Artwork in an Indonesian cave has been found to date back at least 40,000 years, making it the oldest sign yet of human creative art — likely pre-dating art from European caves.

The findings undermine a Eurocentric view of the origins of human creativity and could prompt a ‘gold rush’ to find even older art on the route of human migration from Africa to the east.

The analysis hints at “just what a wealth of undiscovered information there is in Asia”, says Alistair Pike, an archaeologist at the University of Southampton, UK, who in 2013 identified what had been considered the world’s oldest cave art, in Europe2, and had no involvement in the current project. “This paper will likely prompt a hunt.”

The Indonesian images, discovered in a limestone cave on the island of Sulawesi in the 1950s, had previously been thought to date back only 10,000 years. Anything older would, it was assumed, have deteriorated.

Even after a technology that could test that assumption, uranium-thorium dating, became available, no one thought to apply it to the Indonesian cave — until now. Though the paint itself cannot be dated, uranium-thorium dating can estimate the age of the bumpy layers of calcium carbonate (known as ‘cave popcorn’) that formed on the surface of the paintings. As mineral layers are deposited, they draw in uranium. Because uranium decays into thorium at a known rate, the ratio of uranium to thorium isotopes in a sample indicates how old it is.

The researchers dated 12 stencils of human hands and two images of large animals. Because they sampled the top layer of calcium carbonate, the uranium dating technique gave them a minimum age for each sample.

They found that the oldest stencil was at least 39,900 years old — 2,000 years older than the minimum age of the oldest European hand stencil. An image of a babirusa, or ‘pig-deer’, resembling an aubergine with stick-like legs jutting from each end, was estimated to be 35,400 years old — around the same age as the earliest large animal pictures in European caves.

The hand stencils look similar to those found in Europe. But the animal pictures, in addition to reflecting local animals rather than mammoths as in Europe, are stylistically different. The Indonesian images “look ‘line-y’, almost like brush strokes”, says Pike, whereas early European images “look dabbed, almost like finger paint”.

“It allows us to move away from the view that Europe was special,” says Maxime Aubert, an archaeologist at Griffith University in Queensland, Australia, who led the team. “There was some idea that early Europeans were more aware of themselves and their surroundings. Now we can say that’s not true.”

Researchers posit two theories for the evolution of such artwork — either it arose independently in Indonesia, or early humans leaving Africa already had the capacity to make art, and carried it to multiple areas.

Pike thinks that researchers should seek evidence of art along the southern migration route. “India is the most obvious place to look,” he says. “I expect we’ll start getting a lot more photos [of images covered in calcium carbonate] from along that corridor from people who want to date them. This may move the field along very rapidly.” Southeast Asia will also be raked over, he predicts. There are hundreds more caves in that region of Sulawesi alone, and Aubert has also started looking in Borneo.

The discovery weakens a much-debated theory that Neanderthals, who were present in Europe until around 41,000 years ago, might have been responsible for the cave art there. “There were no Neanderthals in Sulawesi,” says Pike. But the hand stencils and choice of subject are very similar to the Indonesian figures, he adds.

Aubert hopes that the discovery might draw attention to the need to protect the caves, many of which have been damaged by mining and other industrial activity. Many of the paintings are flaking off, he says. He hopes that the site might finally, after years of candidacy, be designated a World Heritage Site by the United Nations Education, Social and Cultural Organization, which would accelerate conservation efforts.

Naturedoi:10.1038/nature.2014.16100

http://www.nature.com/news/world-s-oldest-art-found-in-indonesian-cave-1.16100

It’s a point of pride for Belarusian President Alyaksandr Lukashenka: No toilet paper in our sausage.

Lukashenka says that’s one thing that makes Belarusian products better than Russian ones.

He told Russian reporters on October 17 that Russia had lowered its food-quality standards after the 1991 collapse of the Soviet Union “while we, thanks to Lukashenka, retained state standards.”

“Belarusian [food] is of substantially higher in quality. There is no toilet paper in the salami and never was,” he said.

He added that “such facts have been discovered at Russian enterprises — toilet paper, soy, all kinds of additives.”

Both toilet paper and sausage were in short supply in the final years of the Soviet Union.

http://www.rferl.org/content/belarus-russia-food/26642326.html

Ein Weißfuß-Wieselmaki (Lepilemur leucopus) in seinem Schlafbaum.

Emily loves Justin – Stop global warming – Two more weeks till I graduate!: The exchange of information in public toilets is widespread. It also occurs in the world of white-footed sportive lemurs. Only instead of writing on the walls, they use scent-marks in order to communicate with their own kind.. In a study published online in Springer’s journal Behavioral Ecology and Sociobiology, Iris Dröscher and Peter Kappeler from the German Primate Center (DPZ) have found that the urine left on latrine trees serves as a method to maintain contact with family members. It also serves as a means to inform an intruder that there is a male that will defend his partner. Latrines thus serve as information exchange centers and promote social bonding in territorial nocturnal animals that do not live in closely-knit groups.

In the animal kingdom, the use of latrines, which serve as specific locations for urination and defecation, is a common occurrence. Because little is known about why primates, in particular, use the same latrines over and over, the researchers set out to investigate this phenomenon among white-footed sportive lemurs (Lepilemur leucopus) in southern Madagascar. Do they hint to others that they want to defend their mate or territory? Or, do they indicate the fertility of the female? Or do they promote exchange of information within a group and support social bonding? To answer these questions, the researchers wanted to establish where such latrines were found, and if they were used differently between seasons and between individuals of different ages and sexes. In the process, Dröscher and Kappeler spent over 1,000 hours watching the toilet habits of 14 radio-collared adult sportive lemurs.

White-footed sportive lemurs are nocturnal tree-dwellers that are found exclusively in southern Madagascar. They live together in families consisting of parents and their offspring. Even though the family members share a common territory, the individuals do not interact much. Neither do pair-partners sleep in the same tree nor do they associate while foraging. But what they have in common are latrines that are located in the core of their territory. All members of the family visit the same latrines for defecation and urination. Dröscher and Kappeler believe the latrines are a way in which to maintain familiarity and social bonding among members of a social unit, who otherwise have very little contact with each other. Such scent signals are picked up from urine that stains the tree trunks rather than feces that accumulate on the ground under the trees.

Males visited the latrines more often during nights when an intruder invaded the territory. In addition, the males placed scent marks from their specialized anogenital glands preferentially in latrines. “This indicates that latrine use in this primate species should also be connected to mate defense,” says Iris Dröscher, a PhD student at the German Primate Center.

“Scent marks transmit a variety of information such as sexual and individual identity and may function to signal an individual’s presence and identity to others,” continues Dröscher. “Latrines therefore serve as information exchange centers of individual-specific information.”

“Especially nocturnal species with limited habitat visibility and low inter-individual cohesion profit from predictable areas for information exchange to facilitate communication,” says Peter Kappeler, head of the Department for Behavioral Ecology and Sociobiology at the DPZ. “The white-footed sportive lemur has found these information centers by means of latrine use.”

More information: Dröscher I, Kappeler PM (2014): “Maintenance of familiarity and social bonding via communal latrine use in a solitary primate (Lepilemur leucopus).” Behavioral Ecology and Sociobiology, DOI: 10.1007/s00265-014-1810-z

http://phys.org/news/2014-10-lemurs-latrines-exchange-centers.html

Only a couple of families have taken advantage of a new service available at a Saginaw funeral home.

Drive-thru viewings.

Paradise Funeral Chapel (http://www.paradisefuneralchapel.com) recently started offering the option, which allows mourners to pay their last respects on the go. It was designed in part to cater to those with physical limitations.

The funeral home’s president, Ivan Phillips, says he expects more customers to opt for the drive-thru once they learn it’s not a gimmick and is safe to use.

Curtains covering the window open when sensors underneath the pavement recognize the presence of a car. Mourners then get three minutes to view the body as music plays.

Phillips says drive-thru viewings are set up so they don’t conflict with traditional indoor viewings.

http://abcnews.go.com/Weird/wireStory/michigan-funeral-home-drive-option-26263313

I’m still here, but yet I’m gone
I don’t play guitar or sing my songs
They never defined who I am
The man that loves you ’til the end
You’re the last person I will love
You’re the last face I will recall
And best of all, I’m not gonna miss you.
Not gonna miss you.
I’m never gonna hold you like I did
Or say I love you to the kids
You’re never gonna see it in my eyes
It’s not gonna hurt me when you cry
I’m never gonna know what you go through
All the things I say or do
All the hurt and all the pain
One thing selfishly remains
I’m not gonna miss you
I’m not gonna miss you

The Country Music Hall of Fame member, who was diagnosed with Alzheimer’s disease in 2011, is out with the video for the final song he’ll ever record — “I’m Not Gonna Miss You.” It was recorded in 2013 with producer Julian Raymond.

