Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Objective: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). Methods: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Results: Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. Conclusions: This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes

Changes in ponderal index and body mass index across childhood and their associations with fat mass and cardiovascular risk factors at age 15

Background: Little is known about whether associations between childhood adiposity and later adverse cardiovascular health outcomes are driven by tracking of overweight from childhood to adulthood and/or by vascular and metabolic changes from childhood overweight that persist into adulthood. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15. Methods and Findings: Using data from the Avon Longitudinal Study of Parents and Children, we estimated individual trajectories of ponderal index (PI) from 0-2 years and BMI from 2-10 years using random-effects linear spline models (N = 4601). We explored associations between PI/BMI trajectories and DXA-determined total-body fat-mass and cardiovascular risk factors at 15 years (systolic and diastolic blood pressure, fasting LDL-and HDL-cholesterol, triglycerides, C-reactive protein, glucose, insulin) with and without adjustment for confounders. Changes in PI/BMI during all periods of infancy and childhood were associated with greater DXA-determined fat-mass at age 15. BMI changes in childhood, but not PI changes from 0-2 years, were associated with most cardiovascular risk factors in adolescence; associations tended to be strongest for BMI changes in later childhood (ages 8.5-10), and were largely mediated by fat mass at age 15. Conclusion: Changes in PI/BMI from 0-10 years were associated with greater fat-mass at age 15. Greater increases in BMI from age 8.5-10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age. We found little evidence supporting previous reports that rapid PI changes in infancy are associated with future cardiovascular risk. This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight

Evaluering av sammenheng mellom tiltak

While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change's causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels

Ein Marshallplan mit Afrika: Geeignetes Konzept für eine nachhaltige Entwicklung?

Im Januar 2017 stellte Bundesminister Dr. Gerd Müller die Eckpunkte für den Marshallplan mit Afrika vor. Statt weiter Geld nach dem Gießkannenprinzip zu verteilen, soll zukünftig der Aufbau stabiler Wirtschaftsstrukturen gezielt gefördert und die Eigenverantwortung der Regierungen gestärkt werden. In seinem Beitrag stellt Bundesminister Gerd Müller den Marshallplan mit Afrika vor und unterstreicht, dass »eine Partnerschaft auf Augenhöhe« sowie eine verstärkte Mobilisierung privaten Kapitals und privater Investitionen erforderlich sei. Für Andreas Freytag und Susanne Fricke, Universität Jena, unterscheidet sich der aktuelle Marshallplan »wohltuend von althergebrachten Entwicklungsstrategien«. So betone er u.a. die Bedeutung der Wirtschaft für den Entwicklungsprozess Afrikas und mahne Investitionen, Bildung für die Jugend, die Einbindung in die Wertschöpfungsketten sowie die Schaffung eines Mittelstandes an. Ihm fehle aber eine definierte Schwerpunktsetzung. Franz Josef Radermacher, Universität Ulm und Club of Rome, beschreibt als Zielsetzung des Marshallplans eine »Wohlstandsexplosion in Afrika, insbesondere in Nordafrika«, die mit allen Nachhaltigkeitsanforderungen kompatibel gestaltet werden soll. Nach Meinung von Axel Dreher und Sarah Langlotz, Universität Heidelberg, sieht der Marshallplan mit Afrika eine Konzentration der Hilfe auf wenige reformwillige Länder vor, wodurch ärmere Länder an Unterstützung verlieren. Zudem betone der Plan Bedingungen, die an die deutschen Zahlungen geknüpft werden sollen. Detaillierte Bedingungen, von deren Einhaltung konkrete Hilfszahlungen abhängig gemacht werden, seien aber wenig sinnvoll. Deutschland solle sich stattdessen in Richtung einer bedingungslosen Budgethilfe bewegen. Werner Abelshauser, Universität Bielefeld, sieht den Marshallplan als Modell absolut ungeeignet, um Entwicklungsländer voranzubringen. Denn anders als in den meisten Empfängerländern Westeuropas nach dem Krieg fehle es dort gerade an Potenzial und wirtsch

Telerobotics Workstation (TRWS) for Deep Space Habitats

On medium- to long-duration human spaceflight missions, latency in communications from Earth could reduce efficiency or hinder local operations, control, and monitoring of the various mission vehicles and other elements. Regardless of the degree of autonomy of any one particular element, a means of monitoring and controlling the elements in real time based on mission needs would increase efficiency and response times for their operation. Since human crews would be present locally, a local means for monitoring and controlling all the various mission elements is needed, particularly for robotic elements where response to interesting scientific features in the environment might need near- instantaneous manipulation and control. One of the elements proposed for medium- and long-duration human spaceflight missions, the Deep Space Habitat (DSH), is intended to be used as a remote residence and working volume for human crews. The proposed solution for local monitoring and control would be to provide a workstation within the DSH where local crews can operate local vehicles and robotic elements with little to no latency. The Telerobotics Workstation (TRWS) is a multi-display computer workstation mounted in a dedicated location within the DSH that can be adjusted for a variety of configurations as required. From an Intra-Vehicular Activity (IVA) location, the TRWS uses the Robot Application Programming Interface Delegate (RAPID) control environment through the local network to remotely monitor and control vehicles and robotic assets located outside the pressurized volume in the immediate vicinity or at low-latency distances from the habitat. The multiple display area of the TRWS allows the crew to have numerous windows open with live video feeds, control windows, and data browsers, as well as local monitoring and control of the DSH and associated systems

