Inpatient Oral Care

Background: Oral care is proven to prevent colonization of pathogenic organisms in the oral cavity and decrease rates of ventilator-associated pneumonia (VAP). To improve patient health outcomes, one local hospital sought to implement an oral care policy founded on evidence-based research. Purpose: The purpose of this study was to determine best practice for oral care in an intensive care unit. The study is an integral part of creating a comprehensive oral care policy and guide for purchasing hospital-wide oral care products. Methods: Oral care policies at local facilities with intensive care units were reviewed and compared. Clinical practice guidelines and peer-reviewed studies were also utilized. Results: Research revealed inconsistent oral care practices with regards to frequency, oral cleansing agent, and concentration of oral cleansing agent. Discussion/Recommendation: The study was limited by the lack of evidence-based oral care practices. A multivariable research study needs to be conducted to ascertain the best practices of frequency, oral cleansing agent, and concentration of oral cleansing agent for oral care. Areas of interest include patient refusal rates, ventilated versus non-ventilated patients, and acuity of care

Malaria Case-Management following Change of Policy to Universal Parasitological Diagnosis and Targeted Artemisinin-Based Combination Therapy in Kenya

BACKGROUND: The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health systems and case-management indicators between the baseline survey undertaken before implementation of the policy and the follow-up survey following the first year of the implementation activities. METHODS/FINDINGS: National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation. CONCLUSIONS: Most of the case-management indicators have shown some improvement trends; however differences were smaller than expected, rarely statistically significant and still leaving a substantial gap towards optimistic targets. The quantitative and qualitative improvement of interventions will ultimately determine the success of the new policy

Solar cooking in the sahel

Solar cookers are a cheap, practical tool for sustainable development, which can be built and maintained without access to expensive tools or machinery. Solar cookers require direct sunshine for effective cooking, so clouds or heavy atmospheric dust loads can slow down or prevent their use. Surface meteorological (SYNOP) stations record the daily hours of direct sunshine and were used to generate climatology of days with greater than 6 h available for cooking. The SYNOP dataset is very sparse in many parts of Africa and therefore is complemented by the use of geostationary satellite data. Higher temporal resolution surface insolation records are derived from SEVIRI (Spinning Enhanced Visible and Infrared Imager) on board the Meteosat Second Generation satellite series by EUMETSAT's Land Satellite Application Facility, but the approach uses fixed aerosol climatology. Direct surface solar irradiance was derived using the Beer-Lambert law using AODs retrieved from SEVIRI. Validation indicates that its capabilities are strongest over drier and less vegetated surfaces such as those found in the Sahara and Sahel. Biomass-burning aerosol may be significant over the Sahel in winter, and SEVIRI AODs may miss this unless it is masked as cloud, although here SYNOP values are still greater than those from SEVIRI

Experiences of in-patient mental health services: systematic review

Background In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.Aims To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.Method A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.Results Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.Conclusions A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interest K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities

Early emergence of CD19-negative human antibody secreting cells at the plasmablast to plasma cell transition

Long-lived human plasma cells (PCs) play central roles in immunity and autoimmunity and are enriched amongst the subpopulation of CD19-negative human PCs. However, whether human CD19-negative PCs are necessarily ″aged″ cells that have gradually lost CD19 expression is not known. Assessing peripheral blood samples at steady state and during the acute response to influenza vaccination in healthy donors we identify the presence of phenotypic CD19-negative plasmablasts, the proliferative precursor state to mature PCs, and demonstrate by ELISpot that these are antibody-secreting cells (ASCs). During the acute response to influenza vaccination CD19-positive, CD19-low and CD19-negative ASCs secrete vaccine-specific antibody and show linked IGHV repertoires. To address precursor/product relationships we employ in vitro models which mimic both T-dependent and T-independent differentiation finding that the CD19-negative state can be established at the plasmablast to PC transition, that CD19-negative PCs increase as a percentage of surviving PCs in vitro, and that CD19-negative and CD19-positive PCs can be maintained independently. These data provide proof-of-principle for the view that newly generated ASCs can acquire a mature PC phenotype accompanied by loss of CD19 expression at an early stage of differentiation and that ″aging″ is not an obligate requirement for a CD19-negative state to be established