“I’m still here but yet I’m gone/ I don’t play guitar or sing my songs,” the tune begins as it details his struggles with the disease.

The poignant music video that accompanies it spans Campbell’s career. It contrasts Campbell singing in the studio with home video and clips from throughout his career. There are even images of doctors discussing his brain scans with him.

Because of the progression of the disease, the 78-year-old Campbell was admitted to a special care facility in Nashville in April.

“Sadly, Glen’s condition has progressed enough that we were no longer able to keep him at home,” Campbell’s family said in a statement to Rolling Stone. “He is getting fantastic care and we get to see him every day. Our family wants to thank everyone for their continued prayers, love and support.”

Campbell, who was inducted into the Country Music Hall of Fame in 2005 and is best known for his hits like “Rhinestone Cowboy” and “Wichita Lineman,” took his Alzheimer’s in stride.

“I just take it as it comes, you know,” Campbell said in a CNN interview in February 2012. “I know that I have a problem with that (forgetfulness), but it doesn’t bother me. If you’re going to have it handed to you, you have got to take it, anyway. So that is the way I look at it.”

In a career that spans five decades, he released his final album “Ghost on Canvas” in 2011 and then went on a farewell tour.

http://www.cnn.com/2014/10/14/showbiz/glen-campbell-final-song/index.html?hpt=hp_c2

Lisa M Brosseau, ScD, and Rachael Jones, PhD

The authors are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.

Healthcare workers play a very important role in the successful containment of outbreaks of infectious diseases like Ebola. The correct type and level of personal protective equipment (PPE) ensures that healthcare workers remain healthy throughout an outbreak—and with the current rapidly expanding Ebola outbreak in West Africa, it’s imperative to favor more conservative measures.

The precautionary principle—that any action designed to reduce risk should not await scientific certainty—compels the use of respiratory protection for a pathogen like Ebola virus that has:

•No proven pre- or post-exposure treatment modalities
•A high case-fatality rate
•Unclear modes of transmission

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks (1).

The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.

There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids (2,3) and that the only modes of transmission we should be concerned with are those termed “droplet” and “contact.”

These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) “direct” contact with the body fluids of an infected person.

This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.

The second line of reasoning is that respirators or other control measures for infectious aerosols cannot be recommended in developing countries because the resources, time, and/or understanding for such measures are lacking (4).

Although there are some important barriers to the use of respirators, especially PAPRs, in developing countries, healthcare workers everywhere deserve and should be afforded the same best-practice types of protection, regardless of costs and resources. Every healthcare worker is a precious commodity whose well-being ensures everyone is protected.

If we are willing to offer infected US healthcare workers expensive treatments and experimental drugs free of charge when most of the world has no access to them, we wonder why we are unwilling to find the resources to provide appropriate levels of comparatively less expensive respiratory protection to every healthcare worker around the world.

How are infectious diseases transmitted via aerosols?

Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other “aerobiologists” employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture.

Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed “airborne”) can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large “droplets” on their face, eyes, or nose.

Modern research, using more sensitive instruments and analytic methods, has shown that aerosols emitted from the respiratory tract contain a wide distribution of particle sizes—including many that are small enough to be inhaled (5,6). Thus, both small and large particles will be present near an infectious person.

The chance of large droplets reaching the facial mucous membranes is quite small, as the nasal openings are small and shielded by their external and internal structure. Although close contact may permit large-droplet exposure, it also maximizes the possibility of aerosol inhalation.

As noted by early aerobiologists, liquid in a spray aerosol, such as that generated during coughing or sneezing, will quickly evaporate (7), which increases the concentration of small particles in the aerosol. Because evaporation occurs in milliseconds, many of these particles are likely to be found near the infectious person.

The current paradigm also assumes that only “small” particles (less than 5 micrometers [mcm]) can be inhaled and deposited in the respiratory tract. This is not true. Particles as large as 100 mcm (and perhaps even larger) can be inhaled into the mouth and nose. Larger particles are deposited in the nasal passages, pharynx, and upper regions of the lungs, while smaller particles are more likely to deposit in the lower, alveolar regions. And for many pathogens, infection is possible regardless of the particle size or deposition site.

