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Multidrug resistance is an established and growing worldwide public health problem, since few therapeutic options remain available. MRSA is the leading Gram-positive organism which has spread both in the community and healthcare environment. Gram-negative bacteria, either fermenter (enterobacteriaceae) or nonfermenter, pose a major challenge to the healthcare providers because they can express a wide multidrug resistance.Specific keywords combinations were analitically searched in PubMed and Scopus databases. Publications concerning contact precaution procedures were reviewed.The review on infection control and isolation precautions was carried out focusing on bundles that could help healthcare personnel to improve their action.This paper clearly refers to measures in order to control the spread of infectious disease. We provided some synthetic tables that could improve healthcare workers knowledge and help them to apply all fundamental concepts in infection control.

Gait and balance deficits are major impairments for Charcot-Marie-Tooth 1A (CMT1A) patients. However, motor rehabilitation is a challenge in CMT1A patients. There are poor evidences of clinical efficacy and low responsive outcome measures. Instrumented assessment (like inertial sensors) might be new tools to detect patient’s changes. A small sample of CMT1A was assessed before and after the rehabilitation period. Traditional and instrumented assessment measures of gait and balance were used. Results shown that only six-minute walking test showed an improvement after rehabilitation, in all patients. The Instrumented Timed Up and Go subtasks duration did not show responsiveness in CMT1A patients.

In the taiga-tundra ecotone (TTE), vegetation structure change can be subtle and site-dependent, yet occur across the circumpolar region. This asynchronous change may be related to the horizontal and vertical patterns of vegetation structure such as tree density and height within TTE forest patches (i.e., ecotone form) that is driven by local site conditions and linked to ecotone dynamics. The unique circumstance of subtle, variable and widespread vegetation change warrants the application of spaceborne data including high-resolution (< 5 m) spaceborne imagery (HRSI) across broad scales for examining TTE form and predicting dynamics. Recent work demonstrates the fundamental uncertainty of spaceborne-derived forest structure estimates in sparse boreal forests at the plot-scale. Analyses of forest structure at the patch-scale in the TTE provide a means to examine both vertical and horizontal components of ecotone form, their association with landscape characteristics and environmental factors, and a basis for examining the variation of patch characteristics across sites. In this study we demonstrate the potential of spaceborne data for integrating forest height and density to assess TTE form at the scale of TTE forest patches across the circumpolar biome by (i) mapping forest patches in study sites along the TTE in northern Siberia with a multi-resolution suite of spaceborne data, and (ii) examining the uncertainty of forest patch height from this suite of data across ecotone sites of primarily diffuse TTE forms. Results demonstrate the opportunities for improving patch-scale spaceborne estimates of forest height, the vertical component of TTE form, with HRSI. The distribution of relative maximum height uncertainty based on prediction intervals is centered at ~ 40 %. We discuss this uncertainty in light of a conceptual model of general ecotone forms. We highlight how the uncertainty of spaceborne estimates of height can contribute to the uncertainty in identifying TTE forms. A focus on reducing the uncertainty of height estimates in forest patches may improve depiction of TTE form, which may help explain variable forest responses in the TTE to climate change and the vulnerability of portions of the TTE to forest structure change.

Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome.Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded.During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%).The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.

An educational intervention for HAI prevention based on a combination of training, motivation and subsequent application in the current clinical practice in an Italian teaching hospital.In 2015-2016 a pilot mandatory training on HAI targeted to HCWs was organized in the 450 bed teaching hospital Sant'Andrea in Rome. By adopting the "Impact/control matrix" prioritization tool, the relative level of impact (risk in causing or favoring HAI) and control (possibility for HCWs to prevent HAI) attributed by the participants to the issues associated to HAI during their working groups was evaluated.Overall, 34 physicians, 43 nurses and 15 non clinical professionals participated actively in seven courses, identifying 58 different issues related to HAI, which were reported 128 times. Results showed frequently that, within the same type of issue, HCW referred various levels of impact (risk in causing or favoring HAI) and personal control (possibility for HCW to prevent HAI). Overall staff shortage was the most reported problem by HCW in our hospital. Also hand washing was regarded as a main problem, but HCW expressed the feeling that individuals could act more successfully on this issue (high or medium control). Results showed that staff frequently did not know how to handle correctly visitors, similarly many colleagues expressed some difficulty in communicating information to patients and relatives on HAI. Surprisingly, "antimicrobial therapy" and "excessive invasive procedures" were not particularly highlighted by the personnel. HCW expressed satisfaction for the course approac.The study showed an overall good level of knowledge regarding the importance and principles of infection control in our teaching hospital HCW. However personnel perceived a variability in the impact of many issues on HAI and even more on the personal possibility to control their effect. In order to improve HCW compliance with HAI prevention programs, the "Adult Learning" model seems to be very useful.

The effects of aeration on the discharge of silos loaded with initially segregated particles have been evaluated. Experiments were carried out on a two-dimensional laboratory-scale aerated silo, loaded according to either ideal or controlled natural segregation patterns. Two different systems of powders made up of two size cuts were tested, one system belonging to group A and the other to group B of the Geldart classification. One of the two cuts was colored to visualize the segregation changes and the solids flow during discharge. Time variations of the discharged solids discharged were evaluated by means of a rotating sample. Results of aerated discharge were compared with mass flow discharge. From analysis of the experimental results, it is possible to conclude that aerated discharges can effectively promote the uniform solids discharge of horizontally segregated solids of group A powders. In contrast, further segregation occurs for aerated discharges of group B powders below the minimum for fluidization.

An investigation was conducted to compare several variables of off-pump coronary artery bypass (OPCAB) procedures with those using cardiopulmonary bypass (CPB) for myocardial revascularization by two surgeons. The patients were divided into four groups: group 1 patients received CPB for their myocardial revascularization performed by surgeon A; group 2 patients received the OPCAB procedure performed by surgeon A; group 3 patients received CPB for their myocardial revascularization performed by surgeon B; and group 4 received the OPCAB procedure performed by surgeon B. The same anesthesia technique and postoperative management were employed for all patients in this study. The CPB procedures received the same perfusion circuit and conduct. Postoperative laboratory values, including hemoglobin, hematocrit and platelet counts for the OPCAB groups, were higher than the CPB groups. Chest tube drainage was similar for both the OPCAB and CPB groups, but postoperative urine outputs were significantly higher in the CPB groups for both surgeons. Positive fluid balance was statistically greater in the CPB groups compared to the OPCAB groups for both surgeons. Ventilator times, length of stay in the intensive care unit (ICU) and length of hospital stay were not statistically significant for the groups in this study. Postoperative weight gain for both surgeons was higher in the CPB groups. Intraoperative packed red blood cell (PRBC) usage for surgeon B was similar for both the OPCAB and CPB groups, but the OPCAB group for surgeon A had greater intraoperative PRBC usage than the CPB group.

An investigation was conducted to evaluate the effect that surface coating of the hollow-fiber membrane oxygenator had on circulating platelet count drop during cardiopulmonary bypass (CPB). Sixty patients undergoing non-emergency myocardial revascularization for coronary artery disease were randomly divided into two groups. Group one ( n = 32) received the Carmeda®-coated Maxima- Plus PRF oxygenator while the patients in Group two ( n = 28) received the Trillium™-coated Affinity oxygenator during CPB. The net platelet count drops for the pump specimen (15-20 min after the initiation of bypass) for the Carmeda and the Trillium groups were 3.6±15.8% and 6.2±10.2%, respectively. The net platelet count drop for the warming specimen for the Carmeda and the Trillium groups were 2.9±19.4% and 0.5±11.0%, respectively. There were no statistically significant differences between the groups. The authors conclude that using either the Carmeda®-coated Maxima- Plus PRF oxygenator or the Trillium™-coated Affinity® oxygenator afford similar benefits in regards to preserving circulating platelet counts during bypass.

The new Trillium™ Biopassive Surface is a coating designed to minimize the adsorption of protein and the attachment of cells. In previous studies, we were able to demonstrate that, by coating the bypass circuit with small amounts of albumin, the drop in circulating platelet count seen with the newer low-prime hollow-fiber membrane oxygenators is eliminated. A study was undertaken to compare the Avecor Affinity™ oxygenator with albumin in the prime with the Trillium-coated Affinity. Fifty-six patients undergoing nonemergency open-heart surgery were randomly divided into two groups. One group (Albumin) received the Affinity oxygenator with 10 ml of 25% albumin added to the pump prime. The other group (Trillium) received the Trillium-coated Affinity oxygenator. To normalize the data for the effects of hemodilution, the mean net platelet count drop on bypass was calculated for each group. The Albumin group had a net platelet count drop of 0.81 ± 9.78%, while the Trillium group had a drop of 1.58 ± 13.0%. There was no significant statistical difference between the two groups. From our investigation, we concluded that Trillium Biopassive Surface coating affords the Affinity oxygenator the same protective effects on circulating platelet counts as adding albumin to the prime.

Background Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008. Methods Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables. Results Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included. Conclusions A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.

A prospective study was conducted to evaluate the trans-oxygenator pressure gradient across three different hollow-fibre membrane oxygenators during routine cardiopulmonary bypass (CPB). Sixty consecutive open-heart surgery patients were randomly divided into three groups each receiving a different model of membrane oxygenator. Inlet and outlet pressures, as well as patients' pressures, blood flow, revolutions per minute and tympanic membrane temperature were recorded every 15 min during CPB. Within the study groups, there were subsets of patients who exhibited high trans- oxygenator pressures. Although most of these episodes were transient and resolved over a period of time, there were several cases during which the high trans-membrane pressures persisted, resulting in decreasing oxygenator performance. In one such case, oxygenator change-out was required. After extensive analysis and review, the only similarities or correlation that could be made were with the marriage of the newer lower- prime hollow-fibre membrane oxygenators (with corresponding narrow blood path) and the integral uncoated stainless steel heat exchangers. Further study needs to be performed to pinpoint the mechanism and pathophysiology that are involved in this phenomenon.

Ultrathin films of Mn grow epitaxially and pseudomorphically on Fe{001}. Low-energy electron diffraction (LEED) experiments show that with increasing thickness the films contain defects and disorder, but a substantial portion remains well crystallized. A quantitative LEED analysis of a 23-\AA{}-thick film finds that the film has a body-centered-tetragonal structure with lattice parameters: a=2.866 \AA{} and c=3.228 \AA{}, hence with an axial ratio c/a=1.13 and atomic volume 13.3 A${\mathrm{\r{}}}^{3}$/atom. Strain analysis using both the LEED results and the tetragonal structure from dilute Mn alloys determines the Poisson ratio of the film to be near 0.5, hence the film is elastically soft. Both the face-centered- and the body-centered-cubic structures are consistent with the data as underlying phases of the grown film. LEED intensity data show that the distance between Mn layers is small (about 1.3 \AA{}) when the epitaxial film is only two- or three-layers thick, and then increases to become 1.614 \AA{} in the bulk of 14-layer thick films. \textcopyright{} 1996 The American Physical Society.

