Assessing the Effectiveness of a Multicomponent Intervention on Hand Hygiene and Well-Being in Primary Health Care Centers and Schools Lacking Functional Water Supply in Protracted Conflict Settings: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings. OBJECTIVE: This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently. METHODS: This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ≥5 employees, and schools if they had ≤7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating. RESULTS: The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024. CONCLUSIONS: This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion. TRIAL REGISTRATION: ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52959.

Social cognitive elements of mental illness stigma among healthcare professionals currently working in general hospitals: A cross-sectional study from Jordan.

AIM: To assess the social cognitive elements of the stigma of mental illness (knowledge, attitudes and behaviours) among healthcare professionals (HCPs) in Jordan. DESIGN: A cross-sectional descriptive design. METHODS: A total of 206 HCPs were conveniently recruited from general hospitals in Jordan. The mental attitude, knowledge and intended behaviours scales were used to measure stigma elements. RESULTS: Participants reported a moderate level of knowledge, a moderate negative attitude and a moderate or not greater interest to deal with people with mental health illnesses. The bivariate correlation revealed a negative significant correlation between HCPs' knowledge and attitude, indicating that HCPs with more knowledge significantly have more positive attitude (lower average score) towards those suffering from the illness. A more significant correlation was found between HCPs' knowledge and behaviour. The HCPs who had more knowledge were holding more interest and willingness towards dealing with persons with mental illness. PATIENT OR PUBLIC CONTRIBUTION: Negative attitudes among HCPs demand awareness programmes pertaining to the stigma of mental illness to afford higher standards of practice for patients with mental problems.

'Tomato flu' a new epidemic in India: Virology, epidemiology, and clinical features.

This article aims to highlight the current update on the 'tomato flu' outbreak in India. Recently there was an outbreak of a new illness in some parts of India. The disease was very contagious and it manifested with a rash mainly noticed in children younger than nine years. The rash was very painful and blisters were the size of small tomatoes, hence it was termed 'tomato flu'. A detailed literature review was performed on the virology, replication, epidemiology, and clinical features of this disease. The current outbreak was compared with similar other diseases of the past. The affected children exhibited severe rash in the palms, soles, oral cavity, and other body parts. They developed febrile illness with a sore throat, and myalgia followed by blisters on the tongue, gums, and cheeks. The affected children did not develop any complications leading to death. The therapy involved mainly symptomatic, supportive treatment with isolation and maintaining hygienic practices. The causative agent was identified to be Coxsackievirus A16, an RNA virus belonging to the family, Picornaviridae. We conclude that the recent Indian epidemic of this disease might be due to a new variant of Coxsackievirus A16 actually causing HFMD.

The effect of a contact-based intervention on attitudes and intended behaviors of nursing students toward people with mental illness: A quasi-experimental study.

Background and Aim: Although nursing students are professionally and ethically trained and educated to respect patients with a variety of medical and mental problems, they continue to exhibit negative attitudes and behaviors toward mental disease and patients with mental illness. The accumulated evidence indicates that contact-based intervention (CBI) is helpful in enhancing nursing students' attitudes and behaviors toward patients with mental illness. Although evidence found to support the CBI, culture and settings might play a significant role to decide its effectiveness. This would call for testing further the effectiveness of CBI across cultures and healthcare settings. The purpose of this study was to assess the effect of a CBI on the attitudes and intended behaviors of nursing students in Jordan toward people with mental illness. Methods: A quasi-experimental, pre-post, design was used. Data were collected from 81 nursing students from two nursing schools implementing the CBI using self-reported questionnaires to measure students' attitudes and intended behaviors toward people with mental illness. Data were collected during the first semester of the academic year 2019/2020. The paired-samples and independent-samples t tests were used to test the study's hypotheses. Results: At baseline, the results indicated that there were no statistically significant differences between the experimental and control groups in terms of their attitudes and intended behaviors toward people with mental illness. At posttest, statistically significant improvements in the attitudes and intended behaviors of nursing students found in the experimental group and between control and experimental groups toward people with mental illness compared with baseline pretest measures (p < 0.001). Conclusion: The CBI did improve the attitudes and intended behaviors of Jordanian nursing students toward people with mental illness. Significant implications for nurses were discussed.

Spexin as a neuroendocrine signal with emerging functions.

