Methods for securing endotracheal tubes in newborn infants (Review)

Background: Securing the endotracheal tube is a common procedure in the neonatal intensive care unit. Adequate fixation of the tube is essential to ensure effective ventilation of the infant whilst minimising potential complications secondary to the intervention. Methods used to secure the endotracheal tube often vary between units and sometimes even between healthcare providers in the same nursery. Objectives: To compare the different methods of securing the endotracheal tube in the ventilated neonate and their effects on the risk of accidental extubation and other potential complications that can result from an unstable endotracheal tube. Search methods: A literature search of MEDLINE (from 1966 to June 2013), CINAHL (from 1982 to June 2013) and CENTRAL in The Cochrane Library was conducted to identify relevant trials to be analysed. Selection criteria: All randomised and quasi-randomised controlled trials of infants who were intubated for mechanical ventilation in a neonatal intensive care nursery where methods of stabilising the endotracheal tube were being compared. Data collection and analysis: Data were collected from individual studies to determine the methods being compared, the methodology of the trial, and whether there were areas of bias that could significantly affect the results of the studies. In particular, studies were assessed for blinding of randomisation and allocation, blinding of the intervention, completeness of follow up, blinding of outcome assessments and selective reporting. Main results: Five randomised controlled trials were identified and included for review. Accidental extubation was the most common outcome measured (five studies). None of the studies reported on the need for re-intubation or the rate of tube malposition, however one study did report on endotracheal tube slippage. A variety of other adverse effects were reported including mortality, incidence of perioral skin trauma and tube re-taping. All five studies were of poor methodological quality, small size, contained significant risks of bias and compared methods of securing the endotracheal tube that were too dissimilar for the data to be collated or included in a meta-analysis. We have not reported these further. Authors' conclusions: This review highlighted the need for further well designed and completed studies to be conducted for this common neonatal procedure. Evidence is lacking to determine the most effective and safe method to stabilise the endotracheal tube in the ventilated neonate

Re-emergence of Tobacco streak virus Infecting Soybean in the United States and Canada

Tobacco streak virus (TSV), an Ilarvirus, was first confirmed as a viral pathogen of tobacco in 1936 (Johnson 1936) and first reported in North American soybean in 1969 (Fagbenle and Ford 1970). TSV has a wide host range with strains able to infect at least 140 different plant genera, including crop, ornamental, and wild species (Fulton 1948). Due to its extensive host range and strain adaptations, TSV is found in commercial crops worldwide. Since 1969, however, TSV has not been a problem on soybean or commonly reported until the 2013 season, when it was found in fields throughout Iowa. A similar situation is found throughout the Midwest, with TSV being reported in recent years in Illinois, Kansas, and Wisconsin, as well as Ontario, Canada

Harm reduction and law enforcement in Vietnam: influences on street policing

© 2013 Melissa Adele JardineBackground and rationale: The HIV epidemic in Vietnam has from its start been concentrated among injecting drug users. Vietnam instituted the 2006 HIV/AIDS Law which includes comprehensive harm reduction measures, but these are unevenly accepted and inadequately implemented. Ward police are a major determinant of risk for injecting drug users (IDUs), required to participate in drug control practices (especially meeting quotas for detention centres) which impede support for harm reduction. Influences on ward level police regarding harm reduction were studied in Hanoi to learn how to better target education and structural change. Methods: After document review, key informants were interviewed from government, NGOs, INGOs, multilateral agencies, and police, using semi-structured guides. A survey was carried out among ward level police (n=27). Topics covered in both phases included perceptions of harm reduction and the police role in drug law enforcement, and harm reduction training and advocacy among police. Results: Police perceive conflicting responsibilities, but overwhelmingly see their responsibility as enforcing drug laws, identifying and knowing drug users, and selecting those for compulsory detention. Harm reduction training was very patchy, ward police not being seen as important to it; and understanding of harm reduction was limited, tending to reflect drug control priorities. Justification for methadone was as much crime prevention as HIV prevention. Competing pressures on ward police create much anxiety, with performance measures based around drug control; recourse to detention resolves competing pressures more safely. There is much recognition of the importance of discretion, and much use of it to maintain good social order. Policy dissemination approaches within the law enforcement sector were inconsistent, with little communication about harm reduction programs or approaches, and an unfounded assumption that training at senior levels would naturally reach to the street. Discussion: Ward police have not been systematically included in harm reduction advocacy or training strategies to support or operationalise legalised harm reduction interventions. The practices of street police challenge harm reduction policies, entirely understandably given the competing pressures on them. For harm reduction to be effective in Vietnam, it is essential that the ambiguities and contradictions between laws to control HIV and to control drugs be resolved for the street-level police