It’s time to abandon the old paradigm of three mutually exclusive transmission routes for a new one that considers the full range of particle sizes both near and far from a source. In addition, we need to factor in other important features of infectivity, such as the ability of a pathogen to remain viable in air at room temperature and humidity and the likelihood that systemic disease can result from deposition of infectious particles in the respiratory system or their transfer to the gastrointestinal tract.

We recommend using “aerosol transmissible” rather than the outmoded terms “droplet” or “airborne” to describe pathogens that can transmit disease via infectious particles suspended in air.

Is Ebola an aerosol-transmissible disease?

We recently published a commentary on the CIDRAP site discussing whether Middle East respiratory syndrome (MERS) could be an aerosol-transmissible disease, especially in healthcare settings. We drew comparisons with a similar and more well-studied disease, severe acute respiratory syndrome (SARS).

For Ebola and other filoviruses, however, there is much less information and research on disease transmission and survival, especially in healthcare settings.

Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings.

What do we know about Ebola transmission?

No one knows for certain how Ebola virus is transmitted from one person to the next. The virus has been found in the saliva, stool, breast milk, semen, and blood of infected persons (8,9). Studies of transmission in Ebola virus outbreaks have identified activities like caring for an infected person, sharing a bed, funeral activities, and contact with blood or other body fluids to be key risk factors for transmission (10-12).

On the basis of epidemiologic evidence, it has been presumed that Ebola viruses are transmitted by contaminated hands in contact with the mouth or eyes or broken skin or by splashes or sprays of body fluids into these areas. Ebola viruses appear to be capable of initiating infection in a variety of human cell types (13,14), but the primary portal or portals of entry into susceptible hosts have not been identified.

Some pathogens are limited in the cell type and location they infect. Influenza, for example, is generally restricted to respiratory epithelial cells, which explains why flu is primarily a respiratory infection and is most likely aerosol transmissible. HIV infects T-helper cells in the lymphoid tissues and is primarily a bloodborne pathogen with low probability for transmission via aerosols.

Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells—immune response cells located throughout the epithelium (15,16). Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.

The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person. Cough was identified among some cases in a 1995 outbreak in Kikwit, Democratic Republic of the Congo (11), and coughs are known to emit viruses in respirable particles (17). The act of vomiting produces an aerosol and has been implicated in airborne transmission of gastrointestinal viruses (18,19). Regarding diarrhea, even when contained by toilets, toilet flushing emits a pathogen-laden aerosol that disperses in the air (20-22).

Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces (23). Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively (23).

In still air, 3-mcm particles can take up to an hour to settle. With air currents, these and smaller particles can be transported considerable distances before they are deposited on a surface.

There is also some experimental evidence that Ebola and other filoviruses can be transmitted by the aerosol route. Jaax et al (24) reported the unexpected death of two rhesus monkeys housed approximately 3 meters from monkeys infected with Ebola virus, concluding that respiratory or eye exposure to aerosols was the only possible explanation.

Zaire Ebola viruses have also been transmitted in the absence of direct contact among pigs (25) and from pigs to non-human primates (26), which experienced lung involvement in infection. Persons with no known direct contact with Ebola virus disease patients or their bodily fluids have become infected (12).

Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity (27). However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols (25-27).

Altogether, these epidemiologic and experimental data offer enough evidence to suggest that Ebola and other filoviruses may be opportunistic with respect to aerosol transmission(28). That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.

Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)

Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face (1). Therefore, a higher level of protection is necessary.

Which respirator to wear?

As described in our earlier CIDRAP commentary, we can use a Canadian control-banding approach to select the most appropriate respirator for exposures to Ebola in healthcare settings (29). (See this document for a detailed description of the Canadian control banding approach and the data used to select respirators in our examples below.)

The control banding method involves the following steps:

1.Identify the organism’s risk group (1 to 4). Risk group reflects the toxicity of an organism, including the degree and type of disease and whether treatments are available. Ebola is in risk group 4, the most toxic organisms, because it can cause serious human or animal disease, is easily transmitted, directly or indirectly, and currently has no effective treatments or preventive measures.

2.Identify the generation rate. The rate of aerosol generation reflects the number of particles created per time (eg, particles per second). Some processes, such as coughing, create more aerosols than others, like normal breathing. Some processes, like intubation and toilet flushing, can rapidly generate very large quantities of aerosols. The control banding approach assigns a qualitative rank ranging from low (1) to high (4) (eg, normal breathing without coughing has a rank of 1).

