Control Practices Research Articles

Outbreak of New Delhi Metallo-β-lactamase-producing Escherichia coli in a Neonatal Intensive Care Unit, New York State

Background: Outbreaks of carbapenemase-producing (CP) organisms (CPOs), including carbapenem-resistant Enterobacterales (CRE), in neonatal intensive care units (NICUs) are not well documented. The Centers for Disease Control and Prevention (CDC) identifies CP-CRE as an urgent threat to United States (US) healthcare facilities. Wadsworth Center, the New York State (NYS) Department of Health’s (NYSDOH’s) public health laboratory, participates in CDC’s Antimicrobial Resistance Laboratory Network to provide CPO identification, characterization, and surveillance. NYSDOH investigated an outbreak of CP-CRE Escherichia coli (E. coli) infections in NICU patients reported by one hospital. Method: Hospital A reported a CRE E. coli outbreak in their NICU to NYSDOH, as required by NYS Sanitary Code. In response, epidemiologists reviewed case data, conducted case finding, and provided infection control guidance to the hospital. Hospital A continued NICU clinical surveillance and conducted colonization screening to detect additional cases of CRE E. coli. The Wadsworth Center Antimicrobial Resistance Laboratory Network tested isolates from affected patients for CP genes and performed whole genome sequencing (WGS) to determine the CP gene variant, multilocus sequence type (MLST), and relatedness by mutation event (ME) analysis. NYSDOH epidemiologists assessed Hospital A’s infection control practices in affected areas and provided recommendations. Result: Hospital A identified two CRE E. coli infections in NICU patients with overlapping admissions in June-July 2023. Retrospective surveillance identified a third CRE E. coli case in an adult medical intensive care unit patient on admission to Hospital A in June 2023, with prior hospitalization April-May 2023. WGS analysis identified the blaNDM-5 gene in all three CRE E. coli patient isolates. The two NICU patients’ isolates had the same MLST (361/650) and differed by 9 MEs, indicating relatedness to each other and not the adult patient’s (MLST 167/2). NICU patient colonization screening identified no additional blaNDM-5 E. coli cases. NYSDOH’s NICU infection control assessment found that both cases were in adjacent isolettes within three feet of each other. Clean isolettes, equipment, and supplies for new admissions were stored in the clinical care space, not in a separate clean area. Conclusion: CP-CRE is an urgent threat to US healthcare facilities, including hospital NICUs. Though the incidence and prevalence of CP-CRE blaNDM-5 E. coli are not well-defined in NY, single healthcare-associated cases in NICU populations represent an outbreak. The Wadsworth Center Antimicrobial Resistance Laboratory Network’s contributions complement traditional epidemiologic surveillance and investigation methods to provide more specific, comprehensive infection

Anatomy of a pest control failure: introgression of cytochrome P450 337B3 alleles from invasive old-world bollworm into native corn earworm (Lepidoptera: Noctuidae).

The establishment of invasive species populations can threaten the ecological balance in naïve habitats and impact agricultural production practices. Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae)(old-world bollworm, OWBW) and Helicoverpa zea (corn earworm, CEW) were geographically separated prior to the 2013 report of OWBW invasion into South America. Introgression of OWBW-specific cytochrome P450 337B3 (CYP337B3) gene into CEW was repeatedly detected across South America and the Caribbean. Two hybrids were documented from Texas in 2019. In this study, screening insects collected in Olathe, CO, USA, where a failure of pyrethroids to control CEW damage to conventional sweetcorn in 2023 detected 28.6% of insects with the OWBW-specific CYP337B3 marker. Nucleotide sequencing of the CYP337B3 gene identified 73.1% and 26.9% of insects carried CYP337B3v2 and CYP337B3v6 alleles, respectively, and 0.15 overall frequency of CYP337B3 alleles. Based on prior data for distinct phylogeographic origins of CYP337B3v2 and v6 alleles, our results indicate Olathe samples were derived from 2 different introductions: An uncertain source of the v6 allele that was initially reported in West Africa and possibly South American or Caribbean origin of the globally distributed v2 allele. One of the 1618 individuals screened also carried a ribosomal RNA internal transcribed spacer 1 derived from OWBW. Local selection pressures at the Olathe location imposed by repeated pyrethroid exposures are likely attributed to the prevalence of CYP337B3, where control practices hasten the accumulation of phenotypic resistance by adaptive introgression. Pyrethroid and other resistance factors carried by invasive OWBW may continue to impact CEW management tactics across the Americas.