Spexin (SPX), a novel peptide coevolved with the galanin/kisspeptin family, was first identified by bioinformatics prior to its protein purification/functional studies. Its mature peptide is highly conserved among different vertebrate classes. Based on the studies in mammals and fish models, SPX was found to be widely distributed at tissue level, secreted into systemic circulation, identified at notable levels in central nervous system and peripheral tissues, and has been confirmed/implicated in multiple functions in different tissues/organs, suggesting that SPX may serve as a neuroe​ndocrine signal with pleotropic functions. In this article, different isoforms of SPX and their binding with their cognate receptors GalR2 and GalR3, the biological functions of SPX reported in mammals including GI tract movement, energy balance and weight loss, fatty acid uptake, glucose homeostasis, nociception and cardiovascular/renal functions, as well as the recent findings in fish models regarding the role of SPX in reproduction and feeding control will be reviewed with interesting questions for future investigations.

Dual Role of Insulin in Spexin Regulation: Functional Link Between Food Intake and Spexin Expression in a Fish Model.

Spexin (SPX), a neuropeptide discovered by the bioinformatics approach, has been recently identified as a satiety factor in a fish model. However, the functional link between feeding and SPX expression as well as the signal transduction for SPX regulation are totally unknown. In this study, we used goldfish as a model to examine the functional role of insulin as a postprandial signal for SPX regulation in bony fish. In goldfish, feeding could elevate plasma levels of glucose, insulin, and SPX with concurrent rises in insulin and SPX messenger RNA (mRNA) expression in the liver. Similar elevation in SPX mRNA level was also observed in the liver and brain areas involved in appetite control in goldfish after intraperitoneal injection of glucose and insulin, respectively. In parallel experiments with goldfish hepatocytes and brain cell culture, insulin signal induced by glucose was shown to exert a dual role in SPX regulation, namely (1) acting as an autocrine/paracrine signal to trigger SPX mRNA expression in the liver and (2) serving as an endocrine signal to induce SPX gene expression in the brain. Apparently, the peripheral (in the liver) and central actions of insulin (in the brain) on SPX gene expression were mediated by insulin receptor (to a lesser extent by insulin-like growth factor I receptor) coupled to mitogen-activated protein kinase kinase 3/6/p38 mitogen-activated protein kinase and phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin but not mitogen-activated protein kinase kinase 1/2/extracellular signal-regulated kinase 1/2 cascades. Our findings indicate that an insulin component inducible by glucose is present in the liver of the fish model and may serve as the postprandial signal linking food intake with SPX expression both in the central as well as at the hepatic level.

Type II SOCS as a feedback repressor for GH-induced Igf1 expression in carp hepatocytes.

Type II suppressor of cytokine signaling (SOCS) serve as feedback repressors for cytokines and are known to inhibit growth hormone (GH) actions. However, direct evidence for SOCS modulation of GH-induced insulin-like growth factor 1 (Igf1) expression is lacking, and the post-receptor signaling for SOCS expression at the hepatic level is still unclear. To shed light on the comparative aspects of SOCS in GH functions, grass carp was used as a model to study the role of type II SOCS in GH-induced Igf1 expression. Structural identity of type II SOCS, Socs1-3 and cytokine-inducible SH2-containing protein (Cish), was established in grass carp by 5'/3'-RACE, and their expression at both transcript and protein levels were confirmed in the liver by RT-PCR and LC/MS/MS respectively. In carp hepatocytes, GH treatment induced rapid phosphorylation of JAK2, STATs, MAPK, PI3K, and protein kinase B (Akt) with parallel rises in socs1-3 and cish mRNA levels, and these stimulatory effects on type II SOCS were shown to occur before the gradual loss of igf1 gene expression caused by prolonged exposure of GH. Furthermore, GH-induced type II SOCS gene expression could be negated by inhibiting JAK2, STATs, MEK1/2, P38 (MAPK), PI3K, and/or Akt respectively. In CHO cells transfected with carp GH receptor, over-expression of these newly cloned type II SOCS not only suppressed JAK2/STAT5 signaling with GH treatment but also inhibited GH-induced grass carp Igf1 promoter activity. These results, taken together, suggest that type II SOCS could be induced by GH in the carp liver via JAK2/STATs, MAPK, and PI3K/Akt cascades and serve as feedback repressors for GH signaling and induction of igf1 gene expression.

