Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study.

Background: Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives: To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods: An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. Results: A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion: The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. Contributions of the study: The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.

A bibliometric review of peripartum cardiomyopathy compared to other cardiomyopathies using artificial intelligence and machine learning.

As developments in artificial intelligence and machine learning become more widespread in healthcare, their potential to transform clinical outcomes also increases. Peripartum cardiomyopathy is a rare and poorly-characterised condition that presents as heart failure in the last trimester prior to delivery or within 5-6 months postpartum. The lack of a definitive understanding of the molecular causes and clinical progress of this condition suggests that bibliometrics will be well-suited to creating new insights into this serious clinical problem. We examine similarities and differences between peripartum and its closely related familial dilated cardiomyopathy and idiopathic dilated cardiomyopathy. Using PubMed as the source of bibliometric data, we apply artificial intelligence-supported natural language processing to compare extracted data and genes association with these cardiomyopathies. Gene data were enhanced with additional metadata from third-party datasets and then analysed for their impact and specificity for peripartum cardiomyopathy. Artificial intelligence identified 14 genes that distinguished peripartum from both dilated and familial dilated cardiomyopathy. They are as follows: CTSD, RLN2, MMP23B*, SLC17A5, ST2*, PTHLH, CFH*, CFI, GPT, MR1, Rln1, SRI, STAT5A* and THBD. We then used the Human Protein Atlas website that uses affinity-purified rabbit polyclonal antibodies to identify genes that are expressed at the protein level (bold), or as RNA transcripts (*) in healthy human left ventricles. Additional analysis focussed on the full set of peripartum genes on linkage and specificity to cardiomyopathy yielded a different set of thirteen genes (bold font indicates those expressed in cardiomyocytes: PRL, RLN2, PLN, ST2, CTSD, F2, ACE, STAT3, TTN, SPP1, LGALS3, miR-146a, GNB3, SRI). This type of analysis can highlight new avenues for research, aimed at improving genomics-driven peripartum cardiomyopathy diagnosis as well as potential pathological and clinical sub-classification. We expect that this will allow for future improvements in identification, treatment and management of this condition. The first step in the application of these bibliometric-based artificial intelligence methods is to understand the current knowledge, and it is the aim of this paper to show how this might be achieved.

A novel nicastrin mutation in a three-generation Dutch family with hidradenitis suppurativa: a search for functional significance.

BACKGROUND: Mutations in the γ-secretase enzyme subunits have been described in multiple kindreds with familial hidradenitis suppurativa (HS). OBJECTIVE: In this study, we report a novel nicastrin (NCSTN) mutation causing HS in a Dutch family. We sought to explore the immunobiological function of NCSTN mutations using data of the Immunological Genome Project. METHODS: Blood samples of three affected and two unaffected family members were collected. Whole-genome sequencing was performed using genomic DNA isolated from peripheral blood leucocytes. Sanger sequencing was done to confirm the causative NCSTN variant and the familial segregation. The microarray data set of the Immunological Genome Project was used for thorough dissection of the expression and function of wildtype NCSTN in the immune system. RESULTS: In a family consisting of 23 members, we found an autosomal dominant inheritance pattern of HS and detected a novel splice site mutation (c.1912_1915delCAGT) in the NCSTN gene resulting in a frameshift and subsequent premature stop. All affected individuals had HS lesions on non-flexural and atypical locations. Wildtype NCSTN appears to be upregulated in myeloid cells like monocytes and macrophages, and in mesenchymal cells such as fibroblastic reticular cells and fibroblasts. In addition, within the 25 highest co-expressed genes with NCSTN we identified CAPNS1, ARNT and PPARD. CONCLUSION: This study reports the identification a novel NCSTN gene splice site mutation which causes familial HS. The associated immunobiological functions of NCSTN and its co-expressed genes ARNT and PPARD link genetics to the most common environmental and metabolic HS risk factors which are smoking and obesity.

Knowledge and practices of radiographers regarding infection control in radiology departments in Malawi.

