Peer Tutoring Interventions for Students With or At-Risk for Emotional and Behavioral Disorders: A Systematic Review of Reviews.

This systematic review of reviews is the first to summarize peer tutoring outcomes for students with or at-risk for emotional and behavioral disorders (EBD). Eleven narrative literature reviews, three systematic reviews, and two meta-analyses of peer tutoring interventions that met inclusion criteria were summarized. Participants across the 16 reviews included more than 2,404 students with or at-risk for EBD in pre-kindergarten through grade 12 across 73 individual, unduplicated studies. Findings support the efficacy of peer tutoring for students with or at-risk for EBD regarding academic and behavioral outcomes. Lessons learned, and implications for research and practice derived from these reviews are provided.

Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department.

Background: Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods: A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results: Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.

Correction: Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital.

[This corrects the article DOI: 10.1371/journal.pone.0207138.].

The Impact of School Bullying on Physical Activity in Overweight Youth: Exploring Race and Ethnic Differences.

BACKGROUND: About one third of youth in the United States are overweight or obese and African American youth are at an increased risk for pediatric overweight and obesity as well as their complications. Physical activity has been identified as one determinant of overweight and obesity, and school bullying has been found to be associated with decreased physical activity. Guided by the Transactional Stress and Coping Model, this study examines how school bullying might impact the physical activity of white and African American healthy weight and overweight youth. METHODS: Existing, nationally representative, and complex survey data (N = 4509) from the 2005-2006 United States Health Behavior in School-Aged Children (HBSC) were analyzed using multiple group structural equation modeling to evaluate study questions. RESULTS: Support for the hypothesized model was found such that bullying negatively impacted physical activity by way of increasing internalizing symptoms. Possible evidence for parental support, but not peer support, as a protective factor was also found. Results were generally similar for all groups, though some differences are discussed. CONCLUSION: School bullying is a risk factor for reduced physical activity, regardless of race-ethnicity and weight. Implications for school health professionals are discussed.

Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital.

BACKGROUND: Clostridium difficile (CD) is the leading cause of infectious health-care associated diarrhea. However, little is known regarding CD carriage and transmission amongst asymptomatic colonizers. We evaluated carriage, characterized strains and examined epidemiologic linkages in asymptomatic colonized CD patients. METHODS: Rectal swabs from asymptomatic patients admitted to the general medicine ward from April 1-June 30 2012 were collected. PCR-confirmed CD colonies were ribotyped and characterized by Modified-Multi Locus Variable Number Tandem Repeat Analysis (MMLVA). RESULTS: 1549-swabs were collected from 474-patients. Overall, 50/474(10.6%) were CD PCR-positive, 24/50 were colonized at admission, while 26/50 were first identified > = 72 hours after admission. Amongst the 50 CD PCR-positive patients, 90% were asymptomatically colonized and 80% of individuals carried toxigenic CD-strains, including ribotype-027 (5/45:11%). MMLVA revealed five-clusters involving 15-patients harboring toxigenic (4/5) and non-toxigenic CD strains (1/5). In two clusters, patients were CD positive on admission while in the other three clusters involving 10 patients, we observed CD transmission from asymptomatically colonized patients to 8 previously CD-negative patients. CONCLUSIONS: We identified increasing rates of colonization during admission to medical wards. MMLVA typing effectively discriminated between strains and suggests that 20% of patients with CD colonization acquired their strain(s) from asymptomatically colonized individuals in hospital.

Unit-Specific Rates of Hand Hygiene Opportunities in an Acute-Care Hospital.

OBJECTIVE To explore the frequency of hand hygiene opportunities (HHOs) in multiple units of an acute-care hospital. DESIGN Prospective observational study. SETTING The adult intensive care unit (ICU), medical and surgical step-down units, medical and surgical units, and the postpartum mother-baby unit (MBU) of an academic acute-care hospital during May-August 2013, May-July 2014, and June-August 2015. PARTICIPANTS Healthcare workers (HCWs). METHODS HHOs were recorded using direct observation in 1-hour intervals following Public Health Ontario guidelines. The frequency and distribution of HHOs per patient hour were determined for each unit according to time of day, indication, and profession. RESULTS In total, 3,422 HHOs were identified during 586 hours of observation. The mean numbers of HHOs per patient hour in the ICU were similar to those in the medical and surgical step-down units during the day and night, which were higher than the rates observed in medical and surgical units and the MBU. The rate of HHOs during the night significantly decreased compared with day (P92% of HHOs on medical and surgical units, compared to 67% of HHOs on the MBU. CONCLUSIONS Assessment of hand hygiene compliance using product utilization data requires knowledge of the appropriate opportunities for hand hygiene. We have provided a detailed characterization of these estimates across a wide range of inpatient settings as well as an examination of temporal variations in HHOs. Infect Control Hosp Epidemiol 2017;38:411-416.

