Preclinical evaluation of lime juice as a topical microbicide candidate

Background: The continued growth of the global HIV epidemic highlights the urgent need to develop novel prevention strategies to reduce HIV transmission. The development of topical microbicides is likely to take a number of years before such a product would be widely available. This has resulted in a call for the rapid introduction of simpler vaginal intervention strategies in the interim period. One suggested practice would be vaginal douching with natural products including lime or lemon juice. Here we present a comprehensive preclinical evaluation of lime juice (LiJ) as a potential intervention strategy against HIV. Results: Pre-treatment of HIV with LiJ demonstrated direct virucidal activity, with 10% juice inactivating the virus within 5 minutes. However, this activity was significantly reduced in the presence of seminal plasma, where inactivation required maintaining a 1:1 mixture of neat LiJ and seminal plasma for more than 5 minutes. Additionally, LiJ demonstrated both time and dosedependent toxicity towards cervicovaginal epithelium, where exposure to 50% juice caused 75–90% toxicity within 5 minutes increasing to 95% by 30 minutes. Cervicovaginal epithelial cell monolayers were more susceptible to the effects of LiJ with 8.8% juice causing 50% toxicity after 5 minutes. Reconstructed stratified cervicovaginal epithelium appeared more resilient to LiJ toxicity with 30 minutes exposure to 50% LiJ having little effect on viability. However viability was reduced by 75% and 90% following 60 and 120 minutes exposure. Furthermore, repeat application (several times daily) of 25% LiJ caused 80–90% reduction in viability. Conclusion: These data demonstrate that the virucidal activity of LiJ is severely compromised in the presence of seminal plasma. Potentially, to be effective against HIV in vivo, women would need to apply a volume of neat LiJ equal to that of an ejaculate, and maintain this ratio vaginally for 5–30 minutes after ejaculation. Data presented here suggest that this would have significant adverse effects on the genital mucosa. These data raise serious questions about the plausibility and safety of such a prevention approach

Occupational Therapy Student Conceptions of Self-Reflection in Level II Fieldwork

Self-reflection is paramount to the development of professionalism and serves as the foundation of adult education and lifelong learning. Pedagogical approaches in health sciences programs that promote self-reflection are growing in popularity. Current literature identifies a gap in what and how students conceive self-reflection and whether self-reflection is creating professionals that meet the challenges of today’s healthcare climate. This qualitative study explores the conceptions of self-reflection for occupational therapy students in Level II Fieldwork. The use of phenomenographic methodology guided the collection of information-rich data through semi-structured interviews. Twenty-one occupational therapy graduates volunteered to participate in the interviews. Verbatim transcripts were coded to identify categories and patterns in the data. A focused discussion was employed as a member-checking method to ensure accuracy of study outcomes. Participants identified that self-reflection may serve to inform personal and professional practices during occupational therapy student clinical rotations. Although universally defined, student self-reflection occurred in countless ways and took many forms. Participants valued its function in expanded decision making, self-awareness, and competence in fieldwork and everyday occupations. These findings facilitate further research and the creation of new self-reflection educational methods or interventions designed to build or remediate self-reflective capacity of health sciences students during academic and clinical programming

Self-Reflection and its Relationship to Occupational Competence and Clinical Performance in Level II Fieldwork

