Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration

Gender-specific mental health care: The case for women-centred care

Dementia has an estimated global prevalence of 35 million individuals (Alzheimer’s Disease International, 2009). In the UK 570,000 people live with dementia – a figure that will double over the next 30 years, reflecting global predictions (Alzheimer’s Disease International, 2009; Department of Health, 2009). With increasing demand and timescales of at least 5-10 years for the next possible disease modifying breakthrough, services are and have had to undergo change to cope with the increasing levels of need

Chapter 1 An Introduction to Agricultural Biotechnology Regulation in the U.S.

The regulation of agricultural plant and microbial biotechnology products in the United States of America has a rich history that re fl ects the challenges the federal government has faced in the development of appropriate rules and standards needed to determine their safety to humans and the environment. Several factors – the insuf fi cient global food supply, loss or curtailment of the use of older chemistries to control pests due to risks and environmental persistence, the rising demand for safer food commodities, and the uncertainty surrounding the sustainability of agriculture in this and other countries – have added to these challenges. The chapter introduces the U.S. Coordinated Framework for the Regulation of Biotechnology (“Framework”), and the roles of its members: the U.S. Department of Agriculture (USDA), the U.S. Food and Drug Administration (FDA), and the U.S. Environmental Protection Agency (EPA) in regulating agricultural biotechnology in accordance with U.S. federal statutes. The Framework agencies use scienti fi c, risk-based approaches in carrying out their regulatory responsibilities for the products of biotechnology. Relying on their experiences with risk assessment and risk management policies and principles for more conventional products, the Framework agencies have adapted new risk and exposure scenarios into their evaluations to ensure the safe use of these products in agriculture

Crisis and Non-Crisis Short Selling and Bank Enforcement Actions

Employing standard informed trading intuition, we develop testable hypotheses regarding short selling before and after bank enforcement action (EA) initiations. For U.S.-listed bank firm data for 2007 to 2012, we find strong support for differentiated short seller activity and skill in crisis versus non-crisis periods. In financial crises, short sellers predominantly position prior to EAs. The EA initiations then act as information-homogenizing and profit-taking events reducing incentives to remain positioned. In contrast, EAs in non-crisis periods appear to serve as wake-up calls that attract additional short selling. Our findings offer potentially important insights for regulators considering short sellers’ reactions to EA announcements in general, during financial crises, and when not experiencing a broad financial crisis

Are Managed Retreat Programs Successful and Just? A Global Mapping of Success Typologies, Justice Dimensions, and Trade-offs

As managed retreat programs expand across the globe, there is an urgent need to assess whether these programs are reducing exposure to climatic hazards, enhancing adaptive capacity, and improving the living conditions of communities in a just and equitable manner or are they exacerbating existing risks and vulnerabilities? Strictly speaking, are retreat programs successful? Using an expansive intersectional justice approach to examine 138 post-resettlement case studies published between 2000 and 2021 across the Global North and South, we identified five typologies of success – techno-managerial, eco-restorative, compensatory, reformative, and transformative – and their trade-offs and synergies. Our meta-analysis incorporated a variety of metrics: relocation types, funding, decision making, socio-economic class, land use change, livelihood options, and social impacts. We found 26% of cases failed, 43% were successful, and 30% are on-going and therefore success was undetermined. The techno-managerial cases, while successful in the limited terms of relocating residents, paid little attention to equity and justice. The eco-restorative and compensatory cases reduced hazard exposure but revealed the synergies and tensions associated with social, ecological, and intergenerational justice. The reformative and transformative cases improved community wellbeing, rootedness, and access to livelihoods while incorporating diverse justice concerns to different degrees. By intersecting these typologies with multiple dimensions of justice, this study advances a novel planning and analytical tool for assessing the potential success or failure of current and future retreat programs

Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

Summary Background Healthcare associated infections (HAI) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HAI and contain antimicrobial resistance (AMR). Aim To measure the prevalence of HAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HAI was 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most common HAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3% and 13.8% in acute adults, paediatric and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HAI continues to be a public health concern in Scotland. UTI and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings

Stabilization and Global Climate Policy

Abstract in HTML and technical report in PDF available on the Massachusetts Institute of Technology Joint Program on the Science and Policy of Global Change website (http://mit.edu/globalchange/www/).Academic and political debates over long-run climate policy often invoke “stabilization” of atmospheric concentrations of greenhouse gases (GHGs), but only rarely are non-CO2 greenhouse gases addressed explicitly. Even though the majority of short-term climate policies propose trading between gases on a global warming potential (GWP) basis, discussions of whether CO2 concentrations should be 450, 550, 650, or perhaps as much as 750 ppm leave unstated whether there should be no additional forcing from other GHGs beyond current levels or whether separate concentration targets should be established for each GHG. Here we use an integrated modeling framework to examine multi-gas stabilization in terms of temperature, economic costs, carbon uptake, and other important consequences. We show that there are significant differences in both costs and climate impacts between different "GWP equivalent" policies and demonstrate the importance of non-CO2 GHG reduction on timescales of up to several centuries.Sarofim was supported in part by a Martin Sustainability Fellowshi

Objectively measured physical activity and fat mass in a large cohort of children

Background Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity. Methods and Findings We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and fat mass that were unaltered after adjustment for total physical activity. We found a strong negative dose-response association between MVPA and obesity. The odds ratio for obesity in adjusted models between top and the bottom quintiles of minutes of MVPA was 0.03 (95% confidence interval [CI] 0.01-0.13, p-value for trend < 0.0001) in boys and 0.36 (95% CI 0.17-0.74, p-value for trend = 0.006) in girls. Conclusions We demonstrated a strong graded inverse association between physical activity and obesity that was stronger in boys. Our data suggest that higher intensity physical activity may be more important than total activity

Analysis of Climate Policy Targets under Uncertainty

Abstract and PDF report are also available on the MIT Joint Program on the Science and Policy of Global Change website (http://globalchange.mit.edu/).Although policymaking in response to the climate change is essentially a challenge of risk management, most studies of the relation of emissions targets to desired climate outcomes are either deterministic or subject to a limited representation of the underlying uncertainties. Monte Carlo simulation, applied to the MIT Integrated Global System Model (an integrated economic and earth system model of intermediate complexity), is used to analyze the uncertain outcomes that flow from a set of century-scale emissions targets developed originally for a study by the U.S. Climate Change Science Program. Results are shown for atmospheric concentrations, radiative forcing, sea ice cover and temperature change, along with estimates of the odds of achieving particular target levels, and for the global costs of the associated mitigation policy. Comparison with other studies of climate targets are presented as evidence of the value, in understanding the climate challenge, of more complete analysis of uncertainties in human emissions and climate system response.This study received support from the MIT Joint Program on the Science and Policy of Global Change, which is funded by a consortium of government, industry and foundation sponsors

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial

Objective To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers. Design Randomised controlled equivalence/non-inferiority trial. Setting Four NHS hospitals in three trusts. Three of the four were teaching hospitals. Participants All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999. Intervention Assessment by one of three appropriately trained nurses or by one of several preregistration house officers. Main outcome measures History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome). Results 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%). Conclusions There is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment