phenotypic minimum inhibitory concentration (MIC) during the experimental timeframe. The concerning association between CR-IC and overexpression of virulence factors in P. aeruginosa suggests the need for additional investigation to determine if it results in adverse clinical outcomes.

One goal of the Social Work Grand Challenge is to positively influence the applications of technology. Nowhere is the challenge of integrating innovative technology more apparent than in field education settings. However, current technology trends, challenges, as well as interns' use of technology, which is often used in field education settings, particularly after the major shift to virtual platforms due to the COVID-19 Global Pandemic, are not well documented. During Fall 2021, the authors sought to evaluate field educators' (1) current use of technology in social service agencies, (2) perceptions and concerns about technology, and (3) plans for training and engaging student interns with technology. Semi-structured interviews were conducted with fifteen field educators recruited from one social work program. A rigorous thematic analysis approach then was used among six coders to report thematic findings. In this study, we report (1) benefits and limitations of using technology, (2) informal and formal technology training offered to student interns in social service agencies, and (3) recommendations for engaging and training students with technology. Two emerging themes were consistent: (1) generational differences related to technology perspectives of student interns and clients and (2) that the benefits and limitations of technology often are mixed.

Review of Leonora Neville, Anna Komnene: the Life and Works of a Medieval Historian (Oxford: Oxford University Press, 2016).

Evidence suggests that social and academic integration is a vital factor in doctoral student retention. This paper describes findings from a qualitative study which explored the experiences of a cohort of social work doctoral students during the first year in their programme of study. We used the anthropological concept of liminality which describes disorientation through transformative rites of passage, as a sensitising concept, through which to interpret the data. Thematic analysis indicated that the transition into new doctoral student was characterised by uncertainty and chaos and left the participants in an ambiguous position, betwixt and between socially prescribed roles. The findings demonstrate the need for anticipatory guidance and structured, sustained support, particularly within students' first year. Efforts to enhance cohort relationships and mentoring may also help.