Bridging the Gap: Specialized Training Programs for Infection Prevention Specialists Increase Certification Success

Background: The role of the infection preventionist (IP) is complex and encompasses a range of responsibilities requiring extensive knowledge in infection control practices, data analysis, surveillance, performance improvement and collaboration with multidisciplinary teams. Infection prevention certification (CIC) by the certification Board of Infection Control (CBIC) is a standardized marker of knowledge and competencies required for practice in the field. In a 2020 survey of IPs, less than half were certified or planned to become certified. Of those that do take the certification exam, less than three quarters pass on their initial exam attempt. Methods: From 2017 to 2023, fifty-two new IPs were enrolled in a competency-based training program which combined didactic and applied learning on core IP job functions, and a structured mentoring program. The initial didactic phase consisted of evidence-based learning modules with validation of competency through post-training testing and practical demonstration. Education was provided by an advanced practice IP via remote webinars, which included discussion of questions, skills coaching, and review of post-tests. Novice IPs were partnered with at least two preceptors: one advanced practice lead preceptor guided the novice IPs through assigned education modules and oversaw program management and training benchmarks. A second, near-peer preceptor or mentor collaborated with the novice IP in the facility setting. Initial training focused on facility operations, surveillance, rounding and other facility specific activities. Facility mentors were responsible for combining education module topics with practical application of skills. Mentors guided novice IPs through National Healthcare Surveillance network (NHSN) surveillance training and validated surveillance and infection coding until the novice IP had an interrater reliability validation assessing surveillance competency. After the initial training phase, the novice IPs began preparation for certification. This phase included additional training modules aligned with the CBIC certification content outline and practice exams. Results: All 52 novice IPs completed the training program and attempted the CIC examination. The initial pass rate for the certification exam among IPs in the supervised training and mentorship program was 98.1% (n=51). This is 33% higher than the initial pass rate published by CBIC, which was 73.9% (Figure 1). Conclusions: Organizing evidence-based guidelines into topic-specific modules builds a foundation of infection prevention and control knowledge, which is enhanced through remote instruction and direct application of skills under a preceptor’s supervision. This method allows IPs to be introduced to concepts covered in the board certification exam upon hire and support certification with improved outcome

EpiXact-ONT: Long-read whole genome sequencing for rapid outbreak detection and comprehensive plasmid transmission analysis

Background: Healthcare associated infections (HAIs) are a major contributor to patient morbidity and mortality. HAIs are increasingly important due to the rise of multidrug resistant pathogens which can lead to deadly nosocomial outbreaks. Traditional methods for investigating transmissions are slow, costly and have poor detection resolution. In addition, plasmid transmission which can horizontally transfer critical resistance and virulence genes is not part of routine infection control practice due to lack of comprehensive and cost-effective methods capable of identifying both pathogen and/or plasmid transmission. Here we demonstrate the utility of the Oxford Nanopore Technologies (ONT) platform for whole genome sequencing (WGS) based pathogen and plasmids transmission analysis. Methods: We developed a rapid end-to-end process that includes sample preparation, sequencing optimized for generating long-reads and bioinformatics workflow customized for error-prone ONT data. We use Flye to generate de novo assemblies and a secondary bioinformatics step to identify each circular sequence. Individual circular sequences with an Ori (≥1) are identified. For pathogen clonality analysis we perform a pairwise mapping-based chromosomal sequences comparison eliminating need for an external reference genome. Similarly, individual plasmids are separated and compared pairwise. We annotate both the circularized chromosomal and plasmid sequences for known resistance and virulence genes. Results: We performed ONT (and confirmatory Illumina) sequencing of the genomes of 20 bacterial isolates originating from 5 HAI investigations previously performed at Day Zero Diagnostics using epiXact®, our Illumina-based HAI sequencing and analysis lab service. ONT-based clonality determination had 100% agreement with the Illumina based pipeline. We also found that using the outbreak-specific assembled genomes instead of an external reference increased the SNP-calling resolution in the ONT pipeline. We also identified sets of clonal isolates with both identical plasmids and distinct plasmids; as well as sets of non-clonal isolates with identical plasmids and distinct plasmids. In one subset of 7 multi-species isolates, we identified 2-7 circularized plasmid sequences in each isolate, all harboring known resistance genes. 4 plasmids were found in multiple isolates, with each plasmid appearing in between 2 and 4 distinct isolates. Notably, blaNDM was identified in at least 1 plasmid in each isolate. Conclusion: We demonstrate the utility of ONT for comprehensive HAI investigations, establishing the potential to transform healthcare epidemiology with rapid outbreak determination covering pathogen and plasmid transmission in < 2 4 hours from sample receipt.

Estimation of Soil Loss using Remote Sensing Data in a Regional Tropical Humid Catchment Area

Soil erosion has been and continue to be a major threat to environmental degradation especially in the developing countries. Accurate estimation of soil loss will provide reliable information in the management and mitigation solutions to soil erosion. In this study, the soil loss in an erosion prone Anambra State of South East region of Nigeria was estimated. Due to the complex nature of the catchment characteristics of Anambra State, soil loss cannot be estimated precisely by mere application of conventional soil erosion model. Hence a site-specific methodology was developed and applied. Revised Universal Soil Loss Equation (RUSLE) was integrated with the Geographic Information System (GIS) of the environment using remote sensing to build the model. 40-years rainfall data was collated from the Nigeria Meteorological Agency and analyzed. The various parameter of RUSLE which includes: Rainfall Erosivity (R), Soil Erodibility (K), Topography (LS), Land Use and Land Cover (C), and Erosion Control practices (P) were developed and imposed into ArcGIS 10.6 to estimate the amount of annual soil loss in the area. The result indicated that about 27.58km2 (0.59%) of the study area have very low erosion rate of 0 – 5 t ha1year-1 , while the rates of erosion in 1311.52km2 (28.01%), 538.59km2 (11.50%), 1649.08km2 (35.22%), 959.09km2 (20.48%), and 196.76km2 (4.20%) of the study area are 5–10, 10–15, 15–25, 25–50 and >50 t ha-1year-1respectively. This knowledge will help decision makers in managing the land degradation problems in Anambra State of Nigeria. Doi: 10.28991/CEJ-2024-010-07-014 Full Text: PDF

Sustained Microbial Burden Reduction and Impact on Covid19 Cases in Long-Term Care Facility through Advanced Photocatalysis

Background: COVID19 remains deadly to Americans over 75 years old despite vaccination and additional infection control practices in long term care (LTC). The evolution of more transmissible COVID19 variants and continued viral aerosols result in persistent COVID19 outbreaks in LTC during high community levels of COVID19. Despite the end of pandemic Federal support and the continued vulnerability of elderly to the virus, LTC facilities remain dedicated to protecting this vulnerable population. The study hypothesized that utilization of continuous, facility-wide, advanced photocatalysis (AP) disinfection technology will reduce microbial burden in air and on surfaces, demonstrating a decrease in infectious aerosols and subsequent COVID19 cases among residents and workers. Methods: A prospective facility controlled experimental study was performed in skilled nursing facilities in Pennsylvania and New Jersey from January 2023 to April 2023 to surveil aerobic bacterial and fungal colony forming units (CFUs) in air, and Methicillin-resistant Staphylococcus aureus (MRSA) and fungal CFUs on surfaces and floors prior to and post AP technology installation. Impacts on resident COVID19 cases were recorded and compared to the same extended observation period (February-July 2023) one year prior (2022) with similar year over year community COVID19 rates. In addition, two matched control centers in regional proximity to the intervention facility were also prospectively studied. A one-way analysis of variance (ANOVA) was used to analyze mean microbial burdens after each post activation period (significance p <.05). Results: From baseline to final testing, the intervention facility surface testing showed a 93% reduction in mean aerobic bacterial CFUs (p=.002); 96% reduction in mean fungal CFUs (p<.001); 97% reduction in mean MRSA CFUs (p<.001). Floor testing also showed reductions in mean CFUs for aerobic bacteria by 92% (p<.001); 96% for fungi (p<.001); 99% for MRSA (p<.001). Air testing showed reductions in mean CFUs for aerobic bacteria by 87% (p=.005); 36% for fungal (p=.005). The intervention facility observed a 94% reduction in resident COVID19 cases compared to the matched control facilities that increased 46% during the 2023 time period (Figure 1). Conclusion: This study is on the pioneering edge of demonstrating that continuous and persistent disinfection technology reduces contaminant reservoirs on surfaces, floors, and air and clearly decreases infectious aerosols and improves resident outcomes by dramatically reducing COVID19 transmission in LTC facilities.