Purpose: Reflective practitioners embody the ability to critique their own clinical thinking about the dilemmas that frequently arise in professional practice and everyday life. Conflicting evidence exists on whether or not self-reflective practices are effective in promoting academic, clinical, and personal success. This quantitative study investigated self-reflection as a predictor of increased occupational competence and clinical performance in Level II Fieldwork for entry-level Master\u27s degree occupational therapy students. Method: The study used convenience sampling to recruit participants and data were collected via a demographic survey and self-assessment questionnaires. Multiple linear regression analyses were conducted to determine the extent to which self-reflection predicts occupational competence and clinical performance. R2 values were examined to determine the importance of each dependent variable (occupational competence and clinical performance). Results: Findings revealed a statistically significant relationship between self-reflection and occupational competence (p = 0.0053) but not between self-reflection and clinical performance (p = 0.08). Self-reflection accounted for 14% of the variance in clinical performance (R2 = 0.14), and more than one third (R2 = 0.38) of the variance in occupational competence. Results suggest that students who self-reflect regularly during fieldwork may have a greater ability to maintain everyday life routines during the demands of Level II Fieldwork. Conclusions: Self-reflection strongly predicts occupational competence of occupational therapy students during Level II Fieldwork, but does not significantly predict students’ clinical performance. Recommendations: Occupational therapy educators should consider incorporating guided self-reflection activities into the academic program in order to support student occupational competence. Intentional coaching in self-reflection may better prepare students for a clinical setting by supporting healthy daily routines, which may help them to manage stress during Level II Fieldwork. Future research should explore the impact of self-reflection training during clinical rotations (provided by clinical educators) on student clinical performance. Revision of the measurement of clinical performance is warranted to include questions pertaining to soft skills such as self-reflection and awareness

Variance and Rate-of-Change as Early Warning Signals for a Critical Transition in an Aquatic Ecosystem State: A Test Case From Tasmania, Australia

Critical transitions in ecosystem states are often sudden and unpredictable. Consequently, there is a concerted effort to identify measurable early warning signals (EWS) for these important events. Aquatic ecosystems provide an opportunity to observe critical transitions due to their high sensitivity and rapid response times. Using palaeoecological techniques, we can measure properties of time series data to determine if critical transitions are preceded by any measurable ecosystem metrics, that is, identify EWS. Using a suite of palaeoenvironmental data spanning the last 2,400 years (diatoms, pollen, geochemistry, and charcoal influx), we assess whether a critical transition in diatom community structure was preceded by measurable EWS. Lake Vera, in the temperate rain forest of western Tasmania, Australia, has a diatom community dominated by Discostella stelligera and undergoes an abrupt compositional shift at ca. 820 cal yr BP that is concomitant with increased fire disturbance of the local vegetation. This shift is manifest as a transition from less oligotrophic acidic diatom flora (Achnanthidium minutissimum, Brachysira styriaca, and Fragilaria capucina) to more oligotrophic acidic taxa (Frustulia elongatissima, Eunotia diodon, and Gomphonema multiforme). We observe a marked increase in compositional variance and rate-of-change prior to this critical transition, revealing these metrics are useful EWS in this system. Interestingly, vegetation remains complacent to fire disturbance until after the shift in the diatom community. Disturbance taxa invade and the vegetation system experiences an increase in both compositional variance and rate-of-change. These trends imply an approaching critical transition in the vegetation and the probable collapse of the local rain forest system

Upper-Room Ultraviolet Light and Negative Air Ionization to Prevent Tuberculosis Transmission

Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper-room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Perú, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p < 0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p < 0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p < 0.0001) and by UV lights (log-rank 46; p < 0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings

NP3 Exploratory Study 8:Report from the project New Purposes, New Practices, New Pedagogies (NP3)

New Purposes – New Practices – New Pedagogy (NP3) is a collaboration between The Open University, Lancaster University and Manchester Metropolitan University, led by Professor Peter Twining. NP3 is finding out about how children's digital practices influence teaching and learning. NP3 aims to find out about how children use digital devices outside school and what influence (if any) these practices have on what pupils and teachers do inside primary schools. The focus is on pedagogy across the curriculum (rather than the teaching of computing). Our Research Questions (RQs) for these exploratory studies are: RQ1 What are the digital practices that pupils bring to their learning in school? RQ2 Across subject domains what do teachers’ intended and enacted pedagogic practices indicate about their awareness of and the value accorded to pupils’ digital competencies, and how do pupils’ experience these pedagogic practices? RQ3 What institutional circumstances and practices enable or undermine how pupils’ digital competencies and practices are recognised (RQ1) and integrated into teachers’ practice (RQ2)? This brief report provides a snapshot of the digital practices evident in one of the 10 Exploratory Studies that we conducted between October 2015 and March 2016, with a summary of emerging findings from this Exploratory Study. For further details about NP3 go to http://www.np3.org.uk

