Using a theory of planned behaviour framework to explore hand hygiene beliefs at the '5 critical moments' among Australian hospital-based nurses 59

© 2015 White et al. Background: Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses ' beliefs associated with performing hand hygiene guided by the World Health Organization's (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses' decisions to perform hand hygiene according to the recently implemented national guidelines. Methods: Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results: Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions: The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses ' hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses' hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient's surroundings continues to be reported as the most neglected opportunity for compliance

The environmental security debate and its significance for climate change

Policymakers, military strategists and academics all increasingly hail climate change as a security issue. This article revisits the (comparatively) long-standing “environmental security debate” and asks what lessons that earlier debate holds for the push towards making climate change a security issue. Two important claims are made. First, the emerging climate security debate is in many ways a re-run of the earlier dispute. It features many of the same proponents and many of the same disagreements. These disagreements concern, amongst other things, the nature of the threat, the referent object of security and the appropriate policy responses. Second, given its many different interpretations, from an environmentalist perspective, securitisation of the climate is not necessarily a positive development

Anatomy of quantum chaotic eigenstates

The eigenfunctions of quantized chaotic systems cannot be described by explicit formulas, even approximate ones. This survey summarizes (selected) analytical approaches used to describe these eigenstates, in the semiclassical limit. The levels of description are macroscopic (one wants to understand the quantum averages of smooth observables), and microscopic (one wants informations on maxima of eigenfunctions, "scars" of periodic orbits, structure of the nodal sets and domains, local correlations), and often focusses on statistical results. Various models of "random wavefunctions" have been introduced to understand these statistical properties, with usually good agreement with the numerical data. We also discuss some specific systems (like arithmetic ones) which depart from these random models.Comment: Corrected typos, added a few references and updated some result

The response of the Antarctic Circumpolar Current to recent climate change

Observations show a significant intensification of the Southern Hemisphere westerlies, the prevailing winds between the latitudes of 30° and 60° S, over the past decades. A continuation of this intensification trend is projected by climate scenarios for the twenty-first century. The response of the Antarctic Circumpolar Current and the carbon sink in the Southern Ocean to changes in wind stress and surface buoyancy fluxes is under debate. Here we analyse the Argo network of profiling floats and historical oceanographic data to detect coherent hemispheric-scale warming and freshening trends that extend to depths of more than 1,000 m. The warming and freshening is partly related to changes in the properties of the water masses that make up the Antarctic Circumpolar Current, which are consistent with the anthropogenic changes in heat and freshwater fluxes suggested by climate models. However, we detect no increase in the tilt of the surfaces of equal density across the Antarctic Circumpolar Current, in contrast to coarse-resolution model studies. Our results imply that the transport in the Antarctic Circumpolar Current and meridional overturning in the Southern Ocean are insensitive to decadal changes in wind stress

The excess mortality risk of diabetes associated with functional decline in older adults: Results from a 7-year follow-up of a nationwide cohort in Taiwan

<p>Abstract</p> <p>Background</p> <p>Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults.</p> <p>Methods</p> <p>We analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2.</p> <p>Results</p> <p>The crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning.</p> <p>Conclusions</p> <p>Our results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.</p

Functional Implication of Dp71 in Osmoregulation and Vascular Permeability of the Retina

Functional alterations of Müller cells, the principal glia of the retina, are an early hallmark of most retina diseases and contribute to their further progression. The molecular mechanisms of these reactive Müller cell alterations, resulting in disturbed retinal homeostasis, remain largely unknown. Here we show that experimental detachment of mouse retina induces mislocation of the inwardly rectifying potassium channels (Kir4.1) and a downregulation of the water channel protein (AQP4) in Müller cells. These alterations are associated with a strong decrease of Dp71, a cytoskeleton protein responsible for the localization and the clustering of Kir4.1 and AQP4. Partial (in detached retinas) or total depletion of Dp71 in Müller cells (in Dp71-null mice) impairs the capability of volume regulation of Müller cells under osmotic stress. The abnormal swelling of Müller cells In Dp71-null mice involves the action of inflammatory mediators. Moreover, we investigated whether the alterations in Müller cells of Dp71-null mice may interfere with their regulatory effect on the blood-retina barrier. In the absence of Dp71, the retinal vascular permeability was increased as compared to the controls. Our results reveal that Dp71 is crucially implicated in the maintenance of potassium homeostasis, in transmembraneous water transport, and in the Müller cell-mediated regulation of retinal vascular permeability. Furthermore, our data provide novel insights into the mechanisms of retinal homeostasis provided by Müller cells under normal and pathological conditions

A change in the transportation needs today, a better future for tomorrow – climate change review

No sooner than later, the world will be living hell as a result of the transportation effects on our climate now escalating. The pressure is now growing towards their resultant effects to be totally eradicated in order to save our planet otherwise, the stabilisation of these effects; global warming, greenhouse gas (GHG) emission and degradation will need to be sought after. The world all over is at it now in an effort to restore our climate, to save it from the effects of these catastrophes/disasters. On the proposition of the Kyoto Protocol in1997, the main focus was to decrease greenhouse emissions of mainly six gases – Carbon dioxide, methane, nitrous oxide, sulphur hexafluoride, Hydro fluorocarbons (HFCs) and Per fluorinated Compounds (PFCs). And transport alone, accounts for over 26% of global CO2 and has been regarded as one of the few industrial sectors wherein emissions are still on the increase, on this basis, researchers and policy makers are all at it to tackle the menace of climate changes through provision of sustainable transport. This paper focuses on the new and developed technologies like the renewable energy source [RES], which will be an alternative to transport fuels to avoid the dependence on petroleum which after effects are damaging to the world climate, and may probably not be there forever to continue serving the world ever increasing population. While the long term solutions are being sought, these alternatives will make do for now

Crosslinking of a CD4 Mimetic Miniprotein with HIV-1 Env gp140 Alters Kinetics and Specificities of Antibody Responses against HIV-1 Env in Macaques

Evaluation of the epitope specificities, location (systemic, mucosal) and effector function of antibodies elicited by novel HIV-1 immunogens engineered to improve exposure of specific epitopes is critical for HIV-1 vaccine development. Utilizing an array of humoral assays, we evaluated the magnitude, epitope specificity, avidity and function of systemic and mucosal immune responses elicited by a vaccine regimen containing Env cross-linked to a CD4 mimetic miniprotein (gp140-M64U1) in rhesus macaques. Crosslinking of gp140 Env with M64U1 resulted in an earlier increase in both the magnitude and avidity of the IgG binding response compared to Env protein alone. Notably, binding IgG responses at an early time point correlated with Antibody Dependent Cellular Cytotoxicity (ADCC) function at the peak immunity time point, which was higher for the crosslinked Env group compared to the Env group alone. In addition, the crosslinked Env group developed higher IgG responses against a linear epitope in the C1 gp120 region of the HIV-1 envelope glycoprotein. These data demonstrate that structural modification of the HIV-1 envelope immunogen by crosslinking gp140 with the CD4 mimetic M64U1 elicited an earlier increase of binding antibody responses and altered the specificity of the IgG responses that correlated with the rise of subsequent antibody-mediated antiviral functions.IMPORTANCE The development of an efficacious HIV-1 vaccine remains a global priority to prevent new cases of HIV-1 infection. Of the six HIV-1 efficacy trials to date, only one has demonstrated partial efficacy, and the immune correlates analysis of this trial revealed a role for binding antibodies and antibody Fc mediated effector functions. New HIV-1 envelope immunogens are being engineered to selectively expose the most vulnerable and conserved sites on the HIV-1 envelope with the goal of eliciting antiviral antibodies. Evaluation of the humoral responses elicited by these novel immunogen designs in nonhuman primates is critical for understanding how to improve upon immunogen design to inform further testing in human clinical trials. Our results demonstrate that Env structural modifications that aim to mimic the CD4 bound conformation can result in earlier antibody elicitation, altered epitope specificity and increased antiviral function post immunization.This work was supported by the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) grants, Center for HIV/AIDS Vaccine Immunology (CHAVI)/ HIV Vaccine Trials Network (HVTN) Early Stage Investigator (ESI) Award (U19AI067854, UM1AI068618), (HHSN27201100016C), 1P01AI120756 and the NIH NIAID Duke Center for AIDS Research Immunology Core P30 AI 64518. The NHP study was funded by NIH PO1 AI066287-02