Methyl halide transferase-based gas reporters for quantification of filamentous bacteria in microdroplet emulsions.

The application of microfluidic techniques in experimental and environmental studies is a rapidly emerging field. Water-in-oil microdroplets can serve readily as controllable micro-vessels for studies that require spatial structure. In many applications, it is useful to monitor cell growth without breaking or disrupting the microdroplets. To this end, optical reporters based on color, fluorescence, or luminescence have been developed. However, optical reporters suffer from limitations when used in microdroplets such as inaccurate readings due to strong background interference or limited sensitivity during early growth stages. In addition, optical detection is typically not amenable to filamentous or biofilm-producing organisms that have significant nonlinear changes in opacity and light scattering during growth. To overcome such limitations, we show that volatile methyl halide gases produced by reporter cells expressing a methyl halide transferase (MHT) can serve as an alternative nonoptical detection approach suitable for microdroplets. In this study, an MHT-labeled Streptomyces venezuelae reporter strain was constructed and characterized. Protocols were established for the encapsulation and incubation of S. venezuelae in microdroplets. We observed the complete life cycle for S. venezuelae including the vegetative expansion of mycelia, mycelial fragmentation, and late-stage sporulation. Methyl bromide (MeBr) production was detected by gas chromatography-mass spectrometry (GC-MS) from S. venezuelae gas reporters incubated in either liquid suspension or microdroplets and used to quantitatively estimate bacterial density. Overall, using MeBr production as a means of quantifying bacterial growth provided a 100- to 1,000-fold increase in sensitivity over optical or fluorescence measurements of a comparable reporter strain expressing fluorescent proteins. IMPORTANCE Quantitative measurement of bacterial growth in microdroplets in situ is desirable but challenging. Current optical reporter systems suffer from limitations when applied to filamentous or biofilm-producing organisms. In this study, we demonstrate that volatile methyl halide gas production can serve as a quantitative nonoptical growth assay for filamentous bacteria encapsulated in microdroplets. We constructed an S. venezuelae gas reporter strain and observed a complete life cycle for encapsulated S. venezuelae in microdroplets, establishing microdroplets as an alternative growth environment for Streptomyces spp. that can provide spatial structure. We detected MeBr production from both liquid suspension and microdroplets with a 100- to 1,000-fold increase in signal-to-noise ratio compared to optical assays. Importantly, we could reliably detect bacteria with densities down to 106 CFU/mL. The combination of quantitative gas reporting and microdroplet systems provides a valuable approach to studying fastidious organisms that require spatial structure such as those found typically in soils.

Environmental and economic impact of using increased fresh gas flow to reduce carbon dioxide absorbent consumption in the absence of inhalational anaesthetics.

BACKGROUND: Increasing fresh gas flow (FGF) to a circle breathing system reduces carbon dioxide (CO2) absorbent consumption. We assessed the environmental and economic impacts of this trade-off between gas flow and absorbent consumption when no inhalational anaesthetic agent is used. METHODS: A test lung with fixed CO2 inflow was ventilated via a circle breathing system of an anaesthetic machine (Dräger Primus or GE Aisys CS2) using an FGF of 1, 2, 4, or 6 L min-1. We recorded the time to exhaustion of the CO2 absorbent canister, defined as when inspired partial pressure of CO2 exceeded 0.3 kPa. For each FGF, we calculated the economic costs and the environmental impact associated with the manufacture of the CO2 absorbent canister and the supply of medical air and oxygen. Environmental impact was measured in 100 yr global-warming potential, analysed using a life cycle assessment 'cradle to grave' approach. RESULTS: Increasing FGF from 1 to 6 L min-1 was associated with up to 93% reduction in the combined running cost with minimal net change to the 100 yr global-warming potential. Most of the reduction in cost occurred between 4 and 6 L min-1. Removing the CO2 absorbent from the circle system, and further increasing FGF to control CO2 rebreathing, afforded minimal further economic benefit, but more than doubled the global-warming potential. CONCLUSIONS: In the absence of inhalational anaesthetic agents, increasing FGF to 6 L min-1 reduces running cost compared with lower FGFs, with minimal impact to the environment.

Psychometric Validation of an Instrument to Measure Family Coping During a Child's Hospitalization for Cancer.