INTRODUCTION: Adherence to standard infection control precautions (SICP) by radiographers is critical in combating healthcare associated infections (HAIs). Therefore, radiographers need to have adequate knowledge and practices of infection control if they are to contain the magnitude of HAIs. METHODS: Purposive, all-inclusive sampling was used to recruit 62 radiographers from four government referral hospital in Malawi. Radiographers' knowledge and practices of infection control were determined using a self-administered questionnaire. Data collection was carried out in January 2017. Descriptive (e.g. mean and standard deviation) and inferential (Chi2 test) statistics were generated using an MS Excel VBA application. RESULTS: The majority of the respondents (84%) were between 20 and 39 years of age. The study results revealed that radiographers in the four hospitals had mean infection control score (percentage) of 76.8 ± 12.6 for knowledge and a mean infection control score of 65.3 ± 16.1 for practice. A slight significant association between age and knowledge (p < 0.05; Cramer's V 0.26) was found in that radiographers between 40 and 59 years of age (majority of the sample) obtained higher knowledge scores than those 20-39 years of age. CONCLUSION: Given the results, further training is required regarding infection control among radiographers in radiology departments in Malawi. A guideline for infection control, specifically contextualised to be used by radiographers in radiology departments in Malawi, should be developed and implemented to enhance adherence to SICP in these departments.

Food insecurity, social welfare and low birth weight: Implications for childhood malnutrition in an urban Eastern Cape Province township

Background. Limited information is available regarding the impact of food insecurity, low birth weight (LBW) and the protective effect of the child support grant (CSG) on malnutrition in South Africa (SA).Objectives. To describe malnutrition in the context of food insecurity, CSG and LBW history among children younger than 24 months from an underprivileged urban settlement in the Eastern Cape Province of SA.Methods. A descriptive study using a cross-sectional design was used to collect data from a non-probability sample of 400 young children from October 2015 to February 2016. Inferential statistics included t-tests to compare anthropometric data from different birth weight categories and analysis of covariance (ANCOVA) to allow for the effect of covariates.Results. Of the sample, 9% were stunted, 1% were wasted, 16% were overweight, 23% were food secure, 47% were at risk of hunger, and 31% were classified as hungry. LBW history was significantly associated with stunting but not with wasting. CSG holders and 'hungry'households' children had significantly lower mean height-for-age z-scores (HAZ) than non-CSG holders and food-secure households.Despite these apparent associations, when LBW is considered as a covariate, it becomesapparent that neither the CSG nor CCHIP category is significantly related to any of the anthropometric indicators. Conclusion. The Department of Health has to recognise the significant impact of LBW on the prevalence of stunting and thus the need to prioritise antenatal care. Policymakers could aim to make the CSG available to mothers as close after birth as possible, or during pregnancy,in order to be more effective in reducing the long-term effects of LBW

MALDI-TOF MS meets WGS in a VRE outbreak investigation.

The use of MALDI-TOF MS (matrix-assisted laser desorption/ ionization-time of flight mass spectrometry) and WGS (whole genome sequencing) has been described for identification and strain relatedness determination. We describe the complementary use of MALDI-TOF MS and WGS in a VRE (vancomycin-resistant enterococci) outbreak investigation, and discuss some of the challenges with defining strain similarity across these two platforms. Although both assays indicated multiple clusters involved in the outbreak of vancomycin resistant Enterococcus faecium isolates from positive blood cultures of four haematology-oncology patients, the small cohort and discrepancies between findings indicate the limitations of MALDI-TOF MS and the cautious interpretation of MALDI-TOF MS dendrograms during outbreaks. For definitive determination of the evolutionary distance between isolates, WGS can be used.

Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa.

