Compliance with infection control recommendations in South African dental practices: a review of studies published between 1990 and 2007

Published ArticleIn a country where the prevalence of infectious diseases ranks among the highest in the world, infection control in health care facilities should not be debatable. This unfortunately does not seem to be the case in South African oral health care facilities. This study is a systematic review of available literature on the adherence of South African oral health care professionals to infection control recommendations. Nine focus areas were investigated with regard to infection control practices: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and sound housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; as well as other special considerations. Although South African studies are limited and most of them relied on self-reports, which could have resulted in a serious overestimation of compliance, even these studies indicate serious shortcomings with regard to infection control practices in oral health care facilities in this country. This review highlights opportunity for improvement. Furthermore, it identifies possibilities for future research in infection control and also opportunities to improve infection control education for all oral health care workers in the country

Quantitizing Affective Data as Project Evaluation on the Use of a Mathematics Mobile Game and Intelligent Tutoring System

Technology-echnology-enhanced learning generally focuses on the cognitive rather than the affective domain of learning. This multi-method evaluation of the INBECOM project (Integrating Behaviourism and Constructivism in Mathematics) was conducted from the point of view of affective learning levels of Krathwohl et al. (1964). The research questions of the study were: (i) to explore the affective learning experiences of the three groups of participants (researchers, teachers and students) during the use of a mobile game UFractions and an intelligent tutoring system Active Math to enhance the learning of fractions in mathematics; and (ii) to determine the significance of the relationships among the affective learning experiences of the three groups of participants (researchers, teachers and students) in the INBECOM project.This research followed a sequential, equal status, multi-mode research design and methodology where the qualitative data were derived from the interviews with researchers, teachers and students, as well as from learning diaries, feelings blogs, and observations (311 documents) across three contexts (South Africa, Finland, and Mozambique). The qualitative data was quantitized (Saldana, 2009), i.e. analysed deductively in an objective and quantifiable way as instances on an Excel (TM) spreadsheet for statistical analyses. All the data was explored from the affective perspective by labelling the feelings participants experienced according to the affective levels of the Krathwohl et al. (1964) framework.The researchers concluded that: (i) the research participants not only received information, but actively participated in the learning process; responded to what they learned; associated value to their acquired knowledge; organised their values; elaborated on their learning; built abstract knowledge; and adopted a belief system and a personal worldview; and (ii) affirmation of affective learning at all five levels was recognised among the three groups of participants. The study raised a number of issues which could be addressed in future, like how affective levels of learning are intertwined with cognitive levels of learning while learning mathematics in a technology-enhanced learning environment; and how pedagogical models which take into account both cognitive and affective aspects of learning support deep learning

Missed opportunities for measles immunisation in selected western Cape hosl?itals

Measles is still a major cause of childhood mortality and morbidity in South Africa. The World Health Organisation (WHO) has recently recommended that greater a"ention be paid to opportunities for immunisation in the curative sector. This study quantified the extent of missed opportunities for measles immunisation in children a"ending primary, secondary and tertiary level curative hospitals in the western Cape. Exit interviews of 1 068 carers of children aged between 6 and 59 months inclusive showed that 2,4 - 40,7% of carers had been requested to produce a Road-to-Health card, and that 4,8 - 43,1% of carers had a card available. The proportion of children with documented evidence of measles immunisation available ranged from 4,8% to 40,0% between facilities. The study demonstrated that a considerable number of potential opportunities to immunise children against measles are currently being missed in children a"ending hospitals and day hospitals in the western Cape. The study documents the effect of a fragmented approach to health care, and'indicates a need for rapid integration of preventive and curative components of health care into a metropolitan-based primary health care service

Benefits of restoring ecosystem services in urban areas

Cities are a key nexus of the relationship between people and nature and are huge centers of demand for ecosystem services and also generate extremely large environmental impacts. Current projections of rapid expansion of urban areas present fundamental challenges and also opportunities to design more livable, healthy and resilient cities (e.g. adaptation to climate change effects). We present the results of an analysis of benefits of ecosystem services in urban areas. Empirical analyses included estimates of monetary benefits from urban ecosystem services based on data from 25 urban areas in the USA, Canada, and China. Our results show that investing in ecological infrastructure in cities, and the ecological restoration and rehabilitation of ecosystems such as rivers, lakes, and woodlands occurring in urban areas, may not only be ecologically and socially desirable, but also quite often, economically advantageous, even based on the most traditional economic approaches.Peer reviewe

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries.

OBJECTIVE: To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. DESIGN: Observational study. SETTING: Twelve countries, eleven European and South Africa. SAMPLE: National, regional or institutional-level regimens on oxytocin for induction and augmentation labour. METHODS: Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67μg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused. RESULTS: Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. CONCLUSION: Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen

Shared decision making and the practice of community translation in presenting a pre-final Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire: a proposal for improved translation and cross-cultural adaptation

Background Translation and cross cultural adaptation of patient reported outcome measures (PROMs) involves a step referred to as harmonisation, following forward and backward translation of the measure. This article proposes the introduction of methods not previously included in the process of harmonisation. The aim of the study was to introduce shared decision making (SDM) and the practice of community translation (CT) during the harmonisation of the Afrikaans for the Western Cape version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, a PROM that measures symptoms and activity and participation in persons with upper limb conditions. Methods A broader approach to harmonisation is proposed by incorporating CT and SDM in addition to existing methods toward harmonisation. Participants (n = 8) involved in the harmonisation meeting included the principal investigator, a linguistic expert, occupational therapists with knowledge of the target population, context and the DASH questionnaire and members of the target population with and without upper limb conditions. A partnership was formed with the participants (a principle of SDM) and the principles of non-parallel CT and the CT approach were applied during harmonisation. Employing CT principles ensures that the norm for the translation is set by the population the translation is intended for. Results Forward and backward translation of the DASH questionnaire presented a version of the measure in the target language for consideration during harmonisation. There were however a significant number of conceptually problematic items on the version presented at the meeting. Only seven items (7 of 30) remained unchanged. Conclusion SDM and CT was used during the harmonisation of the Afrikaans for the Western Cape DASH questionnaire. Both these practices could have relevance in the translation and cross-cultural adaptation of PROMs where the translation is intended for persons from low socio-economic backgrounds and low levels of education

Sequence-based prediction for vaccine strain selection and identification of antigenic variability in foot-and-mouth disease virus

Identifying when past exposure to an infectious disease will protect against newly emerging strains is central to understanding the spread and the severity of epidemics, but the prediction of viral cross-protection remains an important unsolved problem. For foot-and-mouth disease virus (FMDV) research in particular, improved methods for predicting this cross-protection are critical for predicting the severity of outbreaks within endemic settings where multiple serotypes and subtypes commonly co-circulate, as well as for deciding whether appropriate vaccine(s) exist and how much they could mitigate the effects of any outbreak. To identify antigenic relationships and their predictors, we used linear mixed effects models to account for variation in pairwise cross-neutralization titres using only viral sequences and structural data. We identified those substitutions in surface-exposed structural proteins that are correlates of loss of cross-reactivity. These allowed prediction of both the best vaccine match for any single virus and the breadth of coverage of new vaccine candidates from their capsid sequences as effectively as or better than serology. Sub-sequences chosen by the model-building process all contained sites that are known epitopes on other serotypes. Furthermore, for the SAT1 serotype, for which epitopes have never previously been identified, we provide strong evidence - by controlling for phylogenetic structure - for the presence of three epitopes across a panel of viruses and quantify the relative significance of some individual residues in determining cross-neutralization. Identifying and quantifying the importance of sites that predict viral strain cross-reactivity not just for single viruses but across entire serotypes can help in the design of vaccines with better targeting and broader coverage. These techniques can be generalized to any infectious agents where cross-reactivity assays have been carried out. As the parameterization uses pre-existing datasets, this approach quickly and cheaply increases both our understanding of antigenic relationships and our power to control disease

Engineered SH2 domains with tailored specificities and enhanced affinities for phosphoproteome analysis

Protein phosphorylation is the most abundant post-translational modification in cells. Src homology 2 (SH2) domains specifically recognize phosphorylated tyrosine (pTyr) residues to mediate signaling cascades. A conserved pocket in the SH2 domain binds the pTyr side chain and the EF and BG loops determine binding specificity. By using large phage-displayed libraries, we engineered the EF and BG loops of the Fyn SH2 domain to alter specificity. Engineered SH2 variants exhibited distinct specificity profiles and were able to bind pTyr sites on the epidermal growth factor receptor, which were not recognized by the wild-type Fyn SH2 domain. Furthermore, mass spectrometry showed that SH2 variants with additional mutations in the pTyr-binding pocket that enhanced affinity were highly effective for enrichment of diverse pTyr peptides within the human proteome. These results showed that engineering of the EF and BG loops could be used to tailor SH2 domain specificity, and SH2 variants with diverse specificities and high affinities for pTyr residues enabled more comprehensive analysis of the human phosphoproteome. Statement: Src Homology 2 (SH2) domains are modular domains that recognize phosphorylated tyrosine embedded in proteins, transducing these post-translational modifications into cellular responses. Here we used phage display to engineer hundreds of SH2 domain variants with altered binding specificities and enhanced affinities, which enabled efficient and differential enrichment of the human phosphoproteome for analysis by mass spectrometry. These engineered SH2 domain variants will be useful tools for elucidating the molecular determinants governing SH2 domains binding specificity and for enhancing analysis and understanding of the human phosphoproteome

Tracking the antigenic evolution of foot-and-mouth disease virus

Quantifying and predicting the antigenic characteristics of a virus is something of a holy grail for infectious disease research because of its central importance to the emergence of new strains, the severity of outbreaks, and vaccine selection. However, these characteristics are defined by a complex interplay of viral and host factors so that phylogenetic measures of viral similarity are often poorly correlated to antigenic relationships. Here, we generate antigenic phylogenies that track the phenotypic evolution of two serotypes of footand- mouth disease virus by combining host serology and viral sequence data to identify sites that are critical to their antigenic evolution. For serotype SAT1, we validate our antigenic phylogeny against monoclonal antibody escape mutants, which match all of the predicted antigenic sites. For serotype O, we validate it against known sites where available, and otherwise directly evaluate the impact on antigenic phenotype of substitutions in predicted sites using reverse genetics and serology. We also highlight a critical and poorly understood problem for vaccine selection by revealing qualitative differences between assays that are often used interchangeably to determine antigenic match between field viruses and vaccine strains. Our approach provides a tool to identify naturally occurring antigenic substitutions, allowing us to track the genetic diversification and associated antigenic evolution of the virus. Despite the hugely important role vaccines have played in enhancing human and animal health, vaccinology remains a conspicuously empirical science. This study advances the field by providing guidance for tuning vaccine strains via site-directed mutagenesis through this high-resolution tracking of antigenic evolution of the virus between rare major shifts in phenotype.S1 Data. VNT serological results for serotype O viruses and antisera.S2 Data. LPBE serological results for serotype O viruses and antisera.S3 Data. VNT serological results for serotype SAT1 viruses and antisera.S1 Table. Foot-and-mouth disease virus details with accession numbers.S2 Table. Pan-serotypic reference alignment of FMDV. The dataset shows the aligned VP2, VP3 and VP1 proteins of example SAT1 and O isolates used in the study alongside representative isolates from the other five serotypes. The four contiguous surface-exposed structural motifs confirmed as containing antigenic sites on at least four serotypes are highlighted in red–locations are approximate due to structural differences between the serotypes. The RGD cell surface receptor-binding motif, in the centre of the third site, is highlighted in blue.S3 Table. Residues identified as part of epitopes on structural proteins across the six tested serotypes of FMDV, along with corresponding positions on all serotypes.S4 Table. SAT1 mar-mutants.The authors acknowledge the Biotechnology and Biological Sciences Research Council (BBSRC) Institute Strategic Programme on Livestock Viral Diseases at The Pirbright Institute (BB/J004375/1) [RR SP DJP MM] and BBSRC BB/ G529532/1 [DWB MM], BB/F009186/1 [MM] and BBSRC BB/L004828 [RR] and BBSRC / Department for International Development / Scottish Government grants BB/H009302/1 [RR] and BB/H009175/1 [SP FFM RR] (http://www.bbsrc.ac.uk), and Department for Environment, Food and Rural Affairs grant SE2937 (http://www.gov.uk/defra) [MM]. The Food and Agriculture Organisation financially supported the research to determine one-way relationship and antigenic relatedness of SAT1 viruses under grants OSRO/RAF/721/EC and MTF/INT/003/EEC (http:// www.fao.org) [FFM AL JJE BB], and RMRSA (http:// www.rmrdsa.co.za) (Improving detection and characterisation methods for FMDV and ASFV for cattle and pigs in the SADC region) [BB]. Structural studies supported by the UK Medical Research Council grant MR/N00065X/1 [EEF] (http://www.mrc. ac.uk). The work of the Wellcome Trust Centre in Oxford is supported by the Wellcome Trust core award 090532/Z/07/Z [EEF] (http://www.wellcome.ac. uk).http://www.plosone.orgam2016Microbiology and Plant PathologyProduction Animal Studie