Hand hygiene knowledge and attitudes: comparisons between student nurses

It is recognised that early intervention in healthcare workers’ education is important in terms of embedding effective infection prevention and control knowledge into practice. One of the most important aspects of this education is hand hygiene compliance and technique expectations. This small study was undertaken in collaboration with the University of Dundee, School of Nursing and Midwifery and NHS Tayside. It explored the differences in knowledge, attitudes and practice towards hand hygiene among second and third year student nurses with the aim of reviewing and informing the development of future educational material at undergraduate level in order to continually enhance knowledge and skills and bridge the theory–practice gap. This study concluded that third year student nurses did have a slightly better knowledge base than the second years and that although knowledge, attitudes and practice were reported to be of a good standard overall, there were still some important issues that must be addressed.

Welfare and health of horses transported for slaughter within the European Union Part 1: Methodology and descriptive data

REASONS FOR PERFORMING STUDY

Anecdotal evidence collected by a variety of organisations has highlighted poor welfare in horses transported long distances to slaughter within the European Union.

OBJECTIVE

To investigate welfare of horses being transported long distances within the EU to slaughter.

METHODS

Data on transported horses were recorded at 2 assembly centres in Romania and at 4 abattoirs in Italy over an 8 month period in 2008.

RESULTS

A total of 1519 horses in 64 separate shipments were observed in Romania prior to transport of which 212 horses were deemed unfit for transport and only 3 shipments (5%) complied with Council Regulation (EC) no. 1/2005 with respect to both horse and vehicle compliance. The destination most commonly stated for the horses from these assembly centres was Italy. A total of 1271 horses in 63 separate shipments were observed after transport in Italy, of which 86 horses in 4 shipments had also been observed prior to transport in Romania. The majority of the horses observed at these abattoirs originated from Poland (51%) and Romania (44%). On arrival in Italy at the time of unloading, 471 of 1271 horses (37%) were deemed unfit for transport in accordance with Council Regulation (EC) no. 1/2005 and none of the shipments were compliant with respect to both vehicle and horse requirements. An average of 6 horses per shipment (28% of each shipment) had at least one acute injury on arrival in Italy. A significantly higher prevalence of severe injuries and lameness was found in animals on arrival In Italy compared with animals leaving Romania. Horses examined on arrival in Italy were twice as likely to have 1-3 acute contusions or excoriations as horses examined in Romania. There was also a 2-fold increase in the number of animals deemed unfit for transport.

CONCLUSION

This study has identified evidence of poor welfare in horses being transported long distances to slaughter, including severe lameness and injuries, and a high level of noncompliance with Council Regulation (EC) no. 1/2005 on the Protection of Animals during Transport.

A historical assessment of coastal contamination in Birch Harbor, Maine based on the analysis of mussels collected in the 1940s and the Mussel Watch Program

Coastal contamination in the 1940s was assessed based on analysis of canned blue mussels presumably collected from Birch Harbor, Maine, USA. Analytical results on legacy organic contaminants were compared to long-term National Oceanic and Atmospheric Administration (NOAA) Mussel Watch (MW) monitoring data to estimate the degree of coastal contamination before World War II (WWII) when many synthetic organic compounds were first introduced into the environment. While dieldrin and chlordane were not detected in the canned mussels, dichloro-diphenyl-trichloroethane (DDT) and hexachlorocyclohexanes (HCHs) were present at lower concentrations relative to the more recent MW data. Polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) were detected, and the later were significantly higher in canned mussels relative to the MW data (p<0.05). Furthermore, moving average analysis applied to the MW data depicted three-phased temporal trend patterns (increase-decrease-steady state) for virtually all contaminants indicating an overall increased coastal contamination in post WWII era.