Assessing chlorhexidine resistance in MRSA isolates from hospitals in Cleveland, OH and Detroit, MI

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of procedure-related, skin, and soft-tissue infections. Hospitalized patients who are colonized with MRSA are at a higher risk of developing invasive infections after discharge. Chlorhexidine, an antiseptic/disinfectant, has been used to reduce carriage and prevent infections in these patients. Studies have shown chlorhexidine resistance among MRSA strains. Chlorhexidine resistance is associated with qac genes, which encode multidrug efflux pumps that increase bacterial tolerance to disinfectant agents. The global distribution and prevalence of qacA and qacB genes are highly variable. One study reported that qacA and qacB genes could be found in 0.9% - 83.3% of clinical MRSA isolates worldwide. The goal of this study was to determine the prevalence of chlorhexidine resistance and identify the resistance-associated genes from our MRSA samples using whole genome sequencing (WGS). Methods: 474 MRSA samples were obtained from hospitals in Detroit, MI (287) and Cleveland, OH (187). Whole genome sequencing was performed using the NextSeq (Illumina Inc., CA) platform. The sequencing data was analyzed using ResFinder 4.1, a publicly available database that can be used to identify acquired genes and chromosomal mutations mediating antimicrobial resistance. The output was organized into a data sheet to visualize the presence of the genes of interest. Results: The qacA gene was present in only one MRSA sample from the Cleveland area hospital. In the samples from Detroit, 14 out of 287 showed disinfectant resistance genes. The qacA, qacB, and qacD were present in 1, 6, and 7 samples, respectively. The prevalence of any qac gene in the Cleveland area samples was 0.5%. Meanwhile, the prevalence of any qac gene in Detroit area samples was 4.9%. Among the 7 samples that have qacD gene, 6 samples have more than one copy of qacD. Conclusions: The prevalence of the “qac” gene varied widely based on the origin of the samples. Detroit area samples had more qac genes prevalence than Cleveland area samples. Chlorhexidine is a widely used antiseptic/disinfectant, and it plays a vital role in reducing carriage and preventing infection among hospitalized patients colonized with MRSA. Monitoring and addressing MRSA-reduced susceptibility to chlorhexidine is imperative for maintaining the effectiveness of infection control practices such as decolonization.

The effect of a health education programme on Tuberculosis infection prevention and control practices among HIV-positive patients at three tertiary hospitals in Ogun state, southwest Nigeria

Objective: This research evaluated the impact of a peer-support health education programme on tuberculosis infection prevention and control practices among HIV-positive patients receiving anti-retroviral therapy (ART) in a tertiary hospital. Methods: A quasi-experimental design was used for this study. Forty respondents were randomly selected between January and April 2023. Two tertiary health institutions in Ogun State, Nigeria with Direct Observation Treatment Shortcut programme were purposively selected. Systematic sampling was used to select the participants from the selected facilities and they were grouped into one experimental group (EG) and one control Group (CG). The intervention was implemented for six weeks and data were collected at baseline, immediate post-intervention and at 12th-week follow-up. Results: At the 12th-week follow-up, the peer-supported health education intervention had a significant effect (t78=14.21, effect size =3.09, p <0.05) on the Intervention Group with a mean score (X̅) of 6.85±0.86 compared to the Control Group (CG) with a mean score (X̅) of 3.95±0.96. Furthermore, among the Intervention Group, there is a significant difference (t39=19.0, effect size =3.06, p <0.05) in the effect of the peer-supported health education intervention program on TB infection prevention practices of participants at baseline (X̅ =3.98±0.73) and also at 12th weeks follow-up (X̅ =6.90±0.71). Conclusion: There was a significant association between the intervention and improvement in TB infection prevention and control practices. More focus should be placed on peer-supported health education TB prevention interventions among HIV patients. Also, the National Tuberculosis Control Programme should adopt peer-supported health education interventions to improve prevention practices.

Health Care Practices of Jaffarabadi Buffalo Farmers in Rural Areas of Junagadh District of Gujarat, India

A field study was conducted in Junagadh district of Gujarat to ascertain the health care practices followed by Jaffarabadi buffalo owners and data were collected from randomly selected 320 respondents through personal interview with the help of structured interview schedule. The present study revealed that about 63.12 and 17.50 percent of the respondents regularly vaccinated their buffaloes against Foot and Mouth Disease and Haemorrhagic Septicaemia disease, respectively. None of the respondents vaccinated and tested their buffaloes against brucellosis. Only 18.13 percent of the respondents practiced deworming to their buffaloes at regular interval and followed various practices (spraying, dusting and injectable drugs) for control of ecto–parasites (81.56%) and cleaned animal sheds (76.57%). Only 22.82 percent of the respondents informed that they treated their sick buffaloes by veterinarian. All the respondents washed hind quarters of buffalo after drop of placenta. Most (83.75%) of the respondents kept diseased animals together with healthy ones and majority (70.94%) of the respondents removed the dung twice in a day from animal sheds.