BACKGROUND: Families with children hospitalized for cancer treatment experience multiple, serious challenges. Family coping is a crucial moderator between family stress and family adaptation. A newly developed instrument, the Hospitalization Coping Scale (HCS), measures the effectiveness of family coping during a child's hospitalization. OBJECTIVE: The aims of this study were to revise and validate the psychometric properties of the HCS for families with children hospitalized for cancer treatment in pediatric oncology departments in Mainland China. METHODS: Psychometric properties of the HCS were examined among 253 families with children hospitalized in pediatric oncology departments in 4 hospitals. Reliability, construct validity, known-group validity, and concurrent validity of the revised HCS were examined. RESULTS: The revised 15-item HCS contains 3 renamed factors: maintaining mental stability, mutual support for child care, and seeking support from external systems. Cronbach's α coefficients for the total and 3 factors were .87, .78, .83, and .79, respectively. The revised scale demonstrated sound known-group validity and concurrent validity. CONCLUSIONS: The revised 15-item HCS is a reliable and valid instrument to measure coping effectiveness of families with children hospitalized for cancer treatment. IMPLICATIONS FOR PRACTICE: The HCS can be used by pediatric oncology nurses to assess the effectiveness of family coping during a hospitalization of their child with cancer and may help pediatric oncology nurses to develop and implement realistic support strategies based on assessments of family coping effectiveness.

Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013: its impact in the Northern Rivers, NSW.

OBJECTIVE: The objective of the study was to explore the impact of implementation of the Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013 on child-care centres in the Northern Rivers region of New South Wales (NSW), from the perspective of child-care centre directors. Importance of study: Immunisation is an effective public health intervention, but more than 75 000 Australian children are not fully vaccinated. A recent amendment to the NSW Public Health Act 2010 asks child-care facilities to collect evidence of complete vaccination or approved exemption before allowing enrolment. METHODS: Ten child-care centre directors participated in a semiscripted interview. Interviews were recorded, transcribed and analysed. RESULTS: Common themes included misinterpretation of the amendment before implementation, the importance of adequate notice for implementation, lack of understanding of assessment of compliance, increased administrative requirements, the importance of other public health efforts, and limited change in vaccination rates. Child-care centres differed in their experience of the resources provided by the government, interactions with Medicare, and ease of integration with existing record-keeping methods. CONCLUSIONS: Participants felt that the amendment was successfully implemented. The amendment was felt to have fulfilled its aim of prompting parents who had forgotten to vaccinate, but failed to significantly affect conscientious objectors. Overall, the amendment was perceived to be a positive step in improving vaccination rates, but its impact was largely complementary to other components of the multifaceted vaccination policy.

Effects of vacuum suctioning and strategic drape tenting on oxygen concentration in a simulated surgical field.

STUDY OBJECTIVE: To investigate the isolated and combined effects of vacuum suctioning and strategic drape tenting on oxygen concentration in an experimental setting. DESIGN: Experimental. SETTING: Clinical simulation center of a university-affiliated hospital. PARTICIPANTS: Mannequin simulation of a patient undergoing facial surgery under sedation anesthesia. Supplemental oxygen was delivered via nasal cannula. INTERVENTIONS: Vacuum suctioning and strategic drape tenting. MEASUREMENTS: The experimental trials entailed measuring oxygen concentration around the nasal cannula continuously either in the presence or absence of a standard operating room vacuum suction system and strategic tenting of surgical drapes. The primary outcome was the time required for oxygen concentration to reach 21%. MAIN RESULTS: In the control group (without suction or strategic tenting), a mean time of 180 seconds elapsed until the measured oxygen concentration reached 21% after cessation of oxygen delivery. Use of a vacuum suction device alone (110 seconds; P < .01) or in combination with strategic tenting (110 seconds; P < .01) significantly reduced this time. No significant benefit was seen when tenting was used alone (160 seconds; P < .30). CONCLUSION: Use of a vacuum suction device during surgery will lower local oxygen concentration, and this in turn may decrease the risk of operating room fires. Although strategic tenting of surgical drapes has a theoretical benefit to decreasing the pooling of oxygen around the surgical site, further investigation is necessary before its routine use is recommended.

Validation of Hospitalization Impact Scale among families with children hospitalized for cancer treatment.