3.Identify the level of control. Removing contaminated air and replacing it with clean air, as accomplished with a ventilation system, is effective for lowering the overall concentration of infectious aerosol particles in a space, although it may not be effective at lowering concentration in the immediate vicinity of a source. The number of air changes per hour (ACH) reflects the rate of air removal and replacement. This is a useful variable, because it is relatively easy to measure and, for hospitals, reflects building code requirements for different types of rooms. Again, a qualitative ranking is used to reflect low (1) versus high (4) ACH. Even if the true ventilation rate is not known, the examples can be used to select an appropriate air exchange rate.

4.Identify the respirator assigned protection factor. Respirators are designated by their “class,” each of which has an assigned protection factor (APF) that reflects the degree of protection. The APF represents the outside, environmental concentration divided by the inside, facepiece concentration. An APF of 10 means that the outside concentration of a particular contaminant will be 10 times greater than that inside the respirator. If the concentration outside the respirator is very high, an assigned protection factor of 10 may not prevent the wearer from inhaling an infective dose of a highly toxic organism.

Practical examples

Two examples follow. These assume that infectious aerosols are generated only during vomiting, diarrhea, coughing, sneezing, or similar high-energy emissions such as some medical procedures. It is possible that Ebola virus may be shed as an aerosol in other manners not considered.

Caring for a patient in the early stages of disease (no bleeding, vomiting, diarrhea, coughing, sneezing, etc). In this case, the generation rate is 1. For any level of control (less than 3 to more than 12 ACH), the control banding wheel indicates a respirator protection level of 1 (APF of 10), which corresponds to an air purifying (negative pressure) half-facepiece respirator such as an N95 filtering facepiece respirator. This type of respirator requires fit testing.

Caring for a patient in the later stages of disease (bleeding, vomiting, diarrhea, etc). If we assume the highest generation rate (4) and a standard patient room (control level = 2, 3-6 ACH), a respirator with an APF of at least 50 is needed. In the United States, this would be equivalent to either a full-facepiece air-purifying (negative-pressure) respirator or a half-facepiece PAPR (positive pressure), but standards differ in other countries. Fit testing is required for these types of respirators.

The control level (room ventilation) can have a big effect on respirator selection. For the same patient housed in a negative-pressure airborne infection isolation room (6-12 ACH), a respirator with an assigned protection factor of 25 is required. This would correspond in the United States to a PAPR with a loose-fitting facepiece or with a helmet or hood. This type of respirator does not need fit testing.

Implications for protecting health workers in Africa

Healthcare workers have experienced very high rates of morbidity and mortality in the past and current Ebola virus outbreaks. A facemask, or surgical mask, offers no or very minimal protection from infectious aerosol particles. As our examples illustrate, for a risk group 4 organism like Ebola, the minimum level of protection should be an N95 filtering facepiece respirator.

This type of respirator, however, would only be appropriate only when the likelihood of aerosol exposure is very low. For healthcare workers caring for many patients in an epidemic situation, this type of respirator may not provide an adequate level of protection.

For a risk group 4 organism, any activity that has the potential for aerosolizing liquid body fluids, such as medical or disinfection procedures, should be avoided, if possible. Our risk assessment indicates that a PAPR with a full facepiece (APF = 50) or a hood or helmet (APF = 25) would be a better choice for patient care during epidemic conditions.

We recognize that PAPRs present some logistical and infection-control problems. Batteries require frequent charging (which requires a reliable source of electricity), and the entire ensemble requires careful handling and disinfection between uses. A PAPR is also more expensive to buy and maintain than other types of respirators.

On the other hand, a PAPR with a loose-fitting facepiece (hood or helmet) does not require fit testing. Wearing this type of respirator minimizes the need for other types of PPE, such as head coverings and goggles. And, most important, it is much more comfortable to wear than a negative-pressure respirator like an N95, especially in hot environments.

A recent report from a Medecins Sans Frontieres healthcare worker in Sierra Leone30 notes that healthcare workers cannot tolerate the required PPE for more than 40 minutes. Exiting the workplace every 40 minutes requires removal and disinfection or disposal (burning) of all PPE. A PAPR would allow much longer work periods, use less PPE, require fewer doffing episodes, generate less infectious waste, and be more protective. In the long run, we suspect this type of protection could also be less expensive.

