Performance of Hollow Load Process Challenge Devices (HLPCDs) for the determination of air removal and steam penetration in porous load steam sterilization processes: Part 1 – The evolution of HLPCDs in standards and a review of the current supporting published evidence

Steam sterilization Process Challenge Devices (PCDs) are devices which present a defined challenge to a sterilization process. In part one of a two part series the authors review the published literature covering studies evaluating the removal of air and penetration of steam into hollow tubular devices and then discuss the relevance of the material in support of the current custom and practice of utilising simple tubular PCDs (Hollow Load Process Challenge Devices HLPCDs) as a means of monitoring production loads for adequacy of air removal and steam penetration. This review places such data in the context of the evolution of HLPCDs in the standards for small and large porous load steam sterilizers. With regard to the apparent acceptance of the HLPCD in EN 867-5 into custom and practice for batch monitoring the literature suggests this may be misleading. The literature review concludes that there is an urgent need for an International Standard which describes how a HLPCD can be developed and tested against real medical devices in a range of sterilization processes representing current state of the art in full load conditions

AN EMPIRICAL ANALYSIS OF THE UTILIZATION PATTERNS OF WITHIN FACILITY AND SECONDARY HEALTHCARE SERVICES BY KENTUCKY STATE PRISON INMATES

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists to assist corrections health policy makers strategically plan for future inmate healthcare needs. This research provides an extensive description of the healthcare utilization patterns of a sample of 577 male and female inmates incarcerated at state-operated prisons in Kentucky during the period January 1, 2007, to December 31, 2007 and who have at least one of the chronic conditions of diabetes, hypertension or hyperlipidemia. The primary outcome measures were a count of the number of encounters documented in the inmate‟s electronic health record by 1) medical doctors and advanced registered nurse practitioners (medical care utilization) and 2) psychiatrists and psychologists (mental healthcare utilization), and 3) a dichotomous variable indicating if the inmate had received care from a health provider located outside the prison. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators. Differences in healthcare utilization between various groups of inmates were tested using Pearson‟s chi-squared test for categorical variables and Student t-test for continuous variables. In the bivariate analysis increasing age, being female, having comorbidities, having a diagnosis of mental illness, being obese, not adhering to diet, exercise and medications, refusing or missing treatment, being at a facility with more corrections or medical staff and having better quality of care were all associated with greater healthcare utilization. Negative binomial regression was used to analyze the count outcomes, and multivariate logistic regression analysis was used to analyze the dichotomous outcome. Regression analysis revealed that the number of problems an inmate had recorded in their electronic health record and increasing age were the two greatest predictors of within facility and secondary healthcare utilization. Carrying out case management and disease management for inmates with comorbidities may have benefits for Departments of Corrections and inmates

Einstellungen und Diagnosefähigkeit von Lehrkräften der Biologie im Bereich systemischen Denkens

In dieser qualitativen Studie wurden die Einstellungen und die Diagnosekompetenz von Lehrkräften der Biologie anhand von drei ökologischen Beispielen systemischen Denken untersucht. Den theoretischen Rahmen bildete ein von PCK (Pedagogical Content Know-ledge) abgeleitetes Modell nach Park und Oliver (2008) und Girmes (2006), das die dia-gnostischen, curricularen und personellen Kompetenzen der Lehrkräfte als zentrale Ele-mente der Professionalität ausweist. Zusätzlich wurden unterschiedliche Systemtheorien (Ossimitz 1996; Lecher 1997; Sommer, 2005) beleuchtet, um eine Ableitung eines Kompe-tenzniveaumodells bezogen auf systemisches Denken vornehmen zu können. Aus diesem theoretischen Konstrukt wurden folgende vier Forschungsfragen abgeleitet: Diagnostische Kompetenz: - Wie gut können Lehrkräfte Schüler im Bereich systemischen Denkens einschätzen und beurteilen? - Welche Verständnisprobleme der Lerner erkennen Lehrkräfte? Curriculare Kompetenz: - Welche Beispiele aus dem Bereich systemischen Denkens bringen die Lehrkräfte in den Unterricht ein? Pädagogische Kompetenz: - Welche Einstellungen haben Lehrkräfte bezogen auf ihren Beruf (Berufswahl und Rolle), auf die Förderung der Kompetenzen im Unterricht im Bereich der Ökologie im Unterricht und Kompetenzen in Ökologie? Die Datenerhebung erfolgte mittels Leitfaden strukturierten Interviews. Der Leitfaden bestand aus offenen Fragen zu allgemeinen Einstellungen der Lehrkräfte und drei Beispie-len zu systemischen Denken. Zwei der drei Beispiele wurden von Ossimitz´ Studien (1994e und 1996c), die Schülerantworten im Bereich systemischen Denkens erhoben, übernommen, das Beispiel „Eisbären in Not“ wurde selbst entwickelt. Die Schülerantwor-ten zu den drei Beispielen waren Diagramme, die unterschiedliche Wissens- und Ver-ständnisniveaus aufwiesen. Sie wurden anhand eines nach Sommer (2005) modifizierten Kompetenzniveaumodells ausgewertet. Im Anschluss wurden sechs Lehrkräfte aus Nie-derösterreichischen und Wiener Gymnasien zu etwa einstündigen Leitfaden strukturierten Interviews gebeten. Bei den Interviews wurden die Lehrkräfte mit den Schülerantworten zu den drei Beispielen konfrontiert. Aus den Lehrerantworten wurde die diagnostische Kompetenz der Lehrkäfte bezogen auf systemisches Denken im Kontext von Fragen zur Umweltbildung abgeleitet. Um Daten zur curricularen Kompetenz der Lehrkräfte zu erhalten wurden sie im Interview ersucht, die drei Beispiele entsprechend der Schwerpunktsetzung im Unterricht, Kopplung der Inhalte und Eignung zum fächerübergreifenden Unterricht zu reihen. Zusätzlich wurde die Einstellung zum Einsatz der Beispiele in unterschiedlichen Schulstufen ermittelt und die Aussagen der Lehrpersonen mit den Lehrplänen der Allgemein bildenden Schulen verglichen. Die personelle Kompetenz wurde durch Fragen im Bereich allgemeine und ökologische Einstellungen der Lehrkräfte ermittelt. Allgemeine Einstellungen betrafen die Wahl des Lehrberufs, das Selbstbild der Lehrperson in der Klasse, der Vermittlung von Kompeten-zen im Unterricht und allgemeine Ziele der Lehrkraft. Die ökologische Einstellung hinge-gen betraf die Bedeutung der Ökologie im Unterricht. Die Auswertung der Ergebnisse fand mithilfe der Qualitativen Inhaltsanalyse nach May-ring (2005) statt. Die Kategorienbildung wurde sowohl deduktiv als auch in Hinblick auf die Subkategorien induktiv vorgenommen. Die Interraterreliabilät wurde mithilfe von KAPPA- Werten gemessen. Es konnte festgestellt werden, dass Lehrkräfte im Bereich der Diagnosekompetenz einen Teil der Kenntnisse zur Beurteilung, die auch in den Systemtheorien beschrieben werden, wie zum Beispiel Zusammenhänge, Vernetzung und Inhalte benennen. Zusätzlich wurden weitere Punkte formuliert, die den Lehrenden wichtig erscheinen, wie zum Beispiel die Darstellungsform der Diagramme. Die Lehrpersonen sehen Probleme der Schüler bezogen auf die Beispiele im Bereich Textverständnis, Filterung der wichtigsten Punkte aus dem Text und die Zusammenhänge, die vorhanden sein sollten bei der Übertragung in das Diagramm. Auch die curriculare Kompetenz (z.B. Einordnung der Beispiele in den Unterricht) ist bei den Lehrkräften ausreichend vorhanden, wobei durch unterschiedliche Schwerpunktsetzungen und das neu eingeführte Modulsystem sich die Bewertung als schwierig herausstellte. Im Bereich der Einstellungen sahen sich die meisten Lehrpersonen in Hinblick auf das Selbstbild in der Klasse als Wissensvermittler und Coach. Die Wahl des Lehrberufs wurde aufgrund des Interesses an der Arbeit mit Jugendlichen ergriffen, wobei auch die