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In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
Methods:
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
Results:
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Discussion:
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
Conclusions:
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
Research on the cities of the Classical Greek world has traditionally focused on mapping the organisation of urban space and studying major civic or religious buildings. More recently, newer techniques such as field survey and geophysical survey have facilitated exploration of the extent and character of larger areas within urban settlements, raising questions about economic processes. At the same time, detailed analysis of residential buildings has also supported a change of emphasis towards understanding some of the functional and social aspects of the built environment as well as purely formal ones. This article argues for the advantages of analysing Greek cities using a multidisciplinary, multi-scalar framework which encompasses all of these various approaches and adds to them other analytical techniques (particularly micro-archaeology). We suggest that this strategy can lead towards a more holistic view of a city, not only as a physical place, but also as a dynamic community, revealing its origins, development and patterns of social and economic activity. Our argument is made with reference to the research design, methodology and results of the first three seasons of fieldwork at the city of Olynthos, carried out by the Olynthos Project.
This collection of essays pays tribute to Nancy Freeman Regalado, a ground-breaking scholar in the field of medieval French literature whose research has always pushed beyond disciplinary boundaries. The articles in the volume reflect the depth and diversity of her scholarship, as well as her collaborations with literary critics, philologists, historians, art historians, musicologists, and vocalists - in France, England, and the United States. Inspired by her most recent work, these twenty-four essays are tied together by a single question, rich in ramifications: how does performance shape our understanding of medieval and pre-modern literature and culture, whether the nature of that performance is visual, linguistic, theatrical, musical, religious, didactic, socio-political, or editorial? The studies presented here invite us to look afresh at the interrelationship of audience, author, text, and artifact, to imagine new ways of conceptualizing the creation, transmission, and reception of medieval literature, music, and art.
EGLAL DOSS-QUINBY is Professor of French at Smith College; ROBERTA L. KRUEGER is Professor of French at Hamilton College; E. JANE BURNS is Professor of Women's Studies and Adjunct Professor of Comparative Literature at the University of North Carolina, Chapel Hill.
Contributors: ANNE AZÉMA, RENATE BLUMENFELD-KOSINSKI, CYNTHIA J. BROWN, ELIZABETH A. R. BROWN, MATILDA TOMARYN BRUCKNER, E. JANE BURNS, ARDIS BUTTERFIELD, KIMBERLEE CAMPBELL, ROBERT L. A. CLARK, MARK CRUSE, KATHRYN A. DUYS, ELIZABETH EMERY, SYLVIA HUOT, MARILYN LAWRENCE, KATHLEEN A. LOYSEN, LAURIE POSTLEWATE, EDWARD H. ROESNER, SAMUEL N. ROSENBERG, LUCY FREEMAN SANDLER, PAMELA SHEINGORN, HELEN SOLTERER, JANE H. M. TAYLOR, EVELYN BIRGE VITZ, LORI J. WALTERS, AND MICHEL ZINK.
Excess plutonium not destined for burning as MOX or in Generation IV reactors is both a long-term waste management problem and a security threat. Immobilisation in mineral and ceramic-based waste forms for interim safe storage and eventual disposal is a widely proposed first step. The safest and most secure form of geological disposal for Pu yet suggested is in very deep boreholes and we propose here that the key to successful combination of these immobilisation and disposal concepts is the encapsulation of the waste form in small cylinders of recrystallized granite. The underlying science is discussed and the results of high pressure and temperature experiments on zircon, depleted UO2 and Ce-doped cubic zirconia enclosed in granitic melts are presented. The outcomes of these experiments demonstrate the viability of the proposed solution and that Pu could be successfully isolated from its environment for many millions of years.
Cubic zirconia is a well known, highly durable material with potential uses as an actinide host phase in ceramic waste forms and inert matrix fuels and in containers for very deep borehole disposal of some highly radioactive wastes. To investigate the behaviour of this material under the conditions of possible use, a cube of ∼ 2.5 mm edge was made from a single crystal of yttriastabilized cubic zirconia doped with 0.3 wt.% CeO2. The cube was enclosed in powdered granite within a gold capsule and a small amount of H2O added before sealing. The sealed capsule was held for 4 months in a cold-seal pressure vessel at a temperature of 780°C and a pressure 150 MPa, simulating both the conditions of a deep borehole disposal involving partial melting of the host rock and the conditions under which the actinide waste form might be encapsulated in granite prior to disposal. At the end of the experiment the quenched, largely glassy, sample was cut into thin slices and studied by optical microscopy, EMPA, SEM and cathodoluminescence methods. The results show that no corrosion of the zirconia crystal or reaction with the granite melt occurred and that no detectable diffusion of elements, including Ce, in or out of the zirconia took place on the timescale of the experiment. Consequently, it appears that cubic zirconia could perform most satisfactorily as both an actinide host waste form for encapsulation in solid granite for very deep disposal and as a container material for deep borehole disposal of highly radioactive wastes (HLW), including spent fuel.
Results are presented from a systematic investigation to design and optimize a low-pressure chemical vapor deposition (CVD) process for manganese-doped zinc sulfide (ZnS:Mn) thin films for electroluminescent (EL) device applications. The CVD process used diethylzinc (DEZ), di-π-cyclopentadienyl manganese (CPMn), and hydrogen sulfide (H2S) as co-reactants and hydrogen (H2) as carrier gas. A design of experiments approach was used to derive functionality curves for the dependence of ZnS:Mn film properties on substrate temperature and flow rates (partial pressures) of DEZ, CPMn, H2S, and H2. Film physical, chemical, structural, and optical properties were examined using Rutherford backscattering spectrometry, dynamic secondary ion mass spectroscopy, x-ray photoelectron spectroscopy, nuclear-reaction analysis, x-ray diffraction, transmission electron microscopy, atomic force microscopy, and scanning electron microscopy. EL measurements were carried out on ZnS:Mn-based dielectric–sulfur–dielectric stacks incorporated into alternating-current thin-film electroluminescent devices. An optimized process window was established for the formation of films with predominantly (0 0 2) orientation, grain size larger than 0.2 μm, and Mn dopant level approximately 0.5 at.%. A brightness of 407 cd/m2 (119 fL) and efficiency of 1.6 lm/W were obtained, as measured at 40 V above threshold voltage and 60 Hz frequency.
The aim of the study was to test the hypothesis that raised platelet-activating factor (PAF) may contribute to the aetiology of developmental dyslexia. PAF is a potent proinflammatory mediator which signals cell damage and facilitates natural killer cell activity. Raised PAF may help protect against tumourigenesis. As dyslexia has a partial genetic basis, the PAF hypothesis predicts that dyslexia may be negatively associated with a family history of cancer. To test this prediction, children with dyslexia (n=163) and children without dyslexia (n=154), with (n=152) and without (n=165) a family history of cancer (total n=317; mean age 11 years 5 months, SD 2 years 11 months), were compared on standard psychometrics (British Ability Scales subtests). Results showed that proportionately fewer children with dyslexia (38%) than controls (58.4%) had a family history of cancer, and there was some evidence of a ‘dose’ effect: children who had more relatives with cancer showed better reading and spelling. It was concluded that children at genetic risk of dyslexia who have a family history of cancer have better reading and spelling than those without a family history of cancer, confirming the prediction of the PAF hypothesis.