Adequate protection is essential

To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:
•Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
•All sizes of aerosol particles are easily inhaled both near to and far from the patient.
•Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
•Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
•Experimental data support aerosols as a mode of disease transmission in non-human primates.

Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.

Acknowledgements

We thank Kathleen Harriman, PhD, MPH, RN, Chief, Vaccine Preventable Diseases Epidemiology Section, Immunization Branch, California Department of Public Health, and Nicole Vars McCullough, PhD, CIH, Manager, Global Technical Services, Personal Safety Division, 3M Company, for their input and review.

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http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

BY Erika Engelhaupt

A new nonprofit called OpenBiome is hoping to do for fecal transplants what blood banks have done for transfusions. It’s a kind of Brown Cross.

And it’s an idea whose time has come. Recent trials testing transplants of fecal microbes from the healthy to the sick have been so promising that people are attempting dangerous do-it-yourself fecal transplants by enema, for lack of access to authorized medical procedures.

Graduate students Carolyn Edelstein and Mark B. Smith got the idea for OpenBiome after a friend had trouble getting a fecal transplant to treat an infection with Clostridium difficile. The bacterium causes dangerous, even fatal, diarrhea and in an increasing number of cases is resistant to antibiotics.

People tend to get C. difficile infections after antibiotics or chemotherapy has knocked out helpful bacteria, allowing what is normally a background player to take over. Transplants of fecal bacteria from healthy donors can help reset the microbiome, the mix of bacteria in the body, and crowd out C. difficile. A 2011 review of 317 patients treated for C. difficile found that fecal transplants cleared up infections in 92 percent of patients. And more recent research showed that taking a round of pills containing bacteria isolated from fecal matter (without the feces itself) resolved C. difficile infections in all of 32 patients treated.

There’s also interest in transplanting healthy fecal microbiomes into people with inflammatory bowel disease or even obesity. In one recent test, mice implanted with fecal microbes from thin humans stayed thin, while mice given bacteria from obese people gained weight.

But the transplants are hard to get. As Edelstein and Smith’s friend learned, the U.S. Food and Drug Administration requires lots of paperwork for the experimental therapy, and donor feces has to be screened for a host of potential pathogens.

That’s where OpenBiome steps in. The nonprofit offers hospitals fecal samples for $250 that have been prescreened to ensure they are free of pathogens and parasites. Since October, they’ve sent more than 100 samples to a dozen hospitals and clinics, according to an interview with Smith in the Chronicle of Higher Education. Edelstein, who’s studying public affairs at Princeton, and Smith, who’s studying microbiology at MIT, recruited friends and donors and negotiated permissions with the FDA to set up the organization, which houses its samples at MIT. OpenBiome is also offering to collaborate with researchers for long-term follow-up on patients’ microbiomes.

Because FDA considers feces to be a drug in the context of transplants, OpenBiome is providing stool only for treatment of C. difficile. People hoping to shift their microbiomes for other purposes are still out of luck. Until more testing and approval comes through, that leaves open the risk that some people may resort to home transplants.

Let me be very clear about this: Whipping up an enema of your friend’s stool is a terrible idea.There are excellent reasons why people normally avoid poop: It can carry pathogens and parasites that cause serious disease. Even a donor who appears perfectly healthy might be carrying around bacteria or viruses that his or her immune system or particular microbiome mix is able to deal with. Your mileage may vary.

Your genetics, your immune system, your diet and environment — all these things create the ecology of your insides, making it hard to predict what your outcome might be. What’s more, you may need to make other medically supervised changes along with the transplant. Research on microbiome links to obesity, for instance, suggests that a new “skinny” microbiome has to be accompanied by a switch to a diet lower in fat and calories, or else the new microbes will just be outcompeted.

These dangers and complicating factors are why a supply of prescreened stool is so important. The procedures need to be done under medical supervision, and when done right the results look really promising. The recently tested pill approach avoids some of the yuck factor of fecal transplants, but most transplants are done via an enema, colonoscopy or nose tube to the gut.

If you get transplant material from OpenBiome, you’ll have to submit to one of the usual transplant methods rather than a pill, but you can rest assured you’re getting high-quality stuff. Not only are the samples screened, the donors are among the best and brightest: a few young researchers and scientists from Harvard and MIT.

https://www.sciencenews.org/blog/gory-details/introducing-first-bank-feces?mc_cid=325756381e&mc_eid=9da0429978

Thanks to Jody Troupe for bringing this to the attention of the It’s Interesting community.