Maximizing Resources to Make School Employee Wellness a Reality

Because of the large number of Americans employed within school districts, they are a prime target population for the development and implementation of employee wellness programs. Even with grant support, funding for these programs can be limited. Forming partnerships with universities who have health- and wellness-focused areas of study can be mutually beneficial; school districts can stretch their dollars further, while college students gain hands-on experience for effective employee wellness program implementation. This articles addresses a successful partnership between a local school district and nearby university department to provide an employee wellness program. Specific tips and ideas for implementation of an employee wellness program are provided

The Genetic and Physiological Characteristics of the Symbiodinium spp. in the Endemic Anemone Anthopleura Aureoradiata

Photosynthetic dinoflagellates of the genus Symbiodinium form symbiotic relationships with many marine hosts, including cnidarian corals and sea anemones. This partnership is extremely successful in tropical waters leading to a great diversity of coral species and Symbiodinium types. Environmental condition in the tropics are stable, changes to which can lead to destabilization of the symbiotic interactions between the host and symbiont, which in turn can lead to total breakdown of the partnership and expulsion of the symbiont. Temperate symbiotic cnidarian species, especially sea anemones, are less common but locally abundant. Environmental conditions are highly variable with extreme differences in light and temperature. Adaptation to these conditions has led to the success of resilient partnerships, but also to less diversity of Symbiodinium types. This study looked at the relationship between the endemic New Zealand anemone, Anthopleura aureoradiata, and its symbiotic relationship with the Symbiodinium cells it harbours. The aim was to determine why and how this symbiotic relationship is so resilient to the temperate conditions by 1) determining the molecular identity of the Symbiodinium spp. within the anemone, throughout its latitudinal range and through the seasons, and whether any seasonal changes differed between two habitats, the rocky shore and mudflats; 2) comparing the identity of the Symbiodinium spp. in New Zealand with those from four species of anemones from Europe (Cereus pedunculatus, Anthopleura ballii and Anemonia viridis from the south-west of England and Aiptasia mutabilis from Brittany (France)) to establish any differences or similarities between the northern and southern hemispheres; 3) determining whether resilience to environmental conditions is attributed to the Symbiodinium photoprotective mechanisms. A. aureoradiata were collected in early autumn in five sites from the top (Parengarenga Harbour) to the bottom (Stewart Island) of New Zealand for the latitudinal study. Seasonal anemones were collected from a rocky shore in Wellington Harbour (Point Halswell, Kau Bay) and a mudflat at Pauatahanui Inlet. Symbiodinium types were identified to subcladal level using ITS2 sequencing. A low diversity of types was found, with all anemones harbouring algal cells identified as being similar, or identical to, Symbiodinium sp. Mediterranean clade A (Med clade A) and Symbiodinium sp. Amed (Amed). 96.55% of the anemones from the latitudinal study, all the winter anemones, 87.50% of the summer anemones and almost 78% of the autumn anemones harboured Symbiodinium cells most similar or identical to Med clade A. All Symbiodinium sequences from the European anemones also were identified as being similar or identical to Med clade A or Amed, suggesting that the Symbiodinium in A. aureoradiata are likely not endemic. It is not known whether anemones harbour both types simultaneously and whether a change in dominant symbiont type occurs with seasons within anemones by “shuffling”. The photophysiology of the Symbiodinium cells isolated from the anemones was studied using an Imaging-PAM fluorometer whilst being maintained in six light and temperature treatments. The photosynthetic rate of PSII, energy quenching by NPQ, and photosystem recovery were measured to determine whether the Symbiodinium cells had a strong capacity for photoprotection and were able to down-regulate quickly to reduce photodamage to the chloroplast. The main outcome of this study is that the Symbiodinium cells within A. aureoradiata are very effective in protecting themselves against photo-damage by activating an efficient NPQ system. Down-regulation of the quantum efficiency of PSII under high light conditions appeared to cease altogether. Whether this was a true measurement of down-regulation to stop photodamage, or whether these clade A types use an alternative electron transport that bypasses PSII, and can therefore not be measured with the I-PAM fluorometer technique used, needs to be addressed in future studies