Programmed self-assembly of a quadruplex DNA nanowire.

The ability to produce, reproducibly and systematically, well-defined quadruplex DNA nanowires through controlled rational design is poorly understood despite potential utility in structural nanotechnology. The programmed hierarchical self-assembly of a long four-stranded DNA nanowire through cohesive self-assembly of GpC and CpG "sticky" ends is reported. The encoding of bases within the quadruplex stem allows for an uninterrupted π-stacking system with rectilinear propagation for hundreds of nanometers in length. The wire is mechanically stable and features superior nuclease resistance to double-stranded DNA. The study indicates the feasibility for programmed assembly of uninterrupted quadruplex DNA nanowires. This is fundamental to the systematic investigation of well-defined DNA nanostructures for uses in optoelectronic and electronic devices as well as other structural nanotechnology applications.

Expectant versus surgical management of first-trimester miscarriage: a randomised controlled study.

INTRODUCTION: The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first-trimester miscarriage. METHODS: This randomised prospective study was conducted in the Gynaecology Department at University of Saarland Hospital, Germany between February 2011 and April 2012. A total of 234 women were recruited following diagnosis of the first-trimester incomplete or missed miscarriage and randomised into two groups: 109 women were randomised to expectant management (group I), and 125 women to surgical management (groupII). All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to 4 weeks as appropriate. The outcome measures were: efficacy, short-term complications and duration of vaginal bleeding and pain. RESULTS: Of 234 eligible women, 17 were lost to follow-up, and the remaining 217 women were analysed. The baseline characteristics were similar in both groups. The total success rate at 4 weeks was lower for expectant than for surgical management (81.4 vs 95.7 %; P = 0.0029). The type of miscarriage was a significant factor affecting the success rate. For missed miscarriage, the success rates for expectant versus surgical management were 75 and 93.8 %, respectively. For women with incomplete miscarriage, the rates were 90.5 and 98 %. No differences were found in the number of emergency curettages between the two study groups. The duration of bleeding was significantly more in the expectant than the surgical management (mean 11 vs 7 days; P < 0.0001). The duration of pain was also more in the expectant than the surgical group (mean 8.1 vs 5.5 days; P < 0.0001). The total complication rates were similar in both groups (expectant 5.9 % vs surgical group 6.1 %; P = 0.2479). However, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively; P = 0.0146). CONCLUSION: Expectant management of clinically stable women with first-trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases, and has lower pelvic infection rate than surgical curettage. However, surgical management is more successful, and with a shorter duration of bleeding and pain. Therefore, the patient's preference should be considered in the counselling process.

Erk2 in ovarian development of green mud crab Scylla paramamosain.

We identified extracellular signal-regulated kinase 2 (erk2) from green mud crab, Scylla paramamosain, in this article. It was originally identified from an expressed sequence tag fragment from a normalized gonadal cDNA library. 5' Rapid amplification of cDNA end (RACE) technique was used to obtain the 5' untranslated region (UTR). The full-length cDNA of Sp-erk2 is 1516 bp, including a 5'-terminal UTR of 19 bp, an open-reading frame of 1098 bp, and a 3'-terminal UTR of 399 bp. The translated protein is 365 amino acids in length with a predicted molecular weight of 42 kDa, which is the same as other species. It is the first time that the expression of Sp-erk2 in different stages of ovary development of crustacean was analyzed, and the result showed that the expression of Sp-erk2 increased gradually with ovarian development, with a peak in the mature phase. In situ hybridization histochemistry was used to clarify the detail of expression. Positive signals illustrated that Sp-erk2 mRNA is present in follicular cells when the ovary is in early stages, and in both follicular cells and oocytes when it is in mature phases. All above suggest that Sp-erk2 is important for ovarian development.

Sulfhydryl modification induces calcium entry through IP3-sensitive store-operated pathway in activation-dependent human neutrophils.