The HIV prevalence in South Africa among students at higher education institutions (HEIs) in 2008 was reported to be 3.4%, with the highest HIV prevalence found in the Eastern Cape Province. Students at these facilities are also increasingly affected by socio-economic constraints that may impact on food security. Little is known about the impact of food insecurity on HIV-infected students in HEIs in South Africa. The purpose of this paper is to describe food insecurity and the nutritional status among HIV-infected students on the Nelson Mandela Metropolitan University campuses in South Africa, as well as current initiatives to strengthen the safety nets for food-insecure students. This descriptive, cross-sectional survey was conducted among a convenience sample of known HIV-infected, registered students (n = 63), older than 18 years of age and managed as part of the Campus Health Service antiretroviral therapy (ART) programme. Ethical approval for the study was obtained from the Research Ethics Committee (NMMU) and participants were included in the sample after providing written, informed consent. Findings indicate that food insecurity was common with more than 60% of the sample reporting food insecurity at the household level during the previous month. Of the sample, 51% were classified as being either overweight or obese. Although food insecurity did not contribute to weight loss in our sample, food-insecure students were more likely to consume inadequate amounts of vitamins and minerals, especially antioxidants that are important in supporting the immune system. Food insecurity has been identified as affecting the majority of HIV-infected students in this study, especially regarding their difficulty in accessing nutritious foods. As overweight and obesity also seem to threaten the health and future well-being of the students, appropriate management of the overweight individuals and those with obesity should be instituted in order to prevent the development of chronic diseases of lifestyle, thus allowing for a healthier more productive life. Current intervention strategies to strengthen food security have made inroads to improve access to healthier food options.

The role of defensive ecological interactions in the evolution of conotoxins.

Venoms comprise of complex mixtures of peptides evolved for predation and defensive purposes. Remarkably, some carnivorous cone snails can inject two distinct venoms in response to predatory or defensive stimuli, providing a unique opportunity to study separately how different ecological pressures contribute to toxin diversification. Here, we report the extraordinary defensive strategy of the Rhizoconus subgenus of cone snails. The defensive venom from this worm-hunting subgenus is unusually simple, almost exclusively composed of αD-conotoxins instead of the ubiquitous αA-conotoxins found in the more complex defensive venom of mollusc- and fish-hunting cone snails. A similarly compartmentalized venom gland as those observed in the other dietary groups facilitates the deployment of this defensive venom. Transcriptomic analysis of a Conus vexillum venom gland revealed the αD-conotoxins as the major transcripts, with lower amounts of 15 known and four new conotoxin superfamilies also detected with likely roles in prey capture. Our phylogenetic and molecular evolution analysis of the αD-conotoxins from five subgenera of cone snails suggests they evolved episodically as part of a defensive strategy in the Rhizoconus subgenus. Thus, our results demonstrate an important role for defence in the evolution of conotoxins.

Splenic implant assessment in trauma.

Trauma is a global health issue, being the 4th death cause after cardio-vascular disease, malignancies and chronic pulmonary diseases and the main death cause among young people, under 45 years (1). The frequency of abdominal trauma is 10-12% of all polytrauma, and from all abdominal organs, the spleen and liver are the most often involved in polytraumatized patients case (2). The first purpose of a successful operational management is the control of active bleeding, and the second is preserving as much as possible of the destroyed organs. Over the last decades, the treatment of spleen traumas had been diversified,from nonsurgical treatment to surgical, also complex and diversified: from conservative treatment to splenectomy.Currently, from a therapeutic standpoint, the trends in spleen trauma are orientated towards conservative methods as the clinical and experimental data have shown that €œit is better with the entire spleen than part of it, and better with a part of it than with none at all (Raymond Hinshaw) (3).

Grade IV blunt splenic injury--the role of proximal angioembolization. A case report and review of literature.

The authors present a case of grade IV traumatic spleen rupture (AAST-OIS) and an Injury Severity Score of 21 and a Revised Trauma Score RTS=7.841, which was managed without surgery, but with proximal splenic angioembolization (SAE), with a positive outcome. Indications, types and side-effects of SAE are also discussed with regard to blunt spleen trauma and the benefits of SAE as non-operative treatment approach. It is the first case of a grade IV splenic laceration non-operatively managed to be published in Romania.

The Physical Activity and Health Status of Two Generations of Black South African Professional Women

Increased health risks associated with physical inactivity in the Black population have been reported in recent years. Black women; suffering the highest levels of inactivity; overweight and obesity; are at greatest risk of developing chronic diseases of lifestyle. This explorative-descriptive study investigated the physical activity patterns and health status of two generations of Black professional women; reflecting pre-democracy and post-democracy age groups. Quantitative measures were used; including the ActiGraph GT1M accelerometer; the Global Physical Activity Questionnaire and the Health-Promoting Lifestyle Profile. Sample groups comprised teachers; nurses; social workers and public sector managers. Participants aged between 35 and 45 years were allocated to the older generation group (n = 111); whilst those aged between 18 and 21 years (students in the mentioned professional fields) were allocated to the younger generation group (n = 69). The results indicated that these women displayed lower levels of health-promoting behavioural practices than expected; significantly lower levels of physical activity and significantly higher levels of overweight and obesity than the South African norms. The observation that the younger group appeared to be replicating the patterns of the older women is a cause of concern. Greater compliance to health-promoting behaviours was expected in this group owing to participants' professional involvement in health; education and social development fields. Wide-ranging initiatives are necessary to promote physical activity and health amongst the Black female population in South Africa

[Selective nonoperative management of solid abdominal visceral lesions]. / Managementul selectiv nonoperator al leziunilor viscerale parenchimatoase in traumatismele abdominale.

Selective nonoperative management of abdominal visceral lesions is one of the most important and challenging changes that occurred in the traumatized patient care over the last 20 years. The main advantage of this type of management is the avoidance of unnecessary/nontherapeutic laparotomies. The trauma surgeons who deal with this type of treatment are worried of missed abdominal injuries. Modern diagnostic tools (spiral CT, ultrasound, angiography, laparoscopy) allow the trauma surgeon to accurately characterize the lesions to be nonoperative addressed. This literature review discusses the main elements of selective nonoperative management of principle solid visceral lesions (liver, spleen, kidney). We highlight the advantages and limitations of the main diagnostic instruments used for evaluation of trauma patiens allocated to nonoperative management.

[Splenic angioembolization--a safe, efficient and rational approach]. / Angioembolizarea terapeutica în trauma splenica--eficienta, sigura si rationala.

The authors present a case of postraumatic splenic rupture grade III (AAST-OIS), with injury severity score 10, revised trauma score 7841 managed nonoperatively, by angioembolization, with successful outcome. The indications and different types of splenic angioembolization in trauma are discussed, together with the role of this procedure in increasing the success rate of nonoperative management. Up to our knowledge, this is the first reported case of therapeutic splenic angioembolization in the Romanian medical literature.

First outbreak of PVL-positive nonmultiresistant MRSA in a neonatal ICU in Australia: comparison of MALDI-TOF and SNP-plus-binary gene typing.

The purpose of this brief report is to describe the first outbreak of a community-associated nonmultiresistant and PVL-positive MRSA strain (CC30) in a neonatal intensive care unit in Australia. The utility of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) for microbial typing is compared with single nucleotide polymorphism (SNP) plus binary gene analysis. The composite correlation index analysis of the MALDI-TOF-MS data demonstrated the similar inter-strain relatedness found with the SNP-plus-binary gene typing used to confirm the outbreak. The evolving spread of MRSA emphasizes the importance of surveillance, infection control vigilance and the ongoing investigation of rapid typing methods for MRSA.

Therapeutic use of growth factors in the musculoskeletal system in sports-related injuries.

Growth factors (GFs) act as signalling agents for cells and become a more and more popular mean to influence the human body and its tissues. This review gives an overview of the current possibilities to use such agents in the field of sports related injuries and thus providing the athlete with a whole new potential to minimize recovery time. GFs and its application have been studied intensively for a long time starting with animal studies. For some of this GFs this research has been brought onto the next level to clinical phase trials. Agents such as insulin like growth factor 1 (IGF-1), mechano growth factor (MGF), basic fibroblast growth factor (B-FGF), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor b (TGF-b), bone morphogenetic protein (BMP) and leukemia inhibitory factor (LIF) are being discussed in this review. These GFs not only have the potential to be used to cure injuries but also are being in the centre of interest for doping abusers and are a powerful yet not fully understood technique to gain performance.

[Non-surgical management of patients with blunt abdominal injury: the role of angiography]. / Aspecte ale tratamentului non-operator al traumatismelor abdominale închise: rolul angiografiei.

OBJECTIVE: We evaluated the efficacy of nonsurgical management of patients with blunt hepatic or renal injury using detailed angiographic examinations and transcatheter arterial embolization. METHODS: The study comprises 5 patients: 3 patients with blunt hepatic injury and 2 patients with blunt renal injury. All patients had CT evidence of hepatic injury, respectively renal injury. In one case with hepatic injury, emergency laparotomy was performed before angiography because of unstable circulatory status. DSA-angiography identified the site of bleeding in all patients, followed by selective embolization with particles of TachoComb. Nonsurgical treatment of hepatic or renal injury with transcatheter arterial embolization was successful in all patients. CONCLUSIONS: Our success rate for nonsurgical management of patients with blunt injury to solid abdominal organs should more extensive evaluation and use of angiography for solid abdominal organs injury and the subsequent management of solid abdominal organs injury without surgery.

International Olympic Committee consensus statement: molecular basis of connective tissue and muscle injuries in sport.

Tendon and ligament injures cause significant loss of performance in sport and decreased functional capacity in the workplace. Many of these injures remain difficult to treat, and many individuals have long-term pain and discomfort. Animal studies of growth factor and cell-based therapies have shown promising results, but these treatments also can be misused to enhance athletic performance. The International Olympic Committee (IOC) now has high-level scientific advisors who can advise the IOC as to the use and abuse of these technologies.

The pharmacological effects of ozone on isolated guinea pig tracheal preparations.

Ozone is a potent oxidizing agent with a variety of potential uses, including its antimicrobial and deodorising properties. The recent increased use of ozone led to questions regarding its safety in humans. This study specifically focussed on the in vitro effect of ozone on isolated guinea pig tracheal tissue as well as its effect on the isolated trachea in the presence of various drugs with well-known effects, including methacholine and isoproterenol. The results found in this study identified two direct effects on the isolated trachea due to ozone exposure: (1) a definite contraction of the isolated trachea immediately after exposure to ozone, and (2) a clearly visible and significant hyper responsiveness of the isolated trachea to irritants, e.g. methacholine. Although ozone has a negative effect on the trachea, it was concluded that ozone has no adverse effect on muscarinic receptors. We found that ozone has a significant desensitizing effect on the pharmacological response of beta sympathomimetics (isoproterenol), while isoproterenol itself has a relaxing effect on the ozone-induced contraction of the isolated trachea. Observations in this in vitro study further emphasised that ozone does have a negative effect on respiratory health. It is underlined that the inhalation of ozone should be avoided by workers who are often in contact with the gas, and especially by those with existing airway diseases. An apparent EC(50) value of ozone on the trachea was established by two different methods as 5.71 and 9.78 x 10(-3 )M, respectively.

Public Perception of Community Pharmacists in South Africa : Primary Study

This survey forms part of a study undertaken to identify and quantify the community pharmacist's involvement in the use of non-prescription/over-the-counter (OTC) medicine /self-medication in community pharmacies throughout South Africa. The objectives of this study were to establish the public's perception of the role of and the value added by community pharmacists in the treatment of minor ailments. A survey was conducted amongst 300 consumers prior to the recent changes and introduction of new legislation affecting pharmaceutical care and the dispensing of medicine. The major finding of this study was that the majority of consumers who consulted community pharmacists were satisfied with the comprehensiveness of the counselling and the effectiveness of the treatment provided. A large majority of the participants agreed that community pharmacists play a positive role and add value. It was found that the main reason for visiting a specific pharmacy was the proximity of that pharmacy