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BackgroundSurgery under general anesthesia results in temperature decrease due to the effect of anesthetics and peripheral vasodilation on thermoregulatory centers. Perioperative temperature control is therefore an issue of high importance. In this study, we aimed to compare the warming effect of underbody and overbody blankets in patients undergoing surgery in the lithotomy position under general anesthesia.MethodsFrom September 2018 to October 2019, 99 patients undergoing surgery for colorectal cancer in the lithotomy position were included in this randomized controlled trial and assigned to the intervention group (underbody blanket) or control group (overbody blanket).ResultsThe central temperature was significantly higher in the underbody blanket group than in the overbody blanket group at 90 min after the beginning of the surgery (p = 0.02); also in this group, the peripheral temperature was significantly higher 60 min after the beginning of the surgery (p = 0.02). Regarding postoperative factors, the underbody blanket group had a significantly lower frequency of postoperative shivering (p < 0.01) and a significantly shorter postoperative hospital stay (p = 0.04) than the overbody blanket group.ConclusionsWe recommend the use of underbody blankets for intraoperative temperature control in patients undergoing surgery in the lithotomy position under general anesthesia. Underbody blankets showed improved rise and maintenance of central and peripheral temperature, decreased the incidence of postoperative shivering, and shortened the postoperative length of hospital stay.

Healthcare-associated infections (HAIs) are an important global issue, leading to poor patient outcomes. A potential route of transmission of HAIs is through contact with hospital privacy curtains. The aim of this study is to evaluate cleaning on reduction of curtain bacterial burden. In this pilot cluster randomized controlled trial we compared the bacterial burden between three groups of 24 curtains on a regional burn/plastic surgery ward. A control group was not cleaned. Two groups were cleaned at 3–4 day intervals with either disinfectant spray or wipe. The primary outcome was the difference in mean CFU/cm 2 between day 0 to day 21. The secondary outcome was the proportion of curtains contaminated with Methicillin-resistant Staphylococcus aureus (MRSA). By day 21, the control group was statistically higher (2.2 CFU/cm 2 ) than spray (1.3 CFU/cm 2 ) or wipe (1.5 CFU/cm 2 ) ( p  < 0.05). After each cleaning at 3–4 day intervals, the bacterial burden on the curtains reduced to near day 0 levels; however, the level increased again over the intervening 3–4 days. By day 21, 64% of control curtains were contaminated with MRSA compared to 10% (spray) and 5% (wipe) ( p  < 0.05). This study show that curtains start clean and progressively become contaminated with bacteria. Regularly cleaning curtains with disinfectant spray or wipes reduces bacterial burden and MRSA contamination.

Cows prefer to spend more time lying down in free stalls with more bedding, but no research to date has addressed the effects of bedding quality. Bedding in stalls often becomes wet either from exposure to the elements or from feces and urine. The aim of this study was to test the effect of wet bedding on stall preference and use. Four groups of 6 nonlactating Holstein cows were housed in free stalls bedded daily with approximately 0.1m of fresh sawdust. Following a 5-d adaptation period, each group of cows was tested sequentially with access to stalls with either dry or wet sawdust bedding (86.4±2.1 vs. 26.5±2.1% dry matter), each for 2 d. These no-choice phases were followed by a 2-d free-choice phase during which cows had simultaneous access to stalls containing either wet or dry bedding. Stall usage was assessed by using 24-h video recordings scanned at 10-min intervals, and responses were analyzed by using a mixed model, with group (n = 4) as the observational unit. The minimum and maximum environmental temperatures during the experiment were 3.4±2.2 and 6.8±2.5°C, respectively. When cows had access only to stalls with wet bedding, they spent 8.8±0.8 h/d lying down, which increased to 13.8±0.8 h/d when stalls with dry bedding were provided. Cows spent more time standing with their front 2 hooves in the stall when provided with wet vs. dry bedding (92±10 vs. 32±10 min/d). During the free-choice phase, all cows spent more time lying down in the dry stalls, spending 12.5±0.3 h/d in the dry stalls vs. 0.9±0.3 h/ d in stalls with wet bedding. In conclusion, dairy cows show a clear preference for a dry lying surface, and they spend much more time standing outside the stall when only wet bedding is available.