Realist evaluation of the use of patient experience data to improve the quality of inpatient mental health care (EURIPIDES) in England : study protocol

Introduction Inpatient mental healthcare continues to be an area of high risk and where patients report negative experiences. To ensure the patient voice is heard, National Health Service (NHS) Trusts are required to collect feedback from patients routinely. We do not know what kinds of feedback are most important or what management processes are needed to translate this into effective action plans. Further, we do not know if this makes any difference to the patients themselves. This study seeks to explore which of the many different approaches to collecting and using patient experience data are the most useful for supporting improvements in inpatient mental healthcare. The overarching aim of the study is to arrive at recommendations for best practice in the collection and use of patient experience data in NHS England adult inpatient mental health settings. We present the protocol for Realist Evaluation of the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care study (EURIPIDES). Methods and analysis The study is composed of five work packages (WPs), including a systematic review of patient experiences (WP1); a telephone survey to assist the selection of case sites (WP2); six in depth case studies involving interviews with service users, carers and staff to enable a realist evaluation of the use of patient experience to improve quality in adult inpatient mental health services (WP3); an economic evaluation of patient experience feedback activity (WP5); and a consensus conference (WP4). We discuss the methodological rationale for the five WPs. Ethics and dissemination This study has received approval from West Midlands/South Birmingham NHS Research Ethics Committee. The outcome of the consensus conference meeting (WP4) will form the basis of the outputs to be disseminated to NHS providers. Dissemination will also take place through publications and presentations at relevant conferences

Substrate Type Determines Metagenomic Profiles from Diverse Chemical Habitats

Environmental parameters drive phenotypic and genotypic frequency variations in microbial communities and thus control the extent and structure of microbial diversity. We tested the extent to which microbial community composition changes are controlled by shifting physiochemical properties within a hypersaline lagoon. We sequenced four sediment metagenomes from the Coorong, South Australia from samples which varied in salinity by 99 Practical Salinity Units (PSU), an order of magnitude in ammonia concentration and two orders of magnitude in microbial abundance. Despite the marked divergence in environmental parameters observed between samples, hierarchical clustering of taxonomic and metabolic profiles of these metagenomes showed striking similarity between the samples (>89%). Comparison of these profiles to those derived from a wide variety of publically available datasets demonstrated that the Coorong sediment metagenomes were similar to other sediment, soil, biofilm and microbial mat samples regardless of salinity (>85% similarity). Overall, clustering of solid substrate and water metagenomes into discrete similarity groups based on functional potential indicated that the dichotomy between water and solid matrices is a fundamental determinant of community microbial metabolism that is not masked by salinity, nutrient concentration or microbial abundance.</p

Predictive maps in rats and humans for spatial navigation

Much of our understanding of navigation comes from the study of individual species, often with specific tasks tailored to those species. Here, we provide a novel experimental and analytic framework integrating across humans, rats, and simulated reinforcement learning (RL) agents to interrogate the dynamics of behavior during spatial navigation. We developed a novel open-field navigation task ("Tartarus maze") requiring dynamic adaptation (shortcuts and detours) to frequently changing obstructions on the path to a hidden goal. Humans and rats were remarkably similar in their trajectories. Both species showed the greatest similarity to RL agents utilizing a "successor representation," which creates a predictive map. Humans also displayed trajectory features similar to model-based RL agents, which implemented an optimal tree-search planning procedure. Our results help refine models seeking to explain mammalian navigation in dynamic environments and highlight the utility of modeling the behavior of different species to uncover the shared mechanisms that support behavior

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders—A Scoping Review

Background: Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions. Methods: A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa. Results: Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants. Conclusions: More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa