Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009

<p>Abstract</p> <p>Background</p> <p>During the initial containment phase of influenza A/H1N1 2009, close contacts of cases were traced to provide antiviral prophylaxis within 48 h after exposure and to alert them on signs of disease for early diagnosis and treatment. Passengers seated on the same row, two rows in front or behind a patient infectious for influenza, during a flight of ≥ 4 h were considered close contacts. This study evaluates the timeliness of flight-contact tracing (CT) as performed following national and international CT requests addressed to the Center of Infectious Disease Control (CIb/RIVM), and implemented by the Municipal Health Services of Schiphol Airport.</p> <p>Methods</p> <p>Elapsed days between date of flight arrival and the date passenger lists became available (contact details identified - CI) was used as proxy for timeliness of CT. In a retrospective study, dates of flight arrival, onset of illness, laboratory diagnosis, CT request and identification of contacts details through passenger lists, following CT requests to the RIVM for flights landed at Schiphol Airport were collected and analyzed.</p> <p>Results</p> <p>24 requests for CT were identified. Three of these were declined as over 4 days had elapsed since flight arrival. In 17 out of 21 requests, contact details were obtained within 7 days after arrival (81%). The average delay between arrival and CI was 3,9 days (range 2-7), mainly caused by delay in diagnosis of the index patient after arrival (2,6 days). In four flights (19%), contacts were not identified or only after > 7 days. CI involving Dutch airlines was faster than non-Dutch airlines (<it>P </it>< 0,05). Passenger locator cards did not improve timeliness of CI. In only three flights contact details were identified within 2 days after arrival.</p> <p>Conclusion</p> <p>CT for influenza A/H1N1 2009 among flight passengers was not successful for timely provision of prophylaxis. CT had little additional value for alerting passengers for disease symptoms, as this information already was provided during and after the flight. Public health authorities should take into account patient delays in seeking medical advise and laboratory confirmation in relation to maximum time to provide postexposure prophylaxis when deciding to install contact tracing measures. International standardization of CT guidelines is recommended.</p

Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses

BACKGROUND: Pressure ulcers are a common, painful and costly condition. Results of a 1991 study into the knowledge among Dutch hospital nurses on the usefulness of measures to prevent pressure ulcers showed moderate knowledge. Results were confirmed by subsequent studies. In recent years, Dutch guidelines have been updated and the attention given to pressure ulcer care has been increased. This was expected to improve pressure ulcer care and to increase nurses' knowledge. The aims of the current study were to investigate (1) how much nurses employed in Dutch hospitals know about the usefulness of 28 preventive measures considered in the most recent national pressure ulcer guideline; (2) whether differences in knowledge exist between nurses working in hospitals that audit pressure ulcers and those employed in hospitals that do not; and (3) to study whether knowledge among Dutch hospital nurses regarding the usefulness of preventive measures had changed between 1991 and 2003. METHODS: A cross-sectional study design among nurses employed in Dutch hospitals in 2003 was used to investigate their knowledge and differences in knowledge between nurses employed in different types of institution. A comparative design was used to assess whether knowledge differed between this population and that of Dutch hospital nurses in 1991. The nurses' knowledge was assessed by a written questionnaire. Data of 522 respondents meeting the inclusion criteria were analyzed and compared with the results of the 351 nurses included in the 1991 study. RESULTS: Knowledge in 2003 was slightly better than that in 1991. The nurses were moderately aware of the usefulness of preventive measures. Nurses employed in organizations that monitored pressure ulcers did not display greater knowledge than those employed in organizations that did not do so. CONCLUSION: Knowledge among Dutch hospital nurses about the usefulness of measures to prevent pressure ulcers seems to be moderate. Being employed in an institution that monitors pressure ulcer care hardly affects the knowledge level. Knowledge about prevention has improved little since 1991

Scaffolding for Mathematics Teaching in Inclusive Primary Classrooms: A Video Study

Scaffolding is an important tool for meeting the challenging needs of heterogeneous groups of students in inclusive classrooms. It is especially useful when supporting low achievers. A video study (funded by the Swiss National Science Foundation, Project Nr. 134652) of 36 inclusive classes, (3rd grade, aged 9 years), was conducted to examine how classroom teachers and special education teachers implemented a remedial mathematics program in a classroom setting. The program focused on the following facets of scaffolding: cognitive activation, stimulating discourse, handling errors productively, target orientation, and using manipulatives. The results show that 54 % of the teachers achieved a high competency for using manipulatives and target orientation, facets for which the program provided more detailed instructions. The teachers attained lower values for stimulating discourse, cognitive activation, and handling errors productively, where the program offered more general guidance. The special education teachers had lower rating scores than the classroom teachers, although the same scoring pattern as the teachers. This study shows that it is possible to encourage the use of scaffolding in inclusive classrooms. However, the disparate results for the different facets imply that scaffolding in classroom situations is a competency that cannot simply be adopted from a “program”, and more intensive teacher training programs seem to be necessary

Chromatin modifiers as regulators of mouse epidermal development and tumorigenesis

Die Komplexität des Säugetier-Genoms wird durch vererbbare epigenetische Mechanismen determiniert, welche die Basis für die Differenzierung, die Entwicklung und die zelluläre Homöostase darstellen. Auf der Ebene des Chromatins findet man chemische Modifizierungen der DNA, der Histone, sowie unterschiedliche Nukleosomenkompositionen die zu den epigenetischen Mechanismen gezählt werden. Die Epidermis repräsentiert ein ausgezeichnetes Modellsystem, um die Rolle der Chromatinmodulatoren, welche die Organbildung und die Gewebshomöostase koordinieren, zu definieren. Bei Beeinträchtigung der gut koordinierten Prozesse der epidermalen Entwicklung und Homöostase kann es zu Krankheiten und auch zu Krebs kommen. Hemmer von DNA-Methyltransferasen und Histondeazetylasen werden bereits als epigenetische Arzneimittel in der Krebstherapie verwendet. Jedoch ist die genaue Rolle der Histonazetylierung und der DNA Methylierung während der epidermalen Entwicklung und in Hautkrankheiten noch weitgehend unbekannt. Um dies zu untersuchen haben wir Enzyme zur Deazetylierung (HDAC1 und HDAC2) und das Enzym zur Aufrechterhaltung der DNA-Methylierung gewebespezifisch in der Epidermis mit Hilfe der K5-Cre-Rekombinase ausgeschaltet. Um die Rolle von HDAC1 und HDAC2 aufzuklären, haben wir verschiedene Allelkombinationen der entsprechenden Gene in der Epidermis der Maus deletiert. Mit Hilfe dieser Strategie konnten wir einen dosisabhängigen Effekt dieser Enzyme auf die zelluläre Identität in der Epidermis entdecken. Das Ausschalten von einem der beiden hoch homologen Enzyme HDAC1 oder HDAC2 hat aufgrund eines Kompensierungsmechanismus keinen Effekt auf die epidermale Entwicklung. Die Entfernung eines einzelnen Hdac2 Allels in HDAC1 Knockout Mäusen resultierte jedoch in einem sehr starken Phänotyp. Diese Mäuse zeigen Haarausfall, Hyperproliferation, Hyperkeratose und Entstehung von Hautkrebs. Mäuse mit einem ausgeschaltetem Hdac2 und beiden ausgeschalteten Hdac1 Allelen zeigen beeinträchtigte Sin3A Ko-Repressor Komplex Aktivität und erhöhte Mengen des c-Myc Proteins. Außerdem zeigen die Haarfollikel erhöhten Zelltod und falsche Lokalisierung der Haar Follikel Stammzellen. In einem K5-SOS Hauttumor Model führt die Entfernung von HDAC1 aber nicht HDAC2 zur erhöhten Tumorentwicklung in der Epidermis. Diese Ergebnisse decken eine unerwartete Rolle für HDAC1 in der Kontrolle der Lineage Spezifität und als Tumorsuppressor in der Epidermis auf. Epidermales Ausschalten von Dnmt1 mit der K5-Cre Rekombinase führt zu einem schwerwiegenden Phänotyp der Mäuse. Die Mäuse sterben früh (Tag 9) nach der Geburt und zeigen starke epidermale Defekte, unter anderem Hyperproliferation, reduzierte Differenzierung und Apoptose. Darüberhinaus zeigen die Mäuse eine defekte Hautbarriere, welche später zu einem starken Flüssigkeitsverlust der Mäuse führt. Die Keratinozyten exprimieren hohe Mengen an Chemokinen und Zytokinen, was zur Anlockung von Immunzellen in die Haut führt. Das wiederum verstärkt die Expression der immunologischen Signalmoleküle. Die exzessive Immunreaktion hat auch Einfluss auf entfernte Organe, wie zum Beispiel die Nieren, was weiters zur Proteinurie führt. Wir nehmen an, dass die hypomethylierte DNA in den DNMT1 Knockout Keratinozyten die Aktivierung der Immunantwort auslöst und/oder dass spezifische Gene aufgrund von Promoter Hypomethylierung induziert werden. Die auffällige Aktivierung des Immunsystems aufgrund der Ausschaltung des Dnmt1 Gens konnte etwas abgeschwächt werden indem das MyD88 Gen zusätzlich inaktiviert wurde. Unsere Daten zeigen, dass DNA Methylierung eine essentielle Rolle in der Definition des Zellschicksals in der Epidermis spielt und auch eine wichtige Funktion in der Unterdrückung einer unerwünschten Aktivierung des angeborenen Immunsystems hat.The complexity of the mammalian genome is determined by heritable epigenetic mechanisms, which present the base for differentiation, development and cellular homeostasis. On the level of chromatin, these epigenetic mechanisms include the chemical modification of DNA, histone proteins and changes in nucleosome composition. The epidermis is an optimal model system to define the roles of chromatin modulators which coordinate organogenesis and tissue homeostasis. Disturbances in the well-coordinated processes of epidermal development and homeostasis can lead to diseases and even cancer. Inhibitors of DNA methyltransferases and histone deacetylases are already used as epigenetic drugs in cancer therapy. However the exact role of histone acetylation and DNA methylation during epidermal development and in skin diseases is not fully understood yet. In order to investigate this, we conditionally deleted eraser enzymes of acetylation (HDAC1 and HDAC2) and the writer enzyme for maintenance DNA methylation (DNMT1) in the epidermis by using the K5-Cre recombinase. To examine the role of HADC1 and HADC2 during epidermal development we deleted different allele combinations of Hdac1 and Hdac2. By using this strategy we unraveled a dosage-dependent effect of these enzymes on the cellular identity in the epidermis. Deleting one of the two highly homologous enzymes HDAC1 or HDAC2 has no effect on epidermal development due to compensatory mechanisms. However the ablation of a single Hdac2 allele in HDAC1 knockout mice results in a strong phenotype. The mice show alopecia, hyperproliferation, hyperkeratosis and skin tumor formation. Mice with a deletion of one Hdac2 allele and deletion of both Hdac1 alleles show impaired Sin3A co-repressor complex activity and increased levels of the c-Myc protein. Additionally the hair follicle display increased apoptosis and mislocalization of hair follicle stem cells. In a K5-SOS skin tumor model loss of HDAC1, but not HDAC2 led to enhanced tumor development. These results discovered an unexpected role for HDAC1 in the control of lineage specificity and as a tumor suppressor in the epidermis. Epidermal deletion of Dnmt1 by K5-Cre recombinase results in a severe phenotype of the mice. They die early (P9) after birth and show severe epidermal defects, including hyperproliferation, reduced differentiation and apoptosis. Additionally the mice display a defective skin barrier resulting in dehydration at later stages. Keratinocytes express high levels of chemokines and cytokines, attracting immune cells to the epidermis, which further enhances the expression of immune signaling molecules. The excessive immune reaction impacts also distal organs, such as the kidney, resulting in proteinuria. We hypothesize that the hypomethylated DNA in the DNMT1 knockout keratinocytes induces the activation of the innate immune response and/or specific immune genes get induced upon promoter hypomethylation. The noticeable activation of the immune system upon Dnmt1 deletion could be slightly ameliorated by the additional deletion of MyD88. Our data indicate that the maintenance of DNA methylation by DNMT1 plays essential roles in defining cells fates in the epidermis, but it is also essential for the prevention of inappropriate activation of the innate immune system.submitted by Mirjam Andrea MoserZsfassung in dt. SpracheWien, Med. Univ., Diss., 2015OeBB(VLID)488583