AIM: To make further modifications to and validate the psychometric properties of the Hospitalization Impact Scale. BACKGROUND: A child's repeated and prolonged hospitalization for cancer treatment can result in great changes for the entire family. A hospitalization-specific screening tool is needed to help clinical nurses identify families who are experiencing major impacts during their child's hospitalization. DESIGN: A cross-sectional study was employed to examine the psychometric properties of the Hospitalization Impact Scale. METHOD: The sample consisted of 253 families with children hospitalized for cancer treatment in four paediatric oncology departments in four hospitals in mainland China from September 2013 - March 2014. Parents completed the 36-item Hospitalization Impact Scale, demographic measures and the Family Impact Module of the Pediatric Quality of Life Inventory. Reliability, construct validity, known-group validity and concurrent validity were examined. RESULT: The revised Hospitalization Impact Scale included six factors containing 34 items. It demonstrated sound concurrent validity with the Family Impact Module of the Pediatric Quality of Life Inventory and excellent internal consistency. CONCLUSION: The revised Hospitalization Impact Scale met the standard psychometric criteria for reliability and validity. Thus, it could be applied in paediatric oncology departments to help nurses assess and identify families experiencing major impacts during a child's hospitalization for cancer treatment.

Nursing students' knowledge, attitude and readiness to work for clients with sexual health concerns.

AIMS: To investigate nursing students' knowledge, attitude and readiness to work for clients with sexual health concerns and to identify strategies to help students develop as they take up their role in sexual health-related care. BACKGROUND: There is an increasing global demand for improving sexual health. A better understanding of nursing students' attitude and readiness to work for clients with sexual health concerns is the beginning of this endeavour. The need to explore strategies for developing competent health care practitioners is timely. DESIGN: A cross-sectional survey. METHODS: Nursing students (n = 377) studying in pre- and post-registration programmes were surveyed at a university in Hong Kong using a questionnaire with open- and closed-ended questions about their knowledge, attitude and self-perception on readiness to work for clients with sexual health concerns. RESULTS: Students' knowledge of sexual health was satisfactory. They were positive in acknowledging the nursing role in sexual health care, but hesitant in taking up an active role in practice. Students' readiness to participate in related activities was below satisfactory. Their perception of inadequate knowledge, feelings of anxiety, worries about colleagues' and clients' possible adverse responses and inadequate exemplars were major factors affecting their readiness. This paper also highlighted some important learning areas and strategies that could help in enhancing students' knowledge and confidence in sexual health care practices. CONCLUSION: Improving the educational programme and clinical practice for nursing students is necessary but may not be adequate. Valuing the affective aspect of education, formal recognition of this extended role and advancing related education to a post-experience level would also benefit the development of sexual health care. RELEVANCE TO CLINICAL PRACTICE: Preparing more mentors as exemplars, inviting clinicians and managers as partners in sexual health-related care would help nursing students to work efficiently for clients with sexual health concerns.

Validity and reliability of the Chinese version of the Feetham Family Functioning Survey (FFFS).

A Chinese version of the Feetham Family Functioning Survey (Chinese FFFS) was developed and psychometrically tested using a sample of 317 child-rearing mothers in Hong Kong. The Chinese FFFS is a self-administered questionnaire consisting of 25 items from which an instrument discrepant score (d score) can be extracted. The results from the confirmatory factor analysis and exploratory factor analysis confirm that the Chinese FFFS has a five-factor structure based on the family ecological model, thereby affirming its construct validity. Cronbach's alpha for d scores was .91, indicating a high internal consistency. In the test-retest study of 39 mothers, the correlation coefficient for "total d score" over a 2-week period was .82, which showed high test-retest reliability. The highest discrepant scores in family functioning were at the level of the marital relationship, which requires family nurses to be skilled at assessing and intervening at this family subsystem.

Evaluation of the Morse Fall Scale: applicability in Chinese hospital populations.

BACKGROUND: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion-referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population. OBJECTIVES: To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter-rater and test-retest reliability. DESIGN: The study was a cross-sectional study. SETTINGS: The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study. PARTICIPANTS: A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years. METHODS: The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls. RESULTS: The scale had a sensitivity of 31% and a specificity of 83% when the cut-off point was determined at 45. The field test demonstrated excellent inter-rater reliability with an ICC value of 0.97 (95%CI 0.94-0.98). Repeatability was high with an ICC of 0.98 (95% CI 0.98-0.99). The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item-to-scale correlation. CONCLUSIONS: The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.

The symptom experience of hospitalised Chinese children and adolescents and relationship to pre-hospital factors and behaviour problems.

PURPOSE: To describe the symptom experience of hospitalised Chinese children and adolescents and examine the relationship of symptoms to pre-hospital factors and child behaviour. METHODS: Data were collected at two hospital sites in Hong Kong (HK) and at five hospitals in the Chinese Mainland (CM). A total of 307 hospitalised children and adolescents (ages 2-18) and their primary caregiver (e.g., mother, father or grandparent) participated in the study. Children and adolescents completed an age-appropriate symptom diary on one evening and subsequent morning early in their hospital stay. Parents completed the diary for the children less than 6 years of age. Parents also completed an age-appropriate Chinese version of the Child Behaviour Checklist. RESULTS: Over 50% of the children and adolescents reported some degree of pain, 75% of them reported evening tiredness, and 21% reported gastrointestinal symptoms. The intensity of symptoms varied by age and region and symptoms often co-occurred. Greater symptom burden was predicted by previous surgery, higher level of worst pain prior to hospitalisation, parent report of child behaviour problems, and co-occurrence of other symptoms. CONCLUSIONS: Hospitalised Chinese children manifest symptoms of pain, tiredness, and gastrointestinal distress that vary based on pre-hospital factors and are associated with child behaviour problems. Further research is needed to identify causes and treatments for children's symptoms.

Factors influencing decision to breastfeed.

BACKGROUND: The low prevalence and short duration of breastfeeding in international studies have highlighted the need for more investigations into the problems. International studies have identified certain factors that affect breastfeeding intentions. Due to insufficient published studies on the local breastfeeding situation, this study specifically investigated factors influencing the breastfeeding decision among primipara women in Hong Kong. AIM: The aim of this paper is to report a study investigating the personal, social, cultural, facilities and environmental and other factors contributing to women's decisions to breastfeed, and to exploring first-time mothers' knowledge of breastfeeding and its influence on their breastfeeding intentions. METHODS: Three private and 10 public hospitals in Hong Kong participated in the study. Both quantitative and qualitative data were collected through questionnaires and subsequently by in-depth interviews with 230 first-time mothers 24-48 hours after delivery. RESULTS: The results indicated that personal, cultural, social, and environmental factors are common influencing factors in the decision to breastfeed. Mother's knowledge and attitudes, followed by husband's support, were identified as important in influencing infant feeding choice. Expected local cultural differences were also identified. DISCUSSION: Acknowledgement of the influencing factors could lead to appropriate management of the promotion of breastfeeding. Further research into husband's role, recognition and support for infant feeding and the issue of 'inadequate breast milk' is necessary for a successful breastfeeding campaign. Some other interesting findings typical of the local culture, such as family communication and living environment relating to breastfeeding, are also discussed. CONCLUSIONS: The study has identified the influencing factors that affect women's decision to breastfeed. Recommendations are made for health care professionals and the community to create a more baby-friendly atmosphere and environment for the promotion of breastfeeding.

Psychosocial functioning of hospitalized Chinese adolescents and their families.

The purpose of this study was to describe behavioral and emotional problems, social competence, and family functioning of hospitalized Chinese adolescents and to compare their psychosocial functioning with normative samples of Chinese adolescents and their families. A convenience sample of 103 hospitalized adolescent patients and their families participated. Families came from geographical areas in the Chinese Mainland (5 hospitals) and Hong Kong (2 hospitals). Parents completed a Chinese version of the Child Behavior Checklist for ages 4 to 18 years and the Family Assessment Device. Adolescents responded to a Chinese version of the Youth Self-Report. Youth in the Chinese Mainland and Hong Kong appear to be quite similar in many domains of behavioral functioning. Hospitalized adolescents in Hong Kong and the Chinese Mainland exhibited behavioral and emotional profiles that were qualitatively similar to the norms reported in community samples of Chinese and Chinese-American adolescents, albeit significantly lower than their healthy counterparts. This study examined, for the first time, the psychosocial functioning of hospitalized Chinese adolescents and their families. Our findings contribute to the cultural relevance of measuring adolescent and family responses to a known stressor and are useful for international comparisons by health care providers and researchers.

Culturally appropriate family assessment: analysis of the Family Assessment Device in a pediatric Chinese population.

As part of a larger study, we investigated the adaptation of the Family Assessment Device (FAD) to a Chinese population of hospitalized children (N = 313) compared to a sample of families with healthy children (N = 29) in Hong Kong and Chinese Mainland. Confirmatory factor analysis and exploratory factor analysis (EFA) were performed to examine the FAD structure. The results supported the notion of cultural variations in measuring family functioning. Eight factors were found to explain 30.34% of the variance in family functioning. The Cronbach's alphas of families with hospitalized children ranged from 0.29 to 0.74. Similar reliability scores were found in nonhospitalized families. This study indicates that the Chinese FAD has a different factor structure, reliabilities, and mean scores in several subscales compared to U.S. studies. The psychometric properties of the Chinese FAD may be influenced by the fact that the sample was focused on children rather than adults.