The potential of insecticide-treated bednets (ITNs) to contribute to child survival has been well documented in randomised controlled trials. ITN coverage has increased rapidly in Kenya from 7% in 2004 to 67% in 2006. We aimed to assess the extent to which this investment has led to improvements in child survival. A dynamic cohort of about 3500 children aged 1–59 months were enumerated three times at yearly intervals in 72 rural clusters located in four districts of Kenya. The effect of ITN use on mortality was assessed with Poisson regression to take account of potential effect-modifying and confounding covariates. 100 children died over 2 years. Overall mortality rates were much the same in the first and second years of the study (14·5 per 1000 person-years in the first year and 15·4 per 1000 person-years in the second). After adjustment for age, time period, and a number of other possible confounding variables, ITN use was associated with a 44% reduction in mortality (mortality rate ratio 0·56, 95% CI 0·33–0·96; p=0·04). This level of protection corresponds to about seven deaths averted for every 1000 ITNs distributed. A combined approach of social marketing followed by mass free distribution of ITNs translated into child survival effects that are comparable with those seen in previous randomised controlled trials.

Inexpensive and efficacious interventions that avert childhood deaths in sub-Saharan Africa have failed to reach effective coverage, especially among the poorest rural sectors. One particular example is insecticide-treated bed nets (ITNs). In this study, we present repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assess changes in coverage across socioeconomic groups. We undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0-4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: 2004 (most poor [2.9%] versus least poor [15.6%]; concentration index 0.281); 2005 (most poor [17.5%] versus least poor [37.9%]; concentration index 0.131), and 2006 with near-perfect equality (most poor [66.3%] versus least poor [66.6%]; concentration index 0.000). The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social marketing favoured the least poor. Rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns. These efforts must form an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidized net.

Objective This study aims to assess the bactericidal efficacy of Multilevel Antimicrobial Polymer (MAP-1) on standard bedsheets in Long-term care facility (LTCF). The research quantifies total viable bacteria and MRSA counts and evaluates the percentage difference between treated and control bedding material over a one-week period. Design: A double-blind interventional, double cross-over study. Setting: Haven of Hope Woo Ping Care and Attention Home in Sai Kung, Hong Kong. Methods Over an 8-week period, bedding materials from residents’ rooms were sampled, totalling 288 samples from 96 bedsheets, with half treated with MAP-1 and the remaining serving as controls. MAP-1, developed at The Hong Kong University of Science and Technology, incorporates USFDA and USEPA-approved polymers. Sampling procedures adhered to standardized protocols, and bacterial counts were determined using culture methods. Data analysis employed t -tests and ANOVA to compare microbial loads between the control and treatment groups, with statistical significance set at p  < 0.05. Results The study revealed a significant reduction in total viable bacteria and MRSA counts on bedsheets treated with MAP-1. Noteworthy reductions of 80.37% for total bacteria and 87.31% for MRSA at the end of seven-day use, in the intervention group compared to the control. These reductions were statistically significant across all four observation periods and among both male and female residents. Conclusion The study establishes the bactericidal efficacy of MAP-1 on standard bedsheets, showcasing its potential in diminishing total bacterial counts and MRSA contamination. These results hold promise for enhancing infection control practices and promoting improved sanitary conditions within healthcare settings.

Over half of US dairy operations use tie-stalls, but these farming systems have received relatively little research attention in terms of stall design and management. The current study tested the effects of the amount of 2 bedding materials, straw and shavings, on dairy cattle lying behavior. The effects of 4 levels of shavings, 3, 9, 15, and 24kg/stall (experiment 1, n=12), and high and low levels of straw in 2 separate experiments: 1, 3, 5, and 7kg/stall (experiment 2, n=12) and 0.5, 1, 2, and 3kg/stall (experiment 3, n=12) were assessed. Treatments were compared using a crossover design with lactating cows housed in tie-stalls fitted with mattresses. Treatments were applied for 1 wk. Total lying time, number of lying bouts, and the length of each lying bout was recorded with data loggers. In experiment 1, cows spent 3min more lying down for each additional kilogram of shavings (11.0, 11.7, 11.6, and 12.1±0.24 h/d for 3, 9, 15, and 24kg/stall shavings, respectively). In experiment 2, cows increased lying time by 12min for every additional kilogram of straw (11.2, 12.0, 11.8, and 12.4±0.24 h/d for 1, 3, 5, and 7kg/stall of straw, respectively). There were no differences in lying behavior among the lower levels of straw tested in experiment 3 (11.7±0.32 h/d). These results indicated that additional bedding above a scant amount improves cow comfort, as measured by lying time, likely because a well-bedded surface is more compressible.

