Catia Ferreira


2 CLOUD Japan: Prospective Multi-Hospital Study to Determine the Population-Based Incidence of Hospitalized Clostridium difficile Infections

Authors: Pingping Zhang, Catia Ferreira, Kazuhiro Tateda, Elisa Gonzalez, Shuhei Ito, Kirstin Heinrich, Kevin Sweetland, Michael Pride, Jennifer Moisi, Sharon Gray, Bennett Lee, Fred Angulo


Clostridium difficile (C. difficile) is the most common cause of antibiotic-associated diarrhea and infectious diarrhea in healthcare settings. Japan has an aging population; the elderly are at increased risk of hospitalization, antibiotic use, and C. difficile infection (CDI). Little is known about the population-based incidence and disease burden of CDI in Japan although limited hospital-based studies have reported a lower incidence than the United States. To understand CDI disease burden in Japan, CLOUD (Clostridium difficile Infection Burden of Disease in Adults in Japan) was developed. CLOUD will derive population-based incidence estimates of the number of CDI cases per 100,000 population per year in Ota-ku (population 723,341), one of the districts in Tokyo, Japan. CLOUD will include approximately 14 of the 28 Ota-ku hospitals including Toho University Hospital, which is a 1,000 bed tertiary care teaching hospital. During the 12-month patient enrollment period, which is scheduled to begin in November 2018, Ota-ku residents > 50 years of age who are hospitalized at a participating hospital with diarrhea ( > 3 unformed stools (Bristol Stool Chart 5-7) in 24 hours) will be actively ascertained, consented, and enrolled by study surveillance staff. A stool specimen will be collected from enrolled patients and tested at a local reference laboratory (LSI Medience, Tokyo) using QUIK CHEK COMPLETE® (Abbott Laboratories). which simultaneously tests specimens for the presence of glutamate dehydrogenase (GDH) and C. difficile toxins A and B. A frozen stool specimen will also be sent to the Pfizer Laboratory (Pearl River, United States) for analysis using a two-step diagnostic testing algorithm that is based on detection of C. difficile strains/spores harboring toxin B gene by PCR followed by detection of free toxins (A and B) using a proprietary cell cytotoxicity neutralization assay (CCNA) developed by Pfizer. Positive specimens will be anaerobically cultured, and C. difficile isolates will be characterized by ribotyping and whole genomic sequencing. CDI patients enrolled in CLOUD will be contacted weekly for 90 days following diarrhea onset to describe clinical outcomes including recurrence, reinfection, and mortality, and patient reported economic, clinical and humanistic outcomes (e.g., health-related quality of life, worsening of comorbidities, and patient and caregiver work absenteeism). Studies will also be undertaken to fully characterize the catchment area to enable population-based estimates. The 12-month active ascertainment of CDI cases among hospitalized Ota-ku residents with diarrhea in CLOUD, and the characterization of the Ota-ku catchment area, including estimation of the proportion of all hospitalizations of Ota-ku residents that occur in the CLOUD-participating hospitals, will yield CDI population-based incidence estimates, which can be stratified by age groups, risk groups, and source (hospital-acquired or community-acquired). These incidence estimates will be extrapolated, following age standardization using national census data, to yield CDI disease burden estimates for Japan. CLOUD also serves as a model for studies in other countries that can use the CLOUD protocol to estimate CDI disease burden.

Keywords: Epidemiology, disease burden, Clostridium difficile, study protocol

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1 Eco-Fashion Dyeing of Denim and Knitwear with Particle-Dyes

Authors: Adriana Duarte, Sandra Sampaio, Catia Ferreira, Jaime I. N. R. Gomes


With the fashion of faded worn garments the textile industry has moved from indigo and pigments to dyes that are fixed by cationization, with products that can be toxic, and that can show this effect after washing down the dye with friction and/or treating with enzymes in a subsequent operation. Increasingly they are treated with bleaches, such as hypochlorite and permanganate, both toxic substances. An alternative process is presented in this work for both garment and jet dyeing processes, without the use of pre-cationization and the alternative use of “particle-dyes”. These are hybrid products, made up by an inorganic particle and an organic dye. With standard soluble dyes, it is not possible to avoid diffusion into the inside of the fiber unless using previous cationization. Only in this way can diffusion be avoided keeping the centre of the fibres undyed so as to produce the faded effect by removing the surface dye and showing the white fiber beneath. With “particle-dyes”, previous cationization is avoided. By applying low temperatures, the dye does not diffuse completely into the inside of the fiber, since it is a particle and not a soluble dye, being then able to give the faded effect. Even though bleaching can be used it can also be avoided, by the use of friction and enzymes they can be used just as for other dyes. This fashion brought about new ways of applying reactive dyes by the use of previous cationization of cotton, lowering the salt, and temperatures that reactive dyes usually need for reacting and as a side effect the application of a more environmental process. However, cationization is a process that can be problematic in applying it outside garment dyeing, such as jet dyeing, being difficult to obtain level dyeings. It also should be applied by a pad-fix or Pad-batch process due to the low affinity of the pre-cationization products making it a more expensive process, and the risk of unlevelness in processes such as jet dyeing. Wit particle-dyes, since no pre-cationizartion is necessary, they can be applied in jet dyeing. The excess dye is fixed by a fixing agent, fixing the insoluble dye onto the surface of the fibers. By applying the fixing agent only one to 1-3 rinses in water at room temperature are necessary, saving water and improving the washfastness.

Keywords: denim, garment dyeing, worn look, eco-fashion

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