Vermitt-lung von Fachwissen eine wichtige Rolle spielt. Die Befragung zu allgemeinen Ziele des Biologieunterrichts für Lehrkräfte ergaben, dass eine Vermittlung von Fachwissen und Kompetenzen für die Lehrkräfte wichtig erscheint. In weiterer Folge wurden die Vermitt-lung von Allgemeinbildung und Alltagsbezüge genannt. Für den Bereich der Ökologie wurde vernetztes Denken als wichtigstes Vermittlungskriterium eingestuft.Within this study a qualitative approach has been used to investigate teachers' attitudes and diagnostic competencies in biology, on the basis of three ecological examples, concerned with systemic thinking. A model derived from PCK (Pedagogical Content Knowledge) by Park and Oliver (2008) and Girmes (2006) constitutes the theoretical framework. This model defines teachers' diagnostic, curricular and personal competencies as the main ele-ments of professionalism. These characteristics were mentioned in a study by Park and Oliver (2008) within the framework of PCK, as well as in the "Tableau of Competencies". Moreover, various system theories (Ossimitz 1996, Lecher 1997, Sommer 2005) were examined in order to establish a modified competency model in systemic thinking. Based on this theoretical construct, the following questions were deducted: Diagnostic competency: -To what extent can teachers evaluate and assess students as far as systemic thinking is concerned? -Which problem areas can teachers identify? Curricular competency: -Which examples dealing with systemic thinking do teachers integrate in their teaching? Pedagogical competency. -Which attitudes do teachers show concerning their profession (career choice and role), competencies in teaching and competencies in ecology? Guideline oriented interviews were used to gain data. The guideline was comprised of open questions on the teachers' general attitude and three examples of systemic thinking. Two of the three examples were taken from Ossimitz' studies (1994e and 1996c) in the field of systemic thinking. The third example was newly developed for the present study. Owing to varying levels of knowledge and understanding, the diagrams could be analysed according to the modified competency model. Subsequently, the teachers were confronted with the students' answers from the examples. Six teachers from secondary schools in Lower Austria and Vienna were interviewed about the examples by means of guideline oriented interviews. Thereby, diagnostic and curricular competencies could be identified. Curricular competency was measured with the help of the examples regarding individual priorities, linking of content, interdisciplinary teaching and the use of the examples in different levels of education. This was done by comparison between the teachers' statements and the Austrian curriculum for secondary academic schools (AHS). Personal competency was determined by questions on the teachers' general and ecological attitudes. General attitudes referred to career choice, teaching competencies, the teachers' self image in class and general objectives. Ecological attitudes focussed on the relevance of ecology in education. Qualitative Content Analysis (Mayring 2005) was used to analyse the data. Categories were developed deductively and, as far as subcategories were concerned, inductively. Inter-rater-agreement was measured by Kappa coefficients. The results show that with regard to diagnostic competency teachers were able to name several assessment criteria also mentioned in systems theories, such as interrelationships, cross-linking and content. Additionally, further aspects important to the teachers were mentioned (e.g. visual appearance of the diagrams). The teachers identified potential prob-lems for the students in the areas of reading comprehension, filtering out the main points of a text and transferring interrelationships into diagrams. Furthermore, the teachers show a sufficient level of curricular competency (e.g. grading the tasks). Assessment, however, proves difficult owing to different individual priorities and the newly implicated module system. As far as teachers' attitudes were concerned, most teach-ers regarded themselves as coaches and mediators of knowledge. Motive for the teachers' career choice was interest in working with adolescents, but also the subject area. The teachers considered subject knowledge and competencies important teaching objectives in biology. General knowledge and reference to students' everyday life were also mentioned. In ecology network thinking was judged the most important teaching criteria

Investigating the steam sterilization of dental handpieces

Dental handpieces are used in a wide variety of dental treatment and oral surgery. During patient treatment handpieces becom contaminated with patient material. Due to the design and function of the dental handpieces, internal contamination of handpiece components frequently occurs during use, raising the risk of iatrogenic infection. Dental handpiece lumens represent a challenge for both cleaning and steam sterilization due to limited access. Manufacturers of handpieces and benchtop sterilizers as well as international standards and several guidelines recommend use of a vacuum steam sterilization process for lumen devices; however, non-vacuum is used in many UK dental practices. Therefore the aim of this thesis was to investigate if benchtop steam sterilization processes commonly used in dental practice are appropriate for sterilizing dental handpieces. Critical variables affecting the outcome of steam sterilization, such as pre-cleaning and lubrication were assessed. In order to investigate the above stated aim, four research questions were formulated: 1- Investigating steam penetration into dental handpieces and lumens in general (chapter 4), which was approached using thermometric measurements, chemical and biological indicators were used in different handpiece types (high-speed turbines, slow-speed motors, surgical handpieces) and process challenge devices using non-vacuum and vacuum sterilization cycles in a laboratory setting (chapter 4) and in general dental practices (chapter 6). 2- Investigating the effect of pre-cleaning dental handpieces, contaminated with different test soils from the standards or clinical contamination after patient treatment using a washer-disinfector or a handpiece cleaner-lubricator, which was assessed using the o-phtalaldehyde and G-box method (chapter 7). 3- Investigating the effect of handpiece lubricating oil on microbial inactivation by altering different parameters during a steam sterilization process using a BIER/CIER vessel in St. Paul (MN, US) (chapter 5). 4- Investigating the effect of different humidity levels on chemical and biological indicators using a BIER/CIER vessel in Neuss (Germany) (chapters 3). Thermometric measurements as well as assessment of chemical and biological indicators suggest that not all handpiece types can successfully be sterilized in all non-vacuum benchtop sterilizers. Especially the surgical handpiece appears to be difficult to sterilize. All non-vacuum sterilizers in general dental practice failed to sterilize handpieces. The comparison of the cleaning efficacy of a washer-disinfector and a handpiece cleaner-lubricator showed that a washer-disinfector is more efficient in cleaning the outside of a handpiece. Handpiece lubrication oil appears to impair steam penetration into handpiece lumens. Pre-conditioning in high humidity (90% RH) causes chemical indicators to perform a colour change and indicate successful sterilization quicker than ones pre-conditioned in low humidity (14% RH), which suggests that it is moisture rather than saturated steam that causes chemical indicators to indicate pass conditions. Non-vacuum sterilization benchtop sterilizers are not adequate for sterilizing dental handpieces. A vacuum process is highly recommended in the interest of patient and staff safety. Chemical and biological indicators are not necessarily reliable and results should be interpreted with care

Utility of an Occupational Therapy Driving Intervention for a Combat Veteran

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study

Évaluation de l'entretien médical réalisé par les sportifs sanctionnés pour dopage (expérience de l'Antenne médicale de prévention du dopage Rhône-Alpes de 2002 à 2012)

Contexte: En France, l'accueil des sportifs ayant eu recours au dopage est délégué aux Antennes Médicales de Prévention du Dopage (AMPD) depuis 2001. Le Code du Sport prévoit que tout sportif sanctionné pour dopage sollicitant la restitution de sa licence réalise un entretien avec un médecin d'une AMPD. Au terme de cet entretien, une attestation nominative est délivrée au sportif qui doit la remettre à sa fédération. Objectif: Analyser la pertinence sanitaire des entretiens réglementaires réalisés à l'AMPD Rhône-Alpes entre 2002 et 2012. Méthode: Étude rétrospective analysant les observations issues des entretiens médicaux des sportifs sanctionnés pour dopage. Résultats: 83 sportifs âgés de 28 (+/- 7) ans, majoritairement de sexe masculin, ont été vus. Le cannabis était la substance la plus fréquemment en cause (66,3%), suivi des glucocorticoïdes (19,3%), des stéroïdes anabolisants (7,2%), des diurétiques (4,8%) et des b2 mimétiques (1,2%). Une pharmacodépendance était probable ou avérée dans 27,8% des cas. 7,2% des sportifs polyconsommateurs ne présentaient pas de dépendance. Au final, un suivi médico-psychologique a été proposé à 42,2% des sportifs. Conclusion: Cet entretien médical semble pertinent compte tenu de la fréquence de sujets dépendants et/ou polyconsommateurs. Cette étude suggère des liens étroits entre l usage de produits dopants, les usages à problèmes et les dépendances à diverses substances psychoactives. Deux tiers des sportifs ont été sanctionnés pour usage de cannabis, ce qui interroge sur la pertinence des dispositifs de lutte antidopage et de répression de l usage des stupéfiants, plus généralement, pour réduire l incidence de leurs consommations.Background: In France, since 2001, medical care of athletes resorting to doping are devolved to Preventive Units for Doping (AMPDs). Indeed, the French Sport Code mentions that each athlete sanctioned for doping, who wants his or her license back, has to be interviewed by an AMPD's practitioner. At the end of this interview, a nominative certificate is delivered to the athlete who has to put it back to his or her federation. Objective: To assess the relevance of these medical interviews realized in the Rhône-Alpes' region's AMPD from 2002 to 2012. Method: Retrospective study analyzing the medical observations arising from the doped athletes' interviews. Results: 83 athletes, mainly men, mean age 28 (+/- 7) years old were received. The most frequently involved substance was cannabis (66,3%) followed by glucocorticoids (19,3%), anabolic steroids (7,2%), diuretics (4,8%) and b2 agonists (1,2%). 23 athletes (27,8%) were likely or truly addicted. Among athletes who abused of several psychoactives substances, only 6 (7,2%) were addiction-free. Finally, a medical follow up was proposed to 35 (42,2%) athletes. Conclusion: Given the high prevalence of addiction and/or polyconsumptions' problems among athletes who were sanctioned for doping, this interviewing process seems relevant. Moreover, this study highlights close links between the use of doping substances, drug abuse and addiction. Two thirds of the athletes were sanctioned for cannabis' consumption. So, the relevance of an antidoping fight's policy only bases on repression of drug abuse can be questioned in order to reduce theses consumptions among athletes who take part to competition.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Stakeholder Recommendations to Refine the Fitness-to-Drive Screening Measure

In developing the web-based Fitness-to-Drive Screening Measure (FTDS) and keyform (results output) for use to identify at-risk older drivers, we examined the needs, perspectives, and suggestions of three stakeholders groups: occupational therapy practitioners, certified driver rehabilitation specialists (CDRSs), and family members/caregivers. We conducted three focus groups, which were moderated, recorded, transcribed, and analyzed using directed content analysis. Respondents in two focus groups also rated FTDS aspects (e.g., ease of use, format, and relevance), using a visual analog scale (VAS, 0-10 scale with 10 being excellent). All three stakeholder groups contributed to the development of the web-based FTDS. Results from occupational therapy practitioners addressed face validity, appearance, wording, and usability; CDRSs informed follow-up recommendations; and family members/caregivers provided keyform feedback. High VAS ratings (\u3e 7 on 1-10 scale) from the CDRSs (8.4, SD+0.8) and family members/caregivers (9.01, SD+1.02) indicated FTDS acceptability. Overall, our findings support the measure’s utility and acceptability among these users. As such, the FTDS may position family members/caregivers to identify at-risk older drivers, facilitate targeted discussions of driving difficulty among occupational therapists and their clients, and afford OT-CDRS an entry point for intervention and clinical decision making

Gekrümmte Beton-Leichtbauelemente mit bionisch inspirierten Krafteinleitungssystemen durch Einsatz flexibler GFK-Schalungen

Die Architektur des 21. Jahrhunderts ist geprägt von der freien Formfindung, wobei Ressourceneinsparung in Kombination mit Funktionsintegration immer stärker in den Fokus effizienter Bauweisen rücken. Klassische Werkstoffe, wie z. B. Stahlbeton, stoßen hinsichtlich organischer Formen und Funktionalisierung schnell an ihre Grenzen. Darüber hinaus sind beim Stahlbeton aufgrund der Korrosionsneigung der Stahlbewehrung hohe Betonüberdeckungen gefordert, was der Umsetzung filigraner Bauweisen mit geringen Dicken entgegensteht (s. etwa [1], [2]). Daher ist die Erforschung von neuartigen Betonstrukturen mit Leichtbaueigenschaften unter Anwendung von textilen Bewehrungen seit einigen Jahren Gegenstand intensiver wissenschaftlicher Arbeiten, z. B. in den DFG-SFB 528 und 532, im BMBF-Vorhaben C³ und zahlreichen internationalen Projekten, z. B. [1], [3]–[5]). [Aus: Ausgangsfragen und Zielsetzung]The architecture of the 21st century is characterized by free form finding, whereby saving resources in combination with functional integration are increasingly important for efficient construction methods. Classic materials, such as steel reinforced concrete, quickly reach their limits in terms of organic shapes and functionalization. In addition, due to the corrosion tendency of the steel reinforcement, high concrete coverings are required, which prevents the implementation of filigree construction methods with small thicknesses (see e.g. [1], [2]). Therefore, the research of new types of concrete structures with lightweight properties using textile reinforcement has been the subject of intensive scientific work for some years, e.g. DFG–SFB 528 and 532, BMBF project C³ and numerous international projects, e.g. [1], [3]–[5]). [Off: Initial questions and objectives