Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity

Background: Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low. Aims: To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance. Methods: The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool. Findings: In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk. Discussion: We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty

Reunifying from behind bars: A quantitative study of the relationship between parental incarceration, service use, and foster care reunification

Incarcerated parents attempting to reunify with their children in foster care can find it difficult to complete the activities on their court-ordered case plans, such as drug treatment services and visitation with children. Although much has been written regarding the obstacles that are likely to interfere with reunification for incarcerated parents, very little quantitative research has examined the topic. This study uses secondary data to examine the incarceration experiences and reunification outcomes of a sample of 225 parents in one large urban California county. In multivariate analysis controlling for problems and demographics, incarcerated parents were less likely to reunify with their children; however, service use appeared to mediate this relationship, as the negative association between incarceration and reunification did not persist when service use was included as a variable in the model. Suggestions are made for policy and practice changes to improve reunification outcomes for this population of parents.

Designing multifunctional landscapes for forest conservation

A multifunctional landscape approach to forest protection has been advocated for tropical countries. Designing such landscapes necessitates that the role of different land uses in protecting forest be evaluated, along with the spatial interactions between land uses. However, such evaluations have been hindered by a lack of suitable analysis methodologies and data with fine spatial resolution over long time periods. We demonstrate the utility of a matching method with multiple categories to evaluate the role of alternative land uses in protecting forest. We also assessed the impact of land use change trajectories on the rate of deforestation. We employed data from Kalimantan (Indonesian Borneo) at three different time periods during 2000–2012 to illustrate our approach. Four single land uses (protected areas (PA), natural forest logging concessions (LC), timber plantation concessions (TC) and oil-palm plantation concessions (OC)) and two mixed land uses (mixed concessions and the overlap between concessions and PA) were assessed. The rate of deforestation was found to be lowest for PA, followed by LC. Deforestation rates for all land uses tended to be highest for locations that share the characteristics of areas in which TC or OC are located (e.g. degraded areas), suggesting that these areas are inherently more susceptible to deforestation due to foregone opportunities. Our approach provides important insights into how multifunctional landscapes can be designed to enhance the protection of biodiversity

The functional cancer map: A systems-level synopsis of genetic deregulation in cancer

<p>Abstract</p> <p>Background</p> <p>Cancer cells are characterized by massive dysegulation of physiological cell functions with considerable disruption of transcriptional regulation. Genome-wide transcriptome profiling can be utilized for early detection and molecular classification of cancers. Accurate discrimination of functionally different tumor types may help to guide selection of targeted therapy in translational research. Concise grouping of tumor types in cancer maps according to their molecular profile may further be helpful for the development of new therapeutic modalities or open new avenues for already established therapies.</p> <p>Methods</p> <p>Complete available human tumor data of the Stanford Microarray Database was downloaded and filtered for relevance, adequacy and reliability. A total of 649 tumor samples from more than 1400 experiments and 58 different tissues were analyzed. Next, a method to score deregulation of KEGG pathway maps in different tumor entities was established, which was then used to convert hundreds of gene expression profiles into corresponding tumor-specific pathway activity profiles. Based on the latter, we defined a measure for functional similarity between tumor entities, which yielded to phylogeny of tumors.</p> <p>Results</p> <p>We provide a comprehensive, easy-to-interpret functional cancer map that characterizes tumor types with respect to their biological and functional behavior. Consistently, multiple pathways commonly associated with tumor progression were revealed as common features in the majority of the tumors. However, several pathways previously not linked to carcinogenesis were identified in multiple cancers suggesting an essential role of these pathways in cancer biology. Among these pathways were 'ECM-receptor interaction', 'Complement and Coagulation cascades', and 'PPAR signaling pathway'.</p> <p>Conclusion</p> <p>The functional cancer map provides a systematic view on molecular similarities across different cancers by comparing tumors on the level of pathway activity. This work resulted in identification of novel superimposed functional pathways potentially linked to cancer biology. Therefore, our work may serve as a starting point for rationalizing combination of tumor therapeutics as well as for expanding the application of well-established targeted tumor therapies.</p

Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon

Background: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-HIV treatment. We compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with HIV only and patients coinfected with hepatitis B or C virus in Cameroon. Methods: A retrospective cohort study was conducted among HIV-1-infected patients. Plasma HBV DNA and HCV RNA were tested in positive or indeterminate samples for HBsAg or HCV antibodies, respectively. All patients received nevirapine and lamivudine plus stavudine or zidovudine. Results: Of 169 HIV-1-infected patients with a median baseline CD4 count of 135 cells/mm(3) (interquartile range [IQR] 67 218), 21% were coinfected with HBV or HCV. In coinfected patients, the median viral load was 2.47 x 107 IU/mL for HBV (IQR 3680-1.59 x 10(8)) and 928 000 IU/mL for HCV (IQR 178 400-2.06 x 10(6)). Multivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). The response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of CD4 cell count increase (p = 0.8), HIV-1 viral load below 400 copies/mL (p = 0.9), death (p = 0.3) and death or new AIDS-defining event (p = 0.1). Nevirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. Conclusion: This study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low CD4 cell count in Africa despite frequent coinfections with HBV or HCV and infrequent testing of these infections. Although testing for HBV and HCV should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown

Effective self-regulated science learning through multimedia-enriched skeleton concept maps

This study combines work on concept mapping with scripted collaborative learning. Purpose: The objective was to examine the effects of self-regulated science learning through scripting students’ argumentative interactions during collaborative ‘multimedia-enriched skeleton concept mapping’ on meaningful science learning and retention. Programme description: Each concept in the enriched skeleton concept map (ESCoM) contained annotated multimedia-rich content (pictures, text, animations or video clips) that elaborated the concept, and an embedded collaboration script to guide students’ interactions. Sample: The study was performed in a Biomolecules course on the Bachelor of Applied Science program in the Netherlands. All first-year students (N=93, 31 women, 62 men, aged 17–33 years) took part in this study. Design and methods: The design used a control group who received the regular course and an experimental group working together in dyads on an ESCoM under the guidance of collaboration scripts. In order to investigate meaningful understanding and retention, a retention test was administered a month after the final exam. Results: Analysis of covariance demonstrated a significant experimental effect on the Biomolecules exam scores between the experimental group and the control, and the difference between the groups on the retention test also reached statistical significance. Conclusions: Scripted collaborative multimedia ESCoM mapping resulted in meaningful understanding and retention of the conceptual structure of the domain, the concepts, and their relations. Not only was scripted collaborative multimedia ESCoM mapping more effective than the traditional teaching approach, it was also more efficient in requiring far less teacher guidance