A structured framework for improving outbreak investigation audits

Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit. A framework for prioritising which outbreak investigations to audit, an approach for conducting a successful audit, and a template for audit trigger questions was developed and trialled in four foodborne outbreaks and a respiratory disease outbreak in Australia. The following issues were identified across several structured audits: the need for clear definitions of roles and responsibilities both within and between agencies, improved communication between agencies and with external stakeholders involved in outbreaks, and the need for development of performance standards in outbreak investigations - particularly in relation to timeliness of response. Participants considered the audit process and methodology to be clear, useful, and non-threatening. Most audits can be conducted within two to three hours, however, some participants felt this limited the scope of the audit. The framework was acceptable to participants, provided an opportunity for clarifying perceptions and enhancing partnership approaches, and provided useful recommendations for approaching future outbreaks. Future challenges include incorporating feedback from broader stakeholder groups, for example those of affected cases, institutions and businesses; assessing the quality of a specific audit; developing training for both participants and facilitators; and building a central capacity to support jurisdictions embarking on an audit. The incorporation of measurable performance criteria or sharing of benchmark performance criteria will assist in the standardisation of outbreak investigation audit and further quality improvement

Intravenous vitamin C in the treatment of post-laser hyperpigmentation for melasma: A short report

Melasma is difficult to treat. Vitamin C, topical and by iontophoresis, has been shown to be useful. When lasers are used, there is a significant incidence of post-laser hyperpigmentation. There is no single established treatment for the latter. The case history of a 51-year-old Chinese woman is presented. Intravenous vitamin C appears to be useful in treating this complication

Human performance at sea assessed by dynamic visual acuity

Human performance may, among other things, depend on the ability to visually discern (small) objects. This ability is generally quantified under static conditions by means of the visual acuity, a measure of the minimum angle resolved by the eye. However, when the subject himself, his or her eyes, and/or the object to be discerned are moving, acuity gets worse. Small objects cannot be discerned, and texts cannot be read anymore, thus impeding the tasks to be performed. Such conditions are likely to occur on ships. To investigate this loss of capability, we measured the dynamic visual acuity (DVA) of 12 healthy subjects participating in the Canadian Q-303 sea trial, held in February/March 2007 (see Colwell et al., this conference). To measure the DVA, we repeatedly presented digits with variable spatial resolution on a CRT to be observed by the subjects. To control for object and eye movements, we used a static and a moving fixation dot interrupted by the digits for 200 ms each time only. The digits were presented statically and moving too. A test battery with five different DVA conditions was applied two times each day. Despite unanticipated large variations in individual acuities over the different tests and days, a highly significant effect of seasickness on acuities has been observed, while the effects of ship motion were less significant per se. Apart from showing that DVA is of value to further quantify human performance, these data also support the development of an onsite fit-to-perform screening tool based on DVA

Spectroscopic analysis of protein Fe-NO complexes

The toxic free radical NO (nitric oxide) has diverse biological roles in eukaryotes and bacteria, being involved in signalling, vasodilation, blood clotting and immunity, and as an intermediate in microbial denitrification. The predominant biological mechanism of detecting NO is through the formation of iron nitrosyl complexes, although this is a deleterious process for other iron-containing enzymes. We have previously applied techniques such as UV–visible and EPR spectroscopy to the analysis of protein Fe–NO complex formation in order to study how NO controls the activity of the bacterial transcriptional regulators NorR and NsrR. These studies have analysed NO-dependent biological activity both in vitro and in vivo using diverse biochemical, molecular and spectroscopic methods. Recently, we have applied ultrafast 2D-IR (two-dimensional IR) spectroscopy to the analysis of NO–protein interactions using Mb (myoglobin) and Cc (cytochrome c) as model haem proteins. The ultrafast fluctuations of Cc and Mb show marked differences, indicating altered flexibility of the haem pockets. We have extended this analysis to bacterial catalase enzymes that are known to play a role in the nitrosative stress response by detoxifying peroxynitrite. The first 2D-IR analysis of haem nitrosylation and perspectives for the future are discussed

Quality of partner relationship and emotional responses to a health threat

This study investigated whether existence of a cohabiting relationship and its quality was related to psychological distress in women facing an acute stressor - a health threat. Levels of social support and self-esteem were tested as predictors of distress. One hundred and fifty-eight women with symptomatic breast problems referred to a diagnostic one-stop breast clinic participated in the study. Levels of psychological distress (stress, anxiety, depression), social support, self-esteem and, for women with partners, quality of partner relationship were measured using standardized self-report instruments. No differences were found between women with and without partners in terms of distress and psychosocial variables. However, women in low quality relationships experienced significantly more distress and received less support than women in high quality relationships. Self-esteem was not related to partner relationships. Low personal self-esteem significantly predicted distress on the appointment day for all groups of women, accounting for between 19% and 54% of the variance. Social self-esteem and ideal social support were also found to be significant predictors of distress for women without partners and cohabiting women in low quality relationships. It would appear that women with self-rated poor quality spousal relationships are at risk of elevated psychological morbidity in the context of investigation for suspected breast disease