Policing in a changing Vietnam

Knowledge about policing has been produced and disseminated unevenly so that our understanding comes from a skewed emphasis on the Western (largely Anglo-American) experience. Whilst such literature usually does not openly declare to be making claims of universal validity, it often does so by implication. Fortunately, more empirical research is being undertaken outside the global North.The present study adopted an ethnographic approach to explore the nature of policing and police culture in Vietnam. The origins of the Vietnamese police (according to our modern understanding) are located in a war against colonialism and for national independence emerging in the 1940s in northern Vietnam with officers now required to pledge loyalty to the ruling Communist Party. Over the past three decades, the country has undergone rapid economic and social change. Nevertheless, amid this increasing prosperity, the police confront new challenges.Fieldwork was undertaken over a six-month period in 2016 (and a visit in 2017) with approval from the Ministry of Public Security – a first in Vietnam. The theoretical framework addresses weaknesses in current theorising of policing by proposing a Southern Policing perspective. I offer an extension of the interactive model of police culture and practice developed by Chan (1997; Chan et al., 2003) which draws on Bourdieu’s (1990a) conceptualisations of field and habitus as a relational dynamic. The framework is useful because it provides flexibility for explaining police practices in both Northern and Southern contexts. It can also account for differences in cultural knowledge and institutionalised practices. A Southern Policing perspective also recognises that capital comes in forms which may depart from those identified in previous studies.By applying a Southern Policing perspective to Vietnam, the study reveals variations in the field which illustrate that some assumptions about policing do not necessarily hold for a globally inclusive/comprehensive account of policing. Specifically, I address assumptions about relationships between the police, political system, broad societal culture, legal frameworks, organisations, thecommunity, and gender. These variations have to be understood not asdeviations from Anglo-American normality but as significant separate practices and traditions of policing from which the North may have something to learn

Case study: Methadone maintenance treatment in Hanoi, Vietnam

<p>Abstract</p> <p>Methadone maintenance therapy (MMT) was introduced in the rapidly developing semi-rural district of Tu Liem in Hanoi in December, 2009. Commune police play an integral role in determining which injecting drug users (IDUs) are eligible to commence and continue MMT. This case study highlights the importance of providing training to commune police about MMT to mitigate negative impacts drug law enforcement can have on IDU accessibility to MMT programs.</p

Harm reduction and “Clean” community: can Viet Nam have both?

Abstract The findings of our research show that while police play multiple roles in the fight against drug-related crime, they often perceived their tasks – especially preventing and controlling drug use on the one hand, and supporting harm reduction on the other – as contradictory, and this creates tensions in their work and relations with their communities. Although they are leaders and implementers of harm reduction, not all police know about it, and some remain skeptical or perceive it as contradictory to their main task of fighting drugs. Methadone treatment is seen by some as in competition with their main task of coordinating conventional drug treatment in the rehabilitation center. The history of drug use and the evolution of discourses on drug use in Viet Nam have created these conflicting pressures on police, and thus created contradictory expectations and led to different views and attitudes of police regarding various harm reduction measures. This might aid understanding why, despite the comprehensive and progressive policies on HIV/AIDS and harm reduction in Viet Nam, it is not easy for police to actively and effectively support and be involved in harm reduction at the ground level. To promote the wider acceptance of harm reduction the concept of community safety must be expanded to include community health; harm reduction must be integrated into the “new society” movement; and laws and policies need further revision to reduce contradiction between current drug laws and HIV laws. Harm reduction guidelines for police and other actors need to be disseminated and supported, embodying better ways of working between sectors, and all sectors in the partnership require support for building capacity to contribute to the overall goal.</p

An Outbreak of Salmonella Typhimurium 108/170 at a Privately Catered Barbeque at a Sydney Sports Club

An outbreak of gastrointestinal illness was identified among attendees at a large community barbeque at a Sydney sports club on 30 January 2009. A retrospective cohort study was initiated, and attendees were identified through hospital emergency department gastroenteritis presentations, snowball recruitment through known cases, responders to linguistically specific press, and those returning to the venue the next week. A symptom and food history was collected from attendees, and stool samples were provided for microbiological investigation. An environmental investigation and trace back of implicated foods was also undertaken. Attendance estimates at the barbeque ranged from 100 to 180, and the food was prepared by a family that was not registered as a food business. Seventy one of the 87 attendees identified met the case definition. Thirty attendees (42%) had laboratory confirmed Salmonella Typhimurium phage-type 108/170, all with the same multilocus variable number of tandem repeat analysis typing. Burden of illness was high with 76% of cases seeking medical attention and 18% admitted to hospital. Microbiological evidence confirmed that a number of food items were contaminated with Salmonella Typhimurium 108/170, with the raw egg mayonnaise used in a Russian salad being the most likely primary food vehicle (adjusted odds ratio=10.3 [95% confidence interval 1.79-59.5]). Further, having Russian salad on the plate even if it was not consumed increased the relative risk of illness, thus suggesting that other food items may have been contaminated when they came into contact with it on the plate. This Salmonella outbreak highlighted the risks associated with the improper handling of food in private residences, which are then sold at a large public event

Re-emergence of Tobacco streak virus Infecting Soybean in the United States and Canada

Tobacco streak virus (TSV), an Ilarvirus, was first confirmed as a viral pathogen of tobacco in 1936 (Johnson 1936) and first reported in North American soybean in 1969 (Fagbenle and Ford 1970). TSV has a wide host range with strains able to infect at least 140 different plant genera, including crop, ornamental, and wild species (Fulton 1948). Due to its extensive host range and strain adaptations, TSV is found in commercial crops worldwide. Since 1969, however, TSV has not been a problem on soybean or commonly reported until the 2013 season, when it was found in fields throughout Iowa. A similar situation is found throughout the Midwest, with TSV being reported in recent years in Illinois, Kansas, and Wisconsin, as well as Ontario, Canada.This article is published as Irizarry, M. D., Groves, C. L., Elmore, M. G., Bradley, C. A., Dasgupta, R., German, T. L., Jardine, D. J., Saalau Rojas, E., Smith, D. L., Tenuta, A. U., Whitham, S. A., and Mueller, D. S. 2016. Re-emergence of Tobacco streak virus infecting soybean in the United States and Canada. Plant Health Prog. 17:92-94. doi: 10.1094/PHP-BR-15-0052 . Posted with permission.</p