Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design.

Background: Meaningful research creates evidence for Infection Prevention and Control (IPC) practice. Aim: To establish Infection Prevention Society (IPS) members' research priorities to support future research projects. Methods: A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022-2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach. Findings/Results: 132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety (n = 84, 16.1%); IPC Training and Education (n = 77, 14.8%); and IPC Evidence-based Guidelines (n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes 'Patient Centred Care', 'Training and Education', 'IPC Role and Identity', 'IPC Leadership', 'IPC is Everyone's Responsibility', and 'Research Activity'. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas. Discussion: This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.

Patient specific quality assurance of volumetric modulated arc therapy of synchronous bilateral breast cancer.

Synchronous bilateral breast cancers (SBBC) present a considerable issue in external beam radiotherapy because of large fields size and large target volumes. Mono-isocentric volumetric modulated arc therapy (VMAT) appears as an appropriate irradiation technique for these types of tumors. The aim of this study was to demonstrate the utility of a 3D DVH pretreatment quality assurance program in VMAT of SBBC cases. Twenty SBBC patients who underwent radiation therapy in our department were retrospectively enrolled in this study. Fifteen patients were treated exclusively to the mammary glands. Five patients benefited from a dose boost on the tumor bed (60Gy). Nine patients were irradiated on the supraclavicular nodes (50Gy). This dose was delivered in 25 fractions and integrated boost was used when appropriate. Depending on the complexity of the treatment plans; 2 or 4 arcs VMAT plans were used in a mono-isocentric technique. The patient specific quality assurance (PSQA) was evaluated using COMPASS measured data, COMPASS reconstructed (CR) and COMPASS computed (CC) dose compared to treatment planning system (TPS) dose. Clinical evaluation was based on DVH metrics for target volumes and organ at risks. The maximum average dose deviation between TPS, CC, and CR was below 3%. The paired t-test between TPS, CC, and CR shows a strong agreement (p < 0.001). The 3DVH dose distribution comparison between TPS and COMPASS were also performed with good gamma score for global analysis. COMPASS was successfully evaluated as a 3DVH pretreatment system for SBBC despite the large fields size and complex target volumes. It allows the verification of the plan in 3D patient anatomy and the evaluation of dose discrepancies.

PRELIMINARY STAFF DOSE ASSESSMENT FOR COMMON FLUOROSCOPY GUIDED PROCEDURES AT KORLE-BU TEACHING HOSPITAL, ACCRA, GHANA.

Preliminary studies on effective and eye lens doses of six Radiologists, four Cardiologists have been conducted for a period of 3 months. Electronic dosemeters positioned under and over lead apron of staff were used for the dosimetry. The estimated effective dose per month to Cardiologist and Radiologist were 0.01-0.07 mSv and 0.03-0.14 mSv, respectively. The estimated eye lens doses per month to Cardiologists and Radiologists were also 0.15-0.30 mSv and 0.53-3.39 mSv, respectively. The effective doses per month to staff were below the ICRP acceptable limit of 1.67 mSv/month but the upper limit of the range of estimated eye lens dose exceeded the ICRP acceptable limit by a factor of 2. Regular use of protective goggles and consistent eye lens dose monitoring is encouraged at the hospital for dose optimization.

Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study.

OBJECTIVE: We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. DESIGN: Prospective cohort study. SETTING: Fistula Care Centre in Lilongwe, Malawi. POPULATION: Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment. METHODS: Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. MAIN OUTCOME MEASURES: Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. RESULTS: Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. CONCLUSIONS: While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. TWEETABLE ABSTRACT: Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.

RADIATION PROTECTION MEASURES TAKEN DURING REPATRIATION OF SEALED HIGH ACTIVITY RADIOACTIVE SOURCES IN CAMEROON.

Operational measures taken for the repatriation of Alcyon II 60Co Teletherapy head and El Dorado 6 60Co Teletherapy devices located in Yaounde and Douala respectively are reported. Operations carried out have permit to store Alcyon head in the CC 33 container and to transfer 60Co source from El Dorado 6 device to YKT1B container. These containers are approved as Type B package for securely transport. Optically stimulated luminescence dosimeters had been distributed to all involved persons to estimate the received effective dose during operations. It appears by the present study that, the most received individual effective dose is 130 µSv during the whole process.

Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study.

OBJECTIVE: Determine whether a 1-hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula (VVF) repair. DESIGN: Prospective cohort study. SETTING: Fistula Care Centre in Lilongwe, Malawi. POPULATION: Women with VVF who underwent repair between January 2012 and December 2014. METHODS: Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up. RESULTS: After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow up within 120 days of repair. Of these, 79.8% (n = 276) were completely continent, whereas 20.2% (n = 70) had some degree of incontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-g threshold demonstrates a high predictive value (PPV = 94.0%, 95% CI 90.0-96.9) in detecting women with continence after repair. CONCLUSIONS: At the 1.5-g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult. TWEETABLE ABSTRACT: A negative pad test after repair is associated with continued continence at follow up.

Cowpea pod (Vigna unguiculata) biomass as a low-cost biosorbent for removal of Pb(II) ions from aqueous solution.

The use of cowpea pod (CPP) biomass for the removal of Pb(II) ions from aqueous solution was investigated. The effects of factors such as dosage concentration (0.2 to 1.6 g L-1), pH (2 to 8), contact time (5 to 120 min), metal ion concentrations (10 to 80 mg L-1) and temperature (20 to 50 °C) were examined through batch studies. The biosorption data conformed best to the Langmuir model at the three working temperatures (20, 30 and 40 °C) as revealed by the correlation coefficients (R 2) which were greater than 0.940. The maximum sorption capacity of the CPP for Pb(II) was 32.96 mg g-1 at 313 K. Furthermore, the kinetic data fitted well to the pseudo-second-order model as it had the lowest sum of square error (SSE) values and correlation coefficients close to unity (R 2 > 0.999). The thermodynamic parameters (ΔG°, ΔS° and ΔH°) showed that the biosorption process was spontaneous, feasible and endothermic. The results obtained in the present study indicated that cowpea pod biomass could be used for the effective removal of Pb(II) from aqueous solution.

Investigating the effect of cadmium and aluminium on growth and stress-induced responses in the micropropagated medicinal plant Hypoxis hemerocallidea.

Hypoxis hemerocallidea is a highly utilized medicinal plant in South Africa. Its cultivation has received considerable attention in order to meet the high demand. High levels of cadmium (Cd) and aluminum (Al) in H. hemerocallidea plants sold in traditional medicinal markets was previously reported. The present study used an in vitro propagation model to investigate the uptake of Cd and Al by H. hemerocallidea and their effect on plant growth, elemental uptake and some stress-induced responses such as pigment, malondialdehyde (MDA), proline content and ultrastructural changes. Shoot and root growth of plantlets exposed to Cd, Cd:Al and high concentrations of Al was significantly reduced. Highest concentrations of Cd accumulated in the corms of Cd-treated plantlets while highest Al concentrations occurred in the leaves and roots. There was higher accumulation of Cd and Al when applied singularly compared to the Cd:Al combination treatments. Cd and Al also reduced accumulation of trace elements in micropropagted H. hemerocallidea with lowest concentrations in the Cd:Al combination treatments. Exposure to Cd, Al and Cd:Al significantly reduced the level of chlorophyll but increased the levels of carotenoids, MDA and proline. Ultrastructural changes were also observed in H. hemerocallidea exposed to Cd and Al. All these factors contributed to the inhibition of plant growth and could potentially affect the ability of this important medicinal plant to synthesize bioactive compounds. It is thus necessary to understand heavy metal stress-induced responses in this highly valued medicinal plant to ensure a high quality product for the consumer.

Association between parity and fistula location in women with obstetric fistula: a multivariate regression analysis.

OBJECTIVE: To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location. DESIGN: Cross-sectional study. SETTING: Fistula Care Centre at Bwaila Hospital, Lilongwe, Malawi. POPULATION: Women with OF who presented between September 2011 and July 2014 with a complete obstetric history were eligible for the study. METHODS: Women with OF were surveyed for their obstetric history. Women were classified as multiparous if prior vaginal or caesarean delivery was reported. The location of the fistula was determined at operation: OF involving the urethra, bladder neck, and midvagina were classified as low; OF involving the vaginal apex, cervix, uterus, and ureters were classified as high. MAIN OUTCOME MEASURES: Demographic information was compared between primiparous and multiparous women using chi-squared and Mann-Whitney U-tests. Multivariate logistic regression models were implemented to assess the relationship between variables of interest and fistula location. RESULTS: During the study period, 533 women presented for repair, of which 452 (84.8%) were included in the analysis. The majority (56.6%) were multiparous when the fistula formed. Multiparous women were more likely to have laboured <1 day (62.4 versus 44.5%, P < 0.001), delivered a live-born infant (26.8 versus 17.9%, P = 0.026), and have a high fistula location (37.5 versus 11.2%, P < 0.001). Multiparity [adjusted odds ratio (aOR) = 4.55, 95% confidence interval (CI) 2.27-9.12)] and history of caesarean delivery (aOR = 4.11, 95% CI 2.45-6.89) were associated with development of a high fistula. CONCLUSIONS: Multiparity was common in our cohort, and these women were more likely to have a high fistula. Additional research is needed to understand the aetiology of high fistula including potential iatrogenic causes. TWEETABLE ABSTRACT: Multiparity and caesarean delivery were associated with a high tract fistula in our Malawian cohort.