Evaluation of the reproducibility of the Naranjo Adverse Drug Reaction Probability Scale score in published case reports.

STUDY OBJECTIVE: To assess the reproducibility of Naranjo Adverse Drug Reaction Probability Scale (APS) scores in published case reports. DESIGN: Reliability analysis. MEASUREMENTS AND MAIN RESULTS: Randomly selected case reports using the APS were identified from the Web of Science database. The APS scores were blinded from the case reports, and scores were then independently calculated by four raters, using the APS. The percentage of exact agreement between raters' and the published APS scores was calculated for all case reports. Categorical scores were compared by using a weighted κ statistic. For numerical scores, descriptive statistics were computed by using raw and absolute difference scores. Twenty-four case reports were independently scored by four raters. Exact agreement between all raters' scores and the published APS scores was found in five (21%) of the 24 reports. Agreement between individual rater's scores and the published categorical score ranged from 42% to 79%. Weighted κ ranged from 0.12 to 0.61, corresponding to strengths of agreement between poor and good. Difference in scoring by raters resulted in 18% and 27% of case reports being reclassified into higher and lower than reported APS categories, respectively. CONCLUSION: Exact agreement between raters' scores and the published APS score was infrequent. We recommend that authors of case reports include all pertinent details of the case and that journals ensure the robustness of the causality assessment during peer review.

Rate of healthcare worker-patient interaction and hand hygiene opportunities in an acute care setting.

OBJECTIVE: Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital. DESIGN: Prospective observational study. SETTING: Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012. PARTICIPANTS: Healthcare workers. METHODS: One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the "Four Moments for Hand Hygiene." Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day. RESULTS: During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions. CONCLUSIONS: Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.

Use of audit and feedback with fluorescent targeting to achieve rapid improvements in room cleaning in the intensive care unit and ward settings.

Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission of clinically significant pathogens; thus, such surfaces should be cleaned routinely and thoroughly. Fluorescent targeting can be used to provide feedback to frontline cleaning staff on the thoroughness of room cleaning, which can result in substantial improvements in performance. We demonstrate that auditing with fluorescent targeting can be implemented in both the ward and intensive care unit settings using only modest resources, resulting in rapid improvements in cleaning thoroughness.

First reproductive experience persistently affects spatial reference and working memory in the mother and these effects are not due to pregnancy or 'mothering' alone.

Pregnancy and motherhood are life-altering events that result in a number of hormonal, neural and behavioral changes in the mother. Motherhood has been shown to influence spatial learning and memory performance of the mother. In turn new research has shown that reproductive experience (number of times pregnant and mothered) plays a significant role on spatial learning and memory performance. How long these changes persist after weaning and the role of pregnancy and/or mothering on these changes have yet to be fully investigated. The present study aimed to determine whether enhanced spatial working and/or reference memory in the mother is evident long after weaning and whether these effects are due, in part, to pregnancy or 'mothering' alone. Five groups of age-matched rats: multiparous, primiparous, nulliparous, pregnant-only and sensitized rats were tested approximately 1 month after weaning/pup-exposure, or 55 days after birth, on the spatial working/reference version of the radial arm maze. Results show that regardless of error type (reference or working memory errors), primiparous rats make fewer errors compared to multi- and nulli-parous rats, with a trend to enhanced memory compared to sensitized rats. In addition, pregnant-only rats completed the task on significantly fewer days than primiparous, multiparous, nulliparous and sensitized rats. Clearly the combination of first pregnancy and first mothering experience has a significant impact on hippocampus-dependent learning and memory performance in the mother.