As the first line of host defense, neutrophils are stimulated by pro-inflammatory cytokines from resting state, facilitating the execution of immunomodulatory functions in activation state. Sulfhydryl modification has a regulatory role in a wide variety of physiological functions through mediation of signaling transductions in various cell types. Recent research suggested that two kinds of sulfhydryl modification, S-nitrosylation by exogenous nitric oxide (NO) and alkylation by N-ethylmaleimide (NEM), could induce calcium entry through a non-store-operated pathway in resting rat neutrophils and DDT1MF-2 cells, while in active human neutrophils a different process has been observed by us. In the present work, data showed that NEM induced a sharp rising of cytosolic calcium concentration ([Ca²âº](c)) without external calcium, followed by a second [Ca²âº](c) increase with readdition of external calcium in phorbol 12-myristate 13-acetate (PMA)-activated human neutrophils. Meanwhile, addition of external calcium did not cause [Ca²âº](c) change of Ca²âº-free PMA-activated neutrophils before application of NEM. These data indicated that NEM could induce believable store-operated calcium entry (SOCE) in PMA-activated neutrophils. Besides, we found that sodium nitroprusside (SNP), a donor of exogenous NO, resulted in believable SOCE in PMA-activated human neutrophils via S-nitrosylation modification. In contrast, NEM and SNP have no effect on [Ca²âº](c) of resting neutrophils which were performed in suspension. Furthermore, 2-Aminoethoxydiphenyl borate, a reliable blocker of SOCE and an inhibitor of inositol 1,4,5-trisphosphate (IP3) receptor, evidently abolished SNP and NEM-induced calcium entry at 75 µM, while preventing calcium release in a concentration-dependent manner. Considered together, these results demonstrated that NEM and SNP induced calcium entry through an IP3-sensitive store-operated pathway of human neutrophils via sulfhydryl modification in a PMA-induced activation-dependent manner.

Effect of base sequence on g-wire formation in solution.

The formation and dimensions of G-wires by different short G-rich DNA sequences in solution were investigated by dynamic light scattering (DLS) and polyacrilamide gel electrophoresis (PAGE). To explore the basic principles of wire formation, we studied the effects of base sequence, method of preparation, temperature, and oligonucleotide concentration. Both DLS and PAGE show that thermal annealing induces much less macromolecular self-assembly than dialysis. The degree of assembly and consequently length of G-wires (5-6 nm) are well resolved by both methods for DNA sequences with intermediate length, while some discrepancies appear for the shortest and longest sequences. As expected, the longest DNA sequence gives the longest macromolecular aggregates with a length of about 11 nm as estimated by DLS. The quadruplex topologies show no concentration dependence in the investigated DNA concentration range (0.1 mM-0.4 mM) and no structural change upon heating.

Developing a telepresence robot for interpersonal communication with the elderly in a home environment.

"Telepresence" is an interesting field that includes virtual reality implementations with human-system interfaces, communication technologies, and robotics. This paper describes the development of a telepresence robot called Telepresence Robot for Interpersonal Communication (TRIC) for the purpose of interpersonal communication with the elderly in a home environment. The main aim behind TRIC's development is to allow elderly populations to remain in their home environments, while loved ones and caregivers are able to maintain a higher level of communication and monitoring than via traditional methods. TRIC aims to be a low-cost, lightweight robot, which can be easily implemented in the home environment. Under this goal, decisions on the design elements included are discussed. In particular, the implementation of key autonomous behaviors in TRIC to increase the user's capability of projection of self and operation of the telepresence robot, in addition to increasing the interactive capability of the participant as a dialogist are emphasized. The technical development and integration of the modules in TRIC, as well as human factors considerations are then described. Preliminary functional tests show that new users were able to effectively navigate TRIC and easily locate visual targets. Finally the future developments of TRIC, especially the possibility of using TRIC for home tele-health monitoring and tele-homecare visits are discussed.

Surveillance of bacterial pathogens of diarrhea disease in Indonesia.

