Continued nursing education in low-income and middle-income countries: a narrative synthesis.

Introduction: Continued nursing education and development can reduce mortality and morbidity of patients and can alleviate the shortage of healthcare workers by training of nurses for high-demand skill sets. We reviewed patterns of educational interventions and strategies in initiating behaviour change, improving patient outcomes or knowledge for nurses in low- and middle-income countries (LMICs). Methods: The study searched the MEDLINE (PubMed), Embase, CINAHL, Google Scholar and Web of Science databases. The study included interventional studies on continued nursing education from 2007 to 2017. Of the 6216 publications retrieved, 98 articles were included and analysed by three independent reviewers. Results: Of the 98 studies that met inclusion criteria, five were randomised controlled trials, two were qualitative in design and the remaining 91 were quasi-experimental, before-and-after studies. Of these studies, the median sample size of participants was 64, and the majority were conducted in Asia (53.1%). During the 10-year study period, 20.4% was conducted in 2015, the highest proportion, with a general increase in number of studies over time from 2007 to 2017. Main themes that arose from the review included train-the-trainer models, low-dose/high-frequency models, use of multiple media for training, and emphasis on nurse empowerment, strong international partnerships, and the integration of cultural context. Overall, the studies were limited in quality and lacked rigorous study design. Conclusion: Continued nursing education in LMICs is essential and effective in improving nurses' knowledge base, and thus patient outcomes and quality of care. Long-term, randomised studies are needed to understand how training strategies compare in impact on nurses and patients.

Fluorescence intensity ratio stereoscopic transform.

A novel approach to 3-D information processing of 2-D cell images is presented, called fluorescence intensity ratio stereoscopic transform (FIRST). Here, we describe its basic principle of image processing and show the results for the ratio of total internal reflection fluorescence (TIRF) to fluorescence intensity. A simple, intuitive transform algorithm would help us to easily obtain a clear stereoscopic image from two 2-D cell images with different fluorescence intensity. For this purpose, nonlinear evanescent-field (EF) imaging of cell-membrane surface and its intracellular structures by using on-chip grating coupler is achieved. This method enabled us to obtain cell images with different signal-to-background ratio and resolution under microfluidic environments. Specifically, we manipulated optic pathway to partially illuminate microscale objects within the microfluidic channel. These findings imply this method will enable selectively to detect optical signals of biomolecular interaction within the cell membrane in a controlled manner. Furthermore, we believe this approach will help to develop an optofluidic sensor for individually detecting dynamic behaviors of intracellular molecules in living cells under microfluidic cell culture environments.

Simultaneous counting of two subsets of leukocytes using fluorescent silica nanoparticles in a sheathless microchip flow cytometer.

A portable flow cytometer has been recognized as an important tool for many clinical applications such as HIV/AIDS screening in developing countries and regions with limited medical facilities and resources. Conventional flow cytometers typically require multiple detectors for simultaneous identification of multiple subsets of immune cell. To minimize the number of detectors toward portable flow cytometry or to analyze multi-parametric cellular information with minimum number of detectors in conventional flow cytometers, we propose a versatile multiplexed cell-counting method using functional silica nanoparticles (SiNPs). FITC-doped SiNPs, which are 100 times brighter than the FITC molecules itself, were used as new intensity-based fluorescent dye complexes to simultaneously measure two subsets of leukocytes using a single detector. CD45(+)CD4(+) cells tagged with these FITC-doped SiNPs were 50 times brighter than CD45(+)CD4(-) cells tagged only with FITC. To make the overall system compact, a disposable microchip flow cytometer that does not require sheath flow was developed. Combining these dye-doped SiNPs based detection schemes and the sheathless microchip flow cytometer scheme, we successfully identified and counted two subsets of leukocytes simultaneously (R(2) = 0.876). These approaches can be the building blocks for a truly portable and disposable flow cytometer for various clinical cytometry applications.

An impulsive, electropulsation-driven backflow in microchannels during electroporation.

We describe for the first time an impulsive, electropulsation-driven backflow in microchannels for on-chip cell electroporation.