The effect of Universal Teacher-Child Interaction Training on Hispanic teachers' sense of self-efficacy in early childhood education and care settings.

Disparities exist in the availability of high-quality early childhood education and care settings (ECEC) across communities within the United States. Teachers have an imperative role in fostering children's socioemotional development; however, when the classroom climate deteriorates due to disruptive behavior, meeting these emotional and learning needs becomes more difficult. Dealing with challenging behaviors can lead to emotional exhaustion which is directly linked to a decrease in teacher sense of efficacy. Teacher-Child Interaction Training-Universal (TCIT-U) targets teachers' skills to provide quality interactions and decrease child behavior problems. Despite evidence that teacher sense of self-efficacy can inhibit negative teaching practices, a lack of research has explored this construct as related to TCIT-U. The current study is a randomized, wait-list control study measuring the change of teachers' sense of self-efficacy after participating in TCIT-U, and the first known of its kind. The study included mostly Hispanic (96.4%) teachers (N = 84) of ECEC programs across 13 unique sites serving 900 children ages 2-5 years from low-income, urban areas. Results from inferential statistics and hierarchical linear regression tests demonstrated TCIT-U as an effective intervention to improve teachers' sense of efficacy in classroom management, instructional strategies, and student engagement. In addition, this study contributes to the effectiveness of TCIT-U as an in-service training which targets teacher communication skills for teachers with diverse backgrounds in ECEC settings with mostly dual language learners.

Interstitial lung disease associated to erlotinib treatment: a case