Background Forced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH. Methods Patients ( n =100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The body temperature of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected. Results A steady decline in the body temperature was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the body temperature. However, the body temperature still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the body temperature increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the body temperature between the groups was significantly different ( P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group ( P = 0.023). Conclusions The body temperature was significantly better with the use of underbody FAW blankets placed over patients than with them placed under patients. However, there was not a clinically significant difference in body temperature. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071 . It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.

Background After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidized insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania. Methods The ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Government contractors trained and facilitated local government officials to supervise village-level volunteers on a registration of all U5s and the distribution and issuing of LLINs. The registration results formed the basis for the LLIN order and delivery to village level. Caregivers brought their registration coupons to village issuing posts during a three-day period where they received LLINs for their U5s. Household surveys in five districts assessed ITN ownership and use immediately after the campaign. Results Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions. Conclusion A national-level LLIN distribution strategy that fully engaged local government authorities helped avoid additional burden on the healthcare system. Distribution costs per net were comparable to other public health interventions. Particularly among rural residents, ITN ownership and use increased significantly for the intended beneficiaries. The upcoming universal LLIN distribution and further behaviour change communication will further improve ITN ownership and use in 2010-2011.

The objective was to quantify the incidence of tarsal lesions and level of hygiene by stall bed type. Cows were scored on 100 dairies from Wisconsin, Minnesota, Indiana, Iowa, and New York in the fall and winter. Thirty-eight dairies used rubber-filled mattresses (RFM), 27 had sand beds, 29 had waterbeds, and 6 used compost packs (CPk). Stocking density, stall dimensions, bedding amount, bedding frequency, and type of bedding were recorded. One pen of early-lactation multiparous cows on each dairy was scored based on injury of the tarsal joints at the lateral and medial surfaces and tuber calcis at the dorsal, lateral, and medial surfaces. A tarsal score of 1 represented hair loss, 2 was moderate, and 3 indicated severe swelling. Differences between bed types in the percentages of cows with lesions were tested with one-way ANOVA by lesion severity and incidence, with farm as the experimental unit. Cows on sand beds or waterbeds had fewer lesion scores of 1, 2, and 3 than those on RFM. The percentages of score 1 were 54.6±4.4 (RFM), 22.5±4.7 (sand), and 29.8±4.3 (waterbed), whereas the percentages of score 2 were 14.0±1.4, 2.3±1.5, and 5.0±1.4, and of score 3 were 3.0±0.4, 0.2±0.4, and 0.4±0.4. Cows on CPk had no lesions. Hygiene scores ranged from 1 to 5, with 1 being clean and 5 soiled. The percentages of hygiene score 1 were 0 (compost), 0.4 (RFM), 0.4 (sand), and 0.4 (waterbeds); those with score 2 were 79.0, 84.0±0.01, 73.2±0.01, and 80.4±0.01; with score 3 were 20.3, 15.2±0.01, 23.8±0.01, and 18.6±0.01; with score 4 were 0.8, 0.005±0.001, 0.006±0.001, and 0.025±0.003; and with score 5 was 0 for all bed types. Cows on RFM and waterbeds had improved hygiene compared with cows on sand beds. There was no difference in somatic cell count (SCC) by bed type. The percentage of cows in fourth lactation or greater on waterbeds (19.8±1.8) was greater than those on RFM (13.3±1.6) or on sand (13.5±1.8). The percentage culled was lower for cows on waterbeds than on RFM (22.8±1.5 vs. 29.4±1.4). Score 3 tarsal lesions were correlated (r = 0.60) with SCC. The length of the sand bed was correlated with a greater percentage of mature cows. The SCC was correlated with the percentage of cows reported lame on the day of the visit (r = 0.45) and with neck rail height (r = −0.26). On dairies with RFM, severe lesions (r = 0.60), death losses (r = 0.52), and percentage of the herd reported lame on the day of the visit (r = 0.52) were all correlated with the SCC. Dairies with higher percentages of lesions had higher SCC, death losses, lameness, and culling rates. Adding bedding several times per week may reduce the incidence of lesions.