Emerging or reemerging infections due to bacterial disease may be a local, regional or global problem. Bacterial acute gastroenteritis is a potential cause of substantial morbidity in travelers and deployed U.S. military personnel. A surveillance study was conducted over a two-year period in Indonesia among 6760 patients with debilitating diarrheal diseases. Of the 6,760 patients, 587 (9%) of the patient stools were positive for bacteria. The proportions of bacteria isolated from the 587 patients were: Shigella flexneri (39%), Salmonella spp. (26%), Vibrio spp. (17%), S. sonnei (7%), Campylobacter jejuni (4.4%), Salmonella typhi (3%) and S. dysenteriae (2.3%). Shigella flexneri was the most prevalent pathogen isolated, over Vibrio spp. No V. cholerae was isolated in the cities of Pontianak, Padang or Batam in Indonesia. Shigella dysenteriae reemergence was noted in Bali, Kalimantan, Batam and Jakarta after an absence of 15 years. Isolation of a high proportion of S. flexneri, and Vibrio spp. occurred during the rainy months. All bacterial isolates were susceptible to quinolones, with the exception of C. jejuni and Salmonella spp., which were resistant to ciprofloxacin, norfloxacin and nalidixic acid. Our findings highlight the decline of V. cholerae, the rise of S. flexneri and the reemergence of S. dysenteriae in Indonesia. The study also documents the emergence of quinolone-resistant Campylobacter spp. in the Indonesia archipelago.

Cholera in Indonesia in 1993-1999.

Cholera-specific surveillance in Indonesia was initiated to identify the introduction of the newly recognized Vibrio cholerae non-O1, O139 serotype. Findings from seven years (1993-1999) of surveillance efforts also yielded regional profiles of the importance of cholera in both epidemic and sporadic diarrheal disease occurrence throughout the archipelago. A two-fold surveillance strategy was pursued involving 1) outbreak investigations, and 2) hospital-based case recognition. Rectal swabs were transported to Jakarta for culture and isolates were characterized by serotypic identification. Outbreak findings showed that V. cholerae O1, Ogawa serotype, was the predominant etiology in all 17 instances of investigated epidemic transmission. Monitoring of eight hospitals representing seven provinces provided 6,882 specimens, of which 9% were culture positive for V. cholerae: 589 (9%) for O1 and 20 (< 1%) for non-O1 strains. Proportional representation of V. cholerae O1 among cases of sporadic diarrheal illness was variable, ranging from 13% in Jakarta to < 1% in Batam. Overall, 98% of V. cholerae O1 cases were the Ogawa serotype. There was no instance of non-O1, O139 serotype introduction in either epidemic or sporadic disease form. Anti-microbial drug susceptibility was consistently demonstrated, both temporally and spatially, except against colistin. Evidence is provided that epidemic and sporadic cholera occurrence in western Indonesia is associated with periods of low rainfall. Conversely, in the more eastern portion of the country, heavy rainfall may have contributed to epidemic cholera transmission.

The relationship between human papillomavirus and p53 gene in conjunctival squamous cell carcinoma.

PURPOSE: The p53 tumor-suppressor gene has been documented to exist in mutated forms in many types of squamous cell carcinoma in the body. Also in conjunctival squamous cell carcinoma, human papillomavirus (HPV) is accepted as an oncogenic factor. The objective of our study was to establish a correlation between p53 overexpression and the presence of HPV infection within tumor tissues from patients with conjunctival squamous cell carcinoma. METHODS: Tissue sections obtained from paraffin-embedded conjunctival squamous cell carcinoma specimens from 23 patients were examined with light microscopy, polymerase chain reaction (PCR), and immunohistochemistry. RESULTS: Seventy-eight percent of tumors were positive for p53, whereas 22% were positive for HPV. The proportion of patients positive for both p53 and HPV was 17%, whereas another 17% of the patients were negative for both p53 and HPV. Therefore no significant disproportion was found in the distribution of patients' HPV status and p53 status (p = 1.00). No significant correlation or linear association was found between the HPV status and p53 status (r = 0.022; p = 0.920). CONCLUSION: We could not show any statistical association between abnormal p53 gene-product expression by immunohistochemistry in conjunctival squamous cell carcinomas and HPV infection by PCR detection techniques.

Reasons for extraction of permanent teeth in Jordan.

This investigation was carried out to determine the reasons for extraction of permanent teeth in Jordan. A random sample of 200 Jordanian Dentists (1:10) were asked to record reasons for the extraction of permanent teeth during a two week period. Of the 139 dentists responding, only 97 dentists extracted teeth during the study period. A total of 934 teeth were extracted from 582 patients, of these 33.4 per cent were extracted for periodontal disease, and 27.6 per cent because of caries and its sequelae. The study suggests caries and its consequences affected tooth loss throughout life while the rate of tooth loss due to periodontal disease increases with age.