NP3 Exploratory Study 8:Report from the project New Purposes, New Practices, New Pedagogies (NP3)

New Purposes – New Practices – New Pedagogy (NP3) is a collaboration between The Open University, Lancaster University and Manchester Metropolitan University, led by Professor Peter Twining. NP3 is finding out about how children's digital practices influence teaching and learning. NP3 aims to find out about how children use digital devices outside school and what influence (if any) these practices have on what pupils and teachers do inside primary schools. The focus is on pedagogy across the curriculum (rather than the teaching of computing). Our Research Questions (RQs) for these exploratory studies are: RQ1 What are the digital practices that pupils bring to their learning in school? RQ2 Across subject domains what do teachers’ intended and enacted pedagogic practices indicate about their awareness of and the value accorded to pupils’ digital competencies, and how do pupils’ experience these pedagogic practices? RQ3 What institutional circumstances and practices enable or undermine how pupils’ digital competencies and practices are recognised (RQ1) and integrated into teachers’ practice (RQ2)? This brief report provides a snapshot of the digital practices evident in one of the 10 Exploratory Studies that we conducted between October 2015 and March 2016, with a summary of emerging findings from this Exploratory Study. For further details about NP3 go to http://www.np3.org.uk

Quality of life and neck pain in nurses

Objectives: To investigate the association between neck pain and psychological stress in nurses. Material and Methods: Nurses from the Avon Orthopaedic Centre completed 2 questionnaires: the Short Form-36 (SF-36) and 1 exploring neck pain and associated psychological stress. Results: Thirty four nurses entered the study (68% response). Twelve (35.3%) had current neck pain, 13 (38.2%) reported neck pain within the past year and 9 (26.5%) had no neck pain. Subjects with current neck pain had significantly lower mental health (47.1 vs. 70.4; p = 0.002), physical health (60.8 vs. 76.8; p = 0.010) and overall SF-36 scores (56.8 vs. 74.9; p = 0.003). Five (41.7%) subjects with current neck pain and 5 (38.5%) subjects with neck pain in the previous year attributed it to psychological stress. Conclusions: Over 1/3 of nurses have symptomatic neck pain and significantly lower mental and physical health scores. Managing psychological stress may reduce neck pain, leading to improved quality of life for nurses, financial benefits for the NHS, and improved patient care

Validation of a self-efficacy instrument and its relationship to performance of crisis resource management skills

Self-efficacy is thought to be important for resuscitation proficiency in that it influences the development of and access to the associated medical knowledge, procedural skills and crisis resource management (CRM) skills. Since performance assessment of CRM skills is challenging, self-efficacy is often used as a measure of competence in this area. While self-efficacy may influence performance, the true relationship between self-efficacy and performance in this setting has not been delineated. We developed an instrument to measure pediatric residents’ self-efficacy in CRM skills and assessed its content validity, internal structure, and relationship to other variables. After administering the instrument to 125 pediatric residents, critical care fellows and faculty, we performed an exploratory factor analysis within a confirmatory factor analysis as well as a known group comparison. The analyses specified four factors that we defined as: situation awareness, team management, environment management, and decision making. Pediatric residents reported lower self-efficacy than fellows and faculty in each factor. We also examined the correlation between self-efficacy and performance scores for a subset of 30 residents who led video recorded simulated resuscitations and had their performances rated by three observers. We found a significant, positive correlation between residents’ self-efficacy in situation awareness and environment management and their overall performance of CRM skills. Our findings suggest that in a specific context, self-efficacy as a form of self-assessment may be informative with regards to performance