KNOWLEDGE EVALUATION OF MOSQUITO CONTROL PRACTICES WITHIN THE CENTRAL REGION OF JIGAWA STATE, NORTH-WEST NIGERIA

In order to mitigate and manage life-threatening mosquito-borne diseases such as malaria, Dengue, and lymphatic filariasis, both socio-demographic factors and the collective vector control knowledge within the community are pivotal. Hence, the objective of the current study is to evaluate the awareness and understanding of mosquito control practices in specific communities located in Jigawa State, North-west Nigeria. A cross-sectional study was conducted in which 60 structural questionnaires were distributed in the three selected communities. In each village, 20 questionnaires were randomly shared and captured information on Demographical characteristics, House characteristics, Use of mosquito net etc. Among the 60 respondents, only 17(28.3%) of the respondents were participating in community sanitation, majority of respondents 56(93.3%) were found to keep water at home. However, usage of long-lasting insecticide nets (LLINs) on daily basis were recorded significantly highest 48(80%). We therefore recommend promotion of the significance of environmental sanitation as a primary measure for controlling mosquito-borne diseases among them.

Agricultural Engineering Vocational School in Aceh Besar with Behavior Architecture Approach

Currently, Aceh Besar District has a PP Negeri Saree Vocational School in the agricultural section in Saree Aceh Besar, but this school only studies agricultural information. The condition of Aceh Besar District shows that their land use majority is used for agriculture, animal farming and husbandry, fisheries and paddy fields, farm, and other plantations. Abundant natural resources are not processed into a good business due to a shortage of human resources in the field of agricultural engineering. Therefore, it is necessary to include an Agricultural Engineering in those vocational school with aims to create human resources in the field of agricultural machinery and agribusiness. The object design location is on SIM Airport Street, Gani, Kec. Want Jaya, Aceh Besar. The classification of the Agricultural Engineering Vocational School includes the Department of Agricultural Engineering and Agricultural Product Processing Agribusiness. The approach of behavior architecture into the design is behavior setting in completing spatial design, spatial cognition in completing circulation, and environment perception in completing image or building appearance. The analysis used is functional analysis, site analysis and user analysis. The Agricultural Engineering Vocational School in Aceh Besar is designed on an area of 14,950 m2 with multiple building masses. The ground coverage area (KDB) is 40% which is 5,980 m². The facilities in the building meant to support students in the learning process and as well as supporting facilities, those facilities are practice rooms, namely rice threshing machine engineering rooms, rice processing , rice polisher machine, hand tractor, technology for processing agricultural products, quality testing and quality control practice room.

International cooperation in public control of local governments: lessons for Ukraine

The purpose of this article is to examine the legal framework and general theoretical aspects of the formation and implementation of state policy regarding public control over local self-government bodies, comparing regulations in Ukraine and European Union member states. The study employs dialectical, synthesis, and theoretical analysis methods to investigate public control in Ukraine, and systemic-structural, formal-logical, and comparative-legal methods to compare public control practices in Ukraine and other countries. The research highlights that international experience is crucial for improving the functioning of local self-government bodies in Ukraine, and public control over their activities is a factor stimulating the improvement of the implementation of their powers. The need for all countries to coordinate and improve the legal framework for effective cooperation at the municipal level is emphasized. The study notes that under martial law in Ukraine, methods of public control over the functioning of local self-government bodies are limited. Based on the analysis of the aforementioned works, forms of international cooperation in the field of public control over the exercise of local power have been determined.

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2018-2022.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2018 to 2022 (Candida auris, 2012-2022) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial and territorial laboratories to the National Microbiology Laboratory. Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for Clostridioides difficile infections (CDIs), carbapenemase-producing Enterobacterales (CPE) infections, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2017 (retrospectively to 2012) by the National Microbiology Laboratory. Trend analysis for case counts, rates, outcomes, molecular characterization and AMR profiles are presented. From 2018 to 2022, decreased rates per 10,000 patient days were observed for CDIs (7% decrease; 5.42-5.02) and MRSA BSIs (2.9% decrease; 1.04-1.01). Infection rates for VRE BSIs increased by 5.9% (0.34-0.36). Infection rates for CPE remained low but increased by 133% (0.06-0.14). Forty-three C. auris isolates were identified in Canada from 2012 to 2022, with the majority in Western and Central Canada (98%). From 2018 to 2022, the incidence of MRSA BSIs and CDIs decreased and VRE BSI and CPE infections increased in the Canadian acute care hospitals participating in a national sentinel network (CNISP). Few C. auris isolates were identified from 2012 to 2022. Reporting standardized surveillance data to inform the application of infection prevention and control practices in acute care hospitals is critical to help decrease the burden of HAIs and AMR in Canada.

Effects of Two Prey Species Combinations on Larval Development of the Predatory Ladybird Cheilomenes propinqua.

Feeding on mixed, alternating, or changing diets often favor insect development. With the aim to optimize mass rearing and use for the biological control of insect pests, we investigated the effects of various combinations of high-quality (the green peach aphid Myzus persicae) and low-quality (eggs of the grain moth Sitotroga cerealella) foods on the larval development of a predatory ladybird Cheilomenes propinqua. In the first experiment, eggs and aphids were mixed in different proportions; in the second experiment, larvae switched from feeding on aphids to feeding on eggs. Although the beneficial additive effect of mixed foods was detected in some treatments with limited diets, feeding on various combinations of eggs with aphids never resulted in higher survival, faster development, or a larger size of emerging adults than those observed for feeding on unlimited amounts of aphids. For the practice of biological control, we conclude that, if necessary (for example, in the case of temporary shortage or a lack of aphids in mass rearing facilities or in the case of preventing release of C. propinqua adults in greenhouses), C. propinqua larvae can be fed with grain moth eggs by replacing, mixing, or alternating with aphids, although this will inevitably result in a proportional decrease in pre-adult survival, rate of development, weight, and size of the emerging adults. On the other hand, even a minimal addition of aphids can have a substantial positive effect on larvae fed with grain moth eggs.

An overview of fasciolosis in Nepal: epidemiology, diagnosis, and control strategies.

Fasciolosis, caused by Fasciola hepatica and Fasciola gigantica, is a globally prevalent vector-borne disease that affects livestock and humans, with significant economic and zoonotic implications. In Nepal where livestock contributes to 11.5% of the GDP, fasciolosis poses a significant threat to the agriculture sector. The country's diverse geographical and climatic conditions contribute to the widespread prevalence of the disease. Domestic ruminants, including buffalo, cattle, goats, and sheep are extensively affected, with a prevalence rate ranging from 10.25% in goats to 68% in buffalo. The disease also impacts high-altitude regions, affecting even yaks in the Himalayas. Human infections are also on the rise, highlighting the zoonotic nature of the disease. This review provides a comprehensive and in-depth analysis of fasciolosis in Nepal, emphasizing its pathogenesis, epidemiology, and diagnosis. The review also assesses the strategies for controlling fasciolosis in Nepal, including anthelmintic treatments, vector control, and farm management practices. The challenges and limitations of these methods are discussed, underscoring the need for alternative strategies to prevent drug resistance and enhance disease management. Additionally, this paper proposes future directions for the management of fasciolosis in Nepal to provide a comprehensive and effective approach for controlling and managing the disease in the country.

KNOWLEDGE, ATTITUDE, AND PRACTICE OF HEALTHCARE PROFESSIONALS REGARDING INFECTION PREVENTION AT THE TERTIARY CARE HOSPITAL OF PESHAWAR KPK

Occupational health and safety is a crucial element in every organization, especially in a health care setting. Health care workers (HCWs) play a role as vectors and reservoirs for the spread of infection from patient to patient and staff as well. Infection control and prevention practices are essential elements of quality health care and patient safety in health facilities. Objectives: This study was aimed at assessing the levels of knowledge, attitude, and practice scores of the HCWs towards infection control at three public sector hospitals in Peshawar KPK. The study will help policymakers in the design and development of appropriate infection prevention programs and strategic plans by identifying the gap in infection control practices. Method: An institution-based cross-sectional study was conducted to assess the knowledge, attitudes, and practices of nurses regarding infection prevention and control by using a validated and structured questionnaire in three tertiary care hospitals in KPK. The sample size was calculated by using the Raosoft calculator, and the sample size was 318 nurses from these three hospitals, including those nurses who were willing to participate in the study and nurses who had more than one year of experience. Data was analyzed using SPSS version 22. Result: The participants were 55% male and 45% female; 55% were married, 42% were unmarried, 2% were divorced, 51% were diploma holders, 49% were degree holders, and most of the participants were charge nurses, which is 89%, and 11% were working in different administrative positions. Most of the participants who completed the survey were working in intensive care units, which is 66%, and others working in general wards and OPDs. 61% of nurses got information about safety precautions from training, 61% and 29% from books, and 10% from other resources. Participants who got training were 52%, and 48% of participants did not get any training on infection control precautions. Nurses who had knowledge about safety precautions were 84%; only 16% had not enough knowledge about infection control precautions. In attitude and practice about infection control, 58% were in compliance with practice, and 88% showed a positive attitude regarding infection control practices. Conclusion: In the conclusion, we can say that there is enough knowledge among nurses regarding infection control practice, but implementation of this knowledge in practice should be ensured by doing strict supervision of infection control practices in every health care facility.

Breast Cancer Prevention Practices and Knowledge in Italian and Chinese Women in Italy: Clinical Checkups, Free NHS Screening Adherence, and Breast Self-Examination (BSE).

Breast cancer remains a significant global concern, underscoring the critical need for early detection and prevention strategies. Primary and secondary preventive measures, such as routine screenings and behaviors like breast self-examination (BSE), play a crucial role in facilitating early diagnosis. While the National Health System (NHS) in Italy offers free regular screenings for women aged 50-69, there is a lack of clarity regarding the participation of both Italian and Chinese women residing in Italy in these screening programs. This study aims to bridge this knowledge gap by thoroughly assessing the involvement in regular clinical check-ups and the types of screening employed, the adherence to free screenings offered by the NHS, and the practice of BSE among women aged 50-69 of these two groups. Furthermore, it investigates their knowledge and perceptions regarding breast cancer and BSE. Results reveal disparities in breast cancer control practice between Italian and Chinese women in Italy: the former demonstrates higher adherence to clinical checkups (53% vs. 3%, p < 0.001), while both groups show low participation in free NHS screenings (70% vs. 4%, p < 0.001). Additionally, Chinese women reported significantly lower frequency of mammography (96% vs. 33%, p < 0.001) and ultrasound (69% vs. 16%, p < 0.001). The frequency of BSE also differed substantially, with 47% of Chinese women never performing BSE compared to 12% of Italian women (p < 0.001). This comprehensive exploration provides valuable insights, attitudes, and knowledge into the disparities and potential areas for improvement in breast cancer prevention, thus contributing to the overall well-being of these communities. The findings highlight the necessity for educational initiatives aimed at improving awareness and participation in screenings, particularly among the Chinese population. These initiatives could have profound implications for patient education by equipping women with the knowledge and skills necessary to engage in proactive health behaviors.

Effect of the Integrated Weed Control Practices on Sugar Beet Yield, Quality and Associated Weeds

Two-years field trial (2017/18 and 2018/19) was conducted at the Experimental Farm, National Research Centre El-Behaira Governorate, Egypt to compare different herbicidal combinations with different doses on sugar beet yield traits and associated weeds. Sixteen weed control treatment combinations were applied to test their efficiency on sugar beet yield and quality. To form these combinations two broadleaves herbicides (Tigro and Betasana-Trio) were combined with a narrow weed herbicide (Select super) or with the hand weeding treatment. The results showed that Betasana-Trio combination at the lower dose of application 0.675 l fed-1(fed-1 = feddan = 4200 m2) combined with Select Super at 0.375 l fed-1 with or without hand weeding as well as Betasana-Trio at 0.9 l fed-1 combined with hand weeding or Select Super at 0.5 l fed-1 caused high eradication percentages of the total fresh and dry weight of weeds as well as total number of weeds m-2 (&gt;90%). The highest sugar beet yield resulted from the combination of Betasana-Trio 0.675 l fed-1 + Select Super 0.375 l fed-1, which gave the greatest sugar yield fed-1. Although the combination Betasana-Trio at 0.9 l fed-1 + Select Super at 0.5 l fed-1 gave the greatest gross sugar %, it could not achieve the highest sugar yield fed-1.

Development of Risk Management Model for Research and Development Facilities Construction Project in Johor, Malaysia

The construction industry drives economic growth globally but faces challenges namely outdated practices and inadequate risk management. This research focuses on improving Risk Management in Research and Development (R&amp;D) facilities construction projects, often poorly executed by Project Management Offices (PMOs). Most studies typically address risk identification and assessment, they neglect crucial processes like risk control and monitoring. In pursuit of developing a risk management model for R&amp;D facility construction projects in Johor Industrial Park, Malaysia, conducted a descriptive analysis self-administered questionnaires from professionals in R&amp;D and construction fields with utilizing Statistical Package for the Social Sciences software. Additionally, employed Structural Equation Modelling (illustrated through AMOS graphics) to establish a robust and valid model. The outcome of this research reveals a strong, positive, and significant correlation between PMO requirements of Risk Monitoring and Control Practices, which encompass risk reassessment, risk audits, contingency reserves analysis, risk status meetings and Project Success Factors which related to schedule, cost, facilities requirements, and customer satisfaction in the context of RDD facilities construction. This research successfully tackles the research objectives and developed practicable project risk monitoring and control practices of risk management model for R&amp;D facilities construction projects. Therefore, by consistently integrating these practices into their daily project activities, R&amp;D and construction professionals can mitigate risks and address challenges prevalent in the construction industry, contributing to improved project outcomes.

Internet and Telephone Support for Discontinuing Long-Term Antidepressants

There is significant concern regarding increasing long-term antidepressant treatment for depression beyond an evidence-based duration. To determine whether adding internet and telephone support to a family practitioner review to consider discontinuing long-term antidepressant treatment is safe and more effective than a practitioner review alone. In this cluster randomized clinical trial, 131 UK family practices were randomized between December 1, 2018, and March 31, 2022, with remote computerized allocation and 12 months of follow-up. Participants and researchers were aware of allocation, but analysis was blind. Participants were adults who were receiving antidepressants for more than 1 year for a first episode of depression or more than 2 years for recurrent depression who were currently well enough to consider discontinuation and wished to do so and who were at low risk of relapse. Of 6725 patients mailed invitations, 330 (4.9%) were eligible and consented. Internet and telephone self-management support, codesigned and coproduced with patients and practitioners. The primary (safety) outcome was depression at 6 months (prespecified complete-case analysis), testing for noninferiority of the intervention to under 2 points on the 9-item Patient Health Questionnaire (PHQ-9). Secondary outcomes (testing for superiority) were antidepressant discontinuation, anxiety, quality of life, antidepressant withdrawal symptoms, mental well-being, enablement, satisfaction, use of health care services, and adverse events. Analyses for the main outcomes were performed on a complete-case basis, and multiple imputation sensitivity analysis was performed on an intention-to-treat basis. Of 330 participants recruited (325 eligible for inclusion; 178 in intervention practices and 147 in control practices; mean [SD] age at baseline, 54.0 [14.9] years; 223 women [68.6%]), 276 (83.6%) were followed up at 6 months, and 240 (72.7%) at 12 months. The intervention proved noninferior; mean (SD) PHQ-9 scores at 6 months were slightly lower in the intervention arm than in the control arm in the complete-case analysis (4.0 [4.3] vs 5.0 [4.7]; adjusted difference, -1.1; 95% CI, -2.1 to -0.1; P = .03) but not significantly different in an intention-to-treat multiple imputation sensitivity analysis (adjusted difference, -0.9 (95% CI, -1.9 to 0.1; P = .08). By 6 months, antidepressants had been discontinued by 66 of 145 intervention arm participants (45.5%) who provided discontinuation data and 54 of 129 control arm participants (41.9%) (adjusted odds ratio, 1.02; 95% CI, 0.52-1.99; P = .96). In the intervention arm, antidepressant withdrawal symptoms were less severe, and mental well-being was better compared with the control arm; differences were small but significant. There were no significant differences in the other outcomes; 28 of 179 intervention arm participants (15.6%) and 22 of 151 control arm participants (14.6%) experienced adverse events. In this cluster randomized clinical trial of adding internet and telephone support to a practitioner review for possible antidepressant discontinuation, depression was slightly better with support, but the rate of discontinuation of antidepressants did not significantly increase. Improvements in antidepressant withdrawal symptoms and mental well-being were also small. There were no significant harms. Family practitioner review for possible discontinuation of antidepressants appeared safe and effective for more than 40% of patients willing and well enough to discontinue. ISRCTN registry Identifiers: ISRCTN15036829 (internal pilot trial) and ISRCTN12417565 (main trial).