Scaffolding for mathematics teaching in inclusive primary classrooms: a video study

Scaffolding is an important tool for meeting the challenging needs of heterogeneous groups of students in inclusive classrooms. It is especially useful when supporting low achievers. A video study (funded by the Swiss National Science Foundation, Project Nr. 134652) of 36 inclusive classes, (3rd grade, aged 9years), was conducted to examine how classroom teachers and special education teachers implemented a remedial mathematics program in a classroom setting. The program focused on the following facets of scaffolding: cognitive activation, stimulating discourse, handling errors productively, target orientation, and using manipulatives. The results show that 54% of the teachers achieved a high competency for using manipulatives and target orientation, facets for which the program provided more detailed instructions. The teachers attained lower values for stimulating discourse, cognitive activation, and handling errors productively, where the program offered more general guidance. The special education teachers had lower rating scores than the classroom teachers, although the same scoring pattern as the teachers. This study shows that it is possible to encourage the use of scaffolding in inclusive classrooms. However, the disparate results for the different facets imply that scaffolding in classroom situations is a competency that cannot simply be adopted from a "program”, and more intensive teacher training programs seem to be necessary

Inklusiven Mathematikunterricht erforschen: Herausforderungen und erste Ergebnisse aus einer Längsschnittstudie

Am Beispiel einer Interventionsstudie (zwei Experimentalgruppen, eine Kontrollgruppe) im inklusiven Mathematikunterricht im dritten Schuljahr der Grundschule werden anhand erster Ergebnisse Herausforderungen diskutiert, die sich bei der Erforschung von inklusivem Unterricht zeigen. Untersucht wurde einerseits die Effektivität von unterrichtsintegrierten Fördermaßnahmen, andererseits die Rolle der adaptiven Lernbegleitung durch die Lehrkräfte. 34 videografierte Mathematikstunden wurden mit einem hoch-inferenten Rating analysiert. Mehrebenenanalysen zeigen, dass die Intervention bezogen auf die Leistungsentwicklung der Gesamtstichprobe nur in einer Experimentalgruppe effektiv war. Die Interpretation dieses Ergebnisses erweist sich als komplex, u. a. weil der videografierte Unterricht in 13 Klassen von zwei Lehrkräften (Klassenlehrkraft, Förderlehrkraft usw.) durchgeführt worden ist. Insgesamt zeigt sich, dass die große Heterogenität inklusiver Klassen, unterschiedliche Rahmenbedingungen und die Beteiligung von mehreren Lehrkräften am Unterrichtsgeschehen forschungsmethodisch große Herausforderungen beinhalten