Orosomucoid influences the response to antidepressants in major depressive disorder

Orosomucoid, an acute phase protein, carries basic drugs including antidepressants in plasma. Elevated levels have been reported in patients with depression. It has yet to be established whether orosomucoid concentration influences antidepressant response. The orosomucoid gene (ORM1) is polymorphic and the protein isoforms have differing pharmacokinetic properties which could alter plasma profile and blood brain barrier transport of antidepressants. Outpatients (n = 157) in a randomised control trial of fluoxetine versus nortriptyline were genotyped for the ORM1 variants. Plasma concentrations of acute phase proteins were also measured. Outcomes were the completion of an adequate six week trial of antidepressant and response. Response was defined as an improvement >/=60% on the Montgomery-Asperg Depression Rating Scale (MADRS) over six weeks. The first notable finding was that individuals with an ORM1*S/*S genotype were less likely to complete an adequate six week trial of an antidepressant (OR = 4.707, 95% CI 1.769-12.527, P = 0.002). The second was that higher orosomucoid concentrations were found in antidepressant non-responders (91.4%) than responders (79.1%) (F1, 106 = 5.669, P = 0.019). These findings highlight the potential importance of variables such as orosomucoid which impact on drug availability on the therapeutic efficacy of antidepressant drugs.

Retrofitting houses with insulation: a cost-benefit analysis of a randomised community trial

BACKGROUND

Housing is an important environmental influence on population health, and there is growing evidence of health effects from indoor environment characteristics such as low indoor temperatures. However, there is relatively little research, and thus little firm guidance, on the cost-effectiveness of public policies to retrospectively improve the standards of houses. The purpose of this study was to value the health, energy and environmental benefits of retrofitting insulation, through assessing a number of forms of possible benefit: a reduced number of visits to GPs, hospitalisations, days off school, days off work, energy savings and CO(2) savings.

METHODS

All these metrics are used in a cluster randomised trial--the "Housing, Insulation and Health Study"--of retrofitting insulation in 1350 houses, in which at least one person had symptoms of respiratory disease, in predominantly low-income communities in New Zealand.

RESULTS

Valuing the health gains, and energy and CO(2) emissions savings, suggests that total benefits in "present value" (discounted) terms are one and a half to two times the magnitude of the cost of retrofitting insulation.

CONCLUSION

This study points to the need to consider as wide a range of benefits as possible, including health and environmental benefits, when assessing the value for money of an intervention to improve housing quality. From an environmental, energy and health perspective, the value for money of improving housing quality by retrofitting insulation is compelling.

The epidemiology of lion lentivirus infection among a population of free-ranging lions (Panthera leo) in the Kruger National Park, South Africa

Feline immunodeficiency virus is a lentivirus of domestic cats that causes significant lifelong infection. Infection with this or similar lentiviruses has been detected in several nondomestic feline species, including African lions (Panthera leo). Although lion lentivirus (FIVple) infection is endemic in certain lion populations in eastern and southern Africa, little is known about its pathogenic effects or its epidemiological impact in free-ranging lions. This report describes the epidemiological investigation of lentivirus positivity of free-ranging lions in the Kruger National Park, South Africa. A nested polymerase chain reaction assay for virus detection was performed on all whole blood samples collected. In addition, serum samples were tested for cross-reactive antibodies to domestic feline lentivirus antigens and to puma lentivirus synthetic envelope peptide antigen. The results were analysed in conjunction with epidemiological data to provide a descriptive epidemiological study on lion lentivirus infection in a free-ranging population of lions. The overall prevalence of lentivirus infection was 69%, with a prevalence of 41% in the north of the park, and 80% in the south. Adult males had the highest prevalence when combining the factors of sex and age: 94%. The lowest prevalences were found among juveniles, with male juveniles at 29%. Adults were 5.58 times more likely to test positive for FIVple than juveniles, with adult males being 35 times more likely to be test positive for FIVple compared with juvenile males. This research represents the 1st epidemiological study of the lion lentivirus among free-ranging lions in the Kruger National Park.

Is Metabolic Syndrome and Central Obesity Relevent to Biology and Progression of Postmenopausal Breast Cancer?

Introduction: Obesity isassociated with both an increased risk of postmenopausal breast cancer and increased mortality rates. The mechanism is unclear, and central (visceral) obesity, insulin resistance, altered sex steroids, and altered adipokines, are mooted as possible factors. These features may cluster in the so-called Metabolic Syndrome (MetS), and the focus of this study was to systematically relate MetS to standard clinicopathological indices of breast cancer.Methods: Postmenopausal women with newly diagnosed breast cancer (n=105) were prospectively recruited. A detailed clinical and dietary history was performed, as well as body composition analysis, metabolic screen, and plasma measurement of adipokines and inflammatory markers. MetS was defined according to the International Diabetes Federation definition.Results: One hundred and five patients were recruited, the median age was 68 years (40-94) and the mean BMI was 28.3 ± 5.2 kg/m2, with 87% of patients centrally obese. MetS was diagnosed in 39% of patients, and was significantly (p&lt;0.005) associated with 13cm greater waist circumference, higher total and trunk fat mass and increased inflammation with CRP levels almost double for MetS patietns compared to non MetS (10.3 ± 2.7 V's 5.8 ± 1.0 mg/L; p=0.084).Patients with later pathological stage (II- IV) were significantly more likely to be obese (BMI) (45% Vs 16%; p=0.007), centrally obese (waist circumference) (94% Vs 72%; p=0.009), hyperglycaemic (31% Vs 12%; p=0.047), hyperinsulinaemia (19% Vs 0; p=0.026) and 51% had MetS compared to 12% for early stage disease (Path stage 0-I). Patients with node positive disease were significantly more likely to be hyperinsulaemic (22% V's 5%; p=0.030) and have MetS (50% V's 30%; p=0.028) than node negative disease.MetS was not associated with hormone receptor status or serum levels of oestradiol, progesterone, testosterone, or SHBG levels. However, SHBG levels decreased with obesity (p=0.002) and as the number of features of MetS increased (0 features: 87 ± 15.8 compared to 5 features: 32 ±2.7; p=0.003). Insulin levels increased with obesity (p=0.006), and with increasing number of features of MetS.Discussion: MetS and central obesity are common in Irish postmenopausal breast cancer patients. MetS appears to be associated with aggressive tumour biology, and this may have significance in preventive and novel treatment approaches.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1051.

IgE cross-reactivity between Ascaris and domestic mite allergens: the role of tropomyosin and the nematode polyprotein ABA-1

BACKGROUND

Analysis of cross-reactivity between the nematode Ascaris ssp. and dust mites, two important allergen sources in the tropics, will contribute in understanding their influence on asthma and atopy. The objective of this study was to investigate immunoglobulin E (IgE) cross-reactivity between Ascaris and two domestic mites in the tropics.

METHODS

Sera from 24 asthmatic patients were used in ELISA and immunoblotting IgE-binding inhibition assays using Ascaris, Blomia tropicalis and Dermatophagoides pteronyssinus extracts and the recombinants Blo t 10, ABA-1 and Blo t 13 as competitors. Identification of Ascaris allergens was confirmed by mass spectrometry (LC-MS/MS).

RESULTS

We detected at least 12 human IgE-binding components in Ascaris extract. Blomia tropicalis and D. pteronyssinus inhibited 83.3% and 79% of IgE-binding to Ascaris, while Ascaris inhibited 58.3% and 79.3% to B. tropicalis and D. pteronyssinus respectively. Mite tropomyosin inhibited 85% of IgE-binding to Ascaris. Affinity-purified human IgE to rBlo t 10 identified an allergen of 40 kDa in Ascaris extract, further confirmed as tropomyosin by LC-MS/MS. We found no evidence of IgE cross-reactivity between rABA-1 and any allergen component in mite extracts, including rBlo t 13.

CONCLUSIONS

There is cross-reactivity between Ascaris and mites, determined by several allergens including tropomyosin and glutathione-S-transferase. In addition to its potential impact on asthma pathogenesis, Ascaris infection and mite allergy diagnosis relying on the determination of specific IgE could be affected by this cross-reactivity. ABA-1 has no cross-reactive counterpart in mite extracts, suggesting its usefulness as a more specific marker of Ascaris infection.

Significant contributions of the extraembryonic membranes and maternal genotype to the placental pathology in heterozygous Nsdhl deficient female embryos

Mutations in the gene encoding the cholesterol biosynthetic enzyme NSDHL are associated with the X-linked male-lethal bare patches (Bpa) mouse. Mutant male embryos for several Nsdhl alleles die in midgestation with placental insufficiency. We examined here a possible role of the maternal genotype in such placental pathology. Pre-pregnancy plasma cholesterol levels were similar between wild-type (WT) and Bpa(1H)/+ dams fed a standard, cholesterol-free diet. However, there was a marked decrease in cholesterol levels between embryonic day (E)8.5 and E10.5 for both genotypes. Further, there was a significant lag between E11.5 and E13.5 (P = 0.0011) in the recovery of levels in Bpa(1H)/+ dams to their pre-pregnancy values. To investigate possible effects of the maternal genotype on fetal placentation, we generated transgenic mice that expressed human NSDHL and rescued the male lethality of the Bpa(1H) null allele. We then compared placenta area at E10.5 in WT and Bpa(1H)/+ female embryos where the mutant X chromosome was transmitted from a heterozygous mother or a rescued mutant father. In mutant conceptuses, placental areas were approximately 50% less than WT. Surprisingly, expression of Nsdhl in trophoblast lineages of the placenta and yolk sac endoderm, which occurs only from the maternally inherited allele in a female embryo, had the largest effect on placental area (-0.681 mm(2); P < 0.0001). The maternal genotype had a smaller effect, independent of the fetal genotype (-0.283 mm(2); P = 0.024). These data demonstrate significant effects of the mother and fetal membranes on pregnancy outcome, with possible implications for cholesterol homeostasis during human pregnancy.

Rejection of pharmaceutically active compounds and endocrine disrupting compounds by clean and fouled nanofiltration membranes

Rejections of 9 pharmaceuticals and 5 endocrine disruptors by clean and fouled nanofiltration membranes were investigated in this study. Waters containing a cocktail of compounds were filtered by clean and pre-fouled membranes. The rejection of hydrophilic neutral compounds by the clean NF-200 membrane varied from 35 to 70% under steady state conditions while that of NF-90 membrane was in the range of 62-96%. The clean NF-90 membrane rejected nearly all of the hydrophobic neutral compounds (95-98%) predominantly due to size exclusion. Nevertheless, electrostatic repulsion was the main mechanism of rejection of ionic compounds by both membranes (71-94% by NF-200 and 99% by NF-90). Fouling with sodium alginate deteriorated the performance of the NF-200 membrane in rejecting hydrophilic neutral compounds as well as hydrophilic and hydrophobic ionic compounds. In contrast, rejections of hydrophobic neutral compounds by the fouled NF-200 membrane increased by 5-38%. This may be attributed to the incipient interaction of the solutes with the membrane foulant layer resulting in less partitioning and diffusion across the membrane surface. On the other hand, rejections of hydrophobic compounds by NF-90 were not observed to be affected by fouling; however, hydrophilic neutral compounds showed increased rejections by 7-30%.

Improvement in door-to-balloon times in management of acute ST-segment elevation myocardial infarction STEMI through the initiation of 'Code AMI'

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) mandates rapid percutaneous coronary intervention (PCI) for optimal outcomes. The aim of this study was to assess our hospital practice for managing acute STEMI, identify processes associated with time delays, instrument changes to our acute STEMI management protocol and assess their effectiveness for improving our door-to-balloon time.

METHODS

We aimed to achieve this through the establishment of a quality improvement programme involving the cardiology and emergency departments. We analysed consecutive patients presenting with STEMI (April to September 2005 (group A) and the corresponding period in 2006 (group B), and compared patients presenting 'in hours' (0700 hours to 1800 hours (Monday to Friday)) versus 'out of hours' (all other times including public holidays).

RESULTS

In group A, 38 patients presented with a STEMI. Assessing time-to-treatment analysis, the median door to balloon time for primary PCI was significantly greater for 'out of hours' than 'in hours' (120 vs 67 min). The greatest time delay to PCI was from the PCI decision time to catheter laboratory arrival. Local changes were implemented to improve 'out of hours' times, including initiation of 'Code AMI'. There were 59 patients in group B. We found that our changes led to a 29% improvement in 'out of hours' door-to-balloon time (median time 82 min, P = 0.005) with 69% being managed < or =90 min (P = 0.049) (group B).

CONCLUSION

We have shown that ongoing review through a quality improvement programme improves door-to-balloon times, which is integral in the optimal management of patients with acute STEMI treated with primary PCI.

The clinical and pathological differences in prevalent round screen-detected and symptomatic invasive breast cancer

The potential benefits of breast cancer screening include the detection of cancers at a more favourable stage, however, cancers detected during the prevalent round of screening may differ from true screen-detected cancers. These differences are poorly defined. This study prospectively assessed all women between 50 and 64 years of age undergoing curative surgery for breast cancer, both screen-detected and symptomatic, in one screening centre during the prevalent round of the national breast cancer-screening programme. Four hundred and thirty seven patients (364 screen-detected and 73 symptomatic patients) underwent surgery for breast cancer. Symptomatic breast cancers were of a higher grade (p < 0.0001; Chi2) and less likely to be oestrogen receptor positive (49% versus 88%; p < 0.0001; Fisher's exact test); however there was no difference in size of tumour or axillary nodal positivity. This study suggests that tumours detected by screening during the prevalent round of a screening programme are of a more prognostically favourable type than symptomatic breast cancers in the same age group.

Response to azacitidine in patients with myelodysplastic syndrome with marrow fibrosis

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Background: The Myelodysplastic syndrome (MDS) is characterized by aberrant hematopoietic progenitor cell maturation resulting in ineffective hematopoiesis, cytopenia and progression to acute myeloid leukemia. Some individuals with MDS also have fibrosis within the marrow. MDS with marrow fibrosis appears to be biologically and clinically distinct from myeloproliferative disorders with marrow fibrosis such as agnogenic myeloid metaplasia. While azacitidine (AZA), a DNA methyl transferase inhibitor has known activity in MDS, little is known about its efficacy in patients with MDS with marrow fibrosis. Methods: The records of 41 patients with MDS with marrow fibrosis treated with AZA were reviewed. The degree of fibrosis was determined by reticulin staining and ranged from 1+ to 3+. Patients who received at least 2 cycles were considered evaluable for response. All patients were evaluated for toxicity. The International Working Group standardized response criteria for MDS were used for evaluation of response. Results: Patients had a median age of 69 years (range = 44–84). All FAB subtypes were represented (RA = 16, RARS = 6, RAEB = 5, CMML = 8, RAEB-t = 6). The mean International Prognostic Scoring System score was 1.3 and ranged from 0–3.5.. The overall response rate was 63% (26/41): CR = 7% (3/41), PR = 20 % (8/41), major hematological improvement (MHI) = 29% (12/41), and minor hematological improvement (mHI) = 7% (3/41). The response rates did correlate with FAB subgroup or IPSS score. Treatment was well tolerated. The most common side effects were nausea, vomiting, diarrhea and cytopenia. Conclusions: Azacitidine appears to be effective and well tolerated in patients with MDS with marrow fibrosis. Results of this study demonstrate a response rate similar to that reported in previous studies treating MDS regardless of marrow histology. There does not appear to be a material difference in response to AZA between MDS patients with and without marrow fibrosis.

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