Intra-assay reliability and robustness of QuantiFERON(R)-TB Gold In-Tube test in Zambia.

BACKGROUND: Interferon-gamma (IFN-gamma) release assays (IGRAs), such as the QuantiFERON-TB Gold In-Tube test (QFT-GIT), are becoming a preferred method for diagnosis of tuberculosis (TB) infection in many industrialised countries. However, data on the effectiveness of IGRAs in high TB-HIV (human immunodeficiency virus) endemic and resource-limited settings, such as Zambia, are limited. OBJECTIVE: To determine the intra-assay reliability and robustness of QFT-GIT in a field setting in Zambia. DESIGN: During July-October 2007, 109 adult smear-positive TB patients were recruited to determine QFT-GIT reliability and the effect of a 24-h delay in incubation. Two simulated laboratory experiments were also performed using 9-14 volunteers, to explore the effect of power outages during incubation and storage temperature of collection tubes on IFN-gamma responses. RESULTS: QFT-GIT intra-assay concordance was 91.7% (kappa = 0.8). Discordance was observed for nine patients, of whom six were HIV-positive. There was evidence of an association between HIV status and discordant results (OR 1.98, 95%CI 1.06-3.67, P = 0.03). A 24-h delay in incubation changed results for 25 of the 109 (22.9%) patients. Power outages that altered incubation time reduced IFN-gamma responses. CONCLUSION: Although QFT-GIT seems reliable in this setting, we have identified operational factors that affect its robustness. These factors may influence the effectiveness of this test in similar resource-limited settings.

Anaesthetic effects of Adenia gummifera distillates on Apis mellifera (Honeybee).

The anaesthetic activities of steam distillates of Adenia gummifera stem on Apis mellifera were evaluated by a diffusion method. Live, direct and fractional (61-80 degrees C fraction) distillates had greater anaesthetic effect while vacuum distillates were mild. The anaesthetic activity significantly increased with concentration up to 6% (v/v), and then it levelled off, while excessive exposure was lethal. The number of bees in a given volume had no significant effect on anaesthetic activity but container volume (F(cal) = 66.4; F(3,8) = 4.07) and bee-distillate distance (F(cal) = 31.0; F(2,6) = 5.14) did, suggesting the rate of diffusion of active component could be the determining factor. The active component is likely to contain amines and the rest halogenated alkane.

Numerical and experimental results of the operational neutron dosemeter 'Saphydose-N'.

Since 1993, the Institute for Radiological Protection and Nuclear Safety (IRSN) has lead, in association with Electricité de France (EDF), a R&D study of a neutron personal electronic dosemeter. This dosemeter, called 'Saphydose-N', is manufactured by the SAPHYMO company. This paper presents first the optimisation of some detector components using Monte Carlo calculations, and second the test of the manufactured Saphydose-N under radiation following the IEC 1323 standard's recommendations for active personal neutron dosemeters. The measurements with the manufactured dosemeter were performed on the one hand at PTB (Physikalisch-Technische Bundesanstalt) in mono-energetic neutron fields and, on the other hand at IRSN in neutron fields generated by a thermal facility (SIGMA), radionuclide ISO sources and a realistic spectrum (CANEL/T400). The manufactured dosemeter Saphydose-N was also tested during measurement campaigns of the European programme EVIDOS ('Evaluation of Individual Dosimetry in Mixed Neutron and Photon Radiation Fields') at different nuclear workplaces. The study showed that Saphydose-N complies with the recommendations of standard IEC 1323 and can be used at any workplace with no previous knowledge of the neutron field characteristics.

Child sexual abuse in Matabeleland, Zimbabwe.

The extent, nature, causes and consequences of child sexual abuse in Matabeleland. Zimbabwe, are explored by an intersectoral working group consisting of health, legal and AIDS prevention workers who were struck in the course of their work by the regularity with which they saw sexually abused children infected with HIV and STDs. Methods used in this study are record review, focus group discussions, structured and in-depth interviews. Child sexual abuse cases form between 40-60% of the rape cases brought to the attention of hospitals, police and court and many more are believed to remain unreported. Half of the sexual abuse in children is detected through STDs and some have HIV. The majority of offenders are mature men known to the child. Factors influencing child sexual abuse are male dominance in society, men's professed inability to control sexual desire, and magic beliefs. Victims are traumatized by the abuse itself as well as by subsequent problems in family, health and in court. Since child sexual abuse may endanger the life and well-being of the child, it is a serious problem that requires urgent action.