Evidence has been presented suggesting the involvement of integrins and their ligands in mammalian fertilization. In this study we asked whether the alpha 5, alpha v, beta 1 and beta 3 integrin chains, which form receptors for fibronectin and vitronectin, are present on human spermatozoa. Fresh ejaculate spermatozoa and capacitated spermatozoa, before and after a calcium ionophore (A23187)-induced acrosome reaction, were either fixed and their reaction with anti-integrin monoclonal antibodies detected by immunoperoxidase staining or studied without fixation, using cytofluorimetric scanning. Expression of specific integrin chains varied with the functional state of spermatozoa. The alpha 5 chain was not detected on fresh living spermatozoa, but was present on capacitated spermatozoa, whether fixed or living. The pattern of beta 1 expression on living spermatozoa paralleled that of alpha 5. No further increase in the expression of either alpha 5 or beta 1 was observed following an ionophore-promoted acrosome reaction. In contrast, alpha v was detected on neither fresh, living ejaculate spermatozoa, nor following capacitation (< 10% reactive). The percentage of alpha v positive cells increased substantially following ionophore exposure. Expression of beta 3 was similar to alpha v, and the percentage of cells displaying beta 3 correlated with the proportion of spermatozoa that had undergone an acrosome reaction, following ionophore exposure. These results indicate that the expression of integrins on spermatozoa is dynamic, varying with their functional state and that integrin receptors for fibronectin (alpha 5 beta 1) become apparent on the spermatozoan surface during capacitation and vitronectin (alpha v beta 3) following the acrosome reaction.

Selectins are a family of adhesive molecules, involved in the interactions between leukocytes and endothelium and in platelet adhesion. P-selectin, one of the members of this family, is stored in alpha-granules and dense granules of platelets as well as in Weibel-Palade bodies of endothelial cells, and it is rapidly redistributed to the cell surface after activation. It recognizes carbohydrate structures as ligands, in particular sialyl-Lewis(x), which is part of the CD15 antigen. In this work we studied P-selectin expression on gametes. While zona-free human and hamster oocytes did not react with a monoclonal antibody directed against P-selectin, oocytes from both species displayed a reactivity with this antibody following their contact with human spermatozoa, as demonstrated both by covasphere binding and indirect immunofluorescence. Artificial activation of zona-intact human oocytes by means of the calcium lonophore A23187 induced the expression on the oolemma of a moiety reacting with anti-P-selectin antibody as well. P-selectin also appeared to be expressed on the sperm surface following the acrosome reaction, as demonstrated by a flow cytometric study of reactivity of spermatozoa with the anti-P-selectin antibody, using the expression of CD46 as a marker of the acrosome reaction. The localization of the P-selectin moiety on the equatorial region of the plasma membrane of acrosome reacted spermatozoa was confirmed by transmission electron microscopy using immunogold labelling. We suggest that P-selectin might be involved in gamete interactions.

The aim of this study was to assess whether a screening program for fetal cardiac malformations is justified in a low-risk population, and which factors influence its accuracy. The fetal heart was evaluated in 7024 pregnant women at 20–22 weeks, and evaluation was repeated at a more advanced gestational age in 9% of cases. Cardiological follow-up was continued postnatally until 2 years of age. The overall prevalence of cardiac anomaly was 0.93% The incidences of major and minor defects were 0.44% and 0.48%, respectively. There were 23 true positives (0.33%). in 20 cases, the diagnosis was made in the second trimester, and 13 women (6.5%) chose termination of pregnancy. Seventeen of the 20 cases identified in the second trimester were serious malformations. There were 42 false negatives (0.60%). Of these, 12 had signs of cardiac dysfunction at birth or within the 1st month of life, and three of them died as a result of their cardiac anomaly. There were eight false positives (0.11%), all of a minor type. Six abnormal karyotypes, out of a total of 21 performed in the true-positive group (28.5%) were found. In addition five of 42 newborns in the false-negative group had trisomy 21. The overall sensitivity was 35.4% and 61.3% for major defects. The accuracy in two distinct periods was estimated because the level of experience of the operators was different: sensitivity was 45.2% in period 1 (1986–88) (77.8% for major defects) and 26.5% in period 2 (1989–92) (52.9% for major defects). We conclude that a fetal heart screening program in the obstetrics population is justified. It defines a high-risk group for karyotyping, allows planning of delivery in a tertiary center or the choice of terminating the pregnancy for the parents and appears to have a positive cost-benefit ratio. A crucial factor is the level of training and experience of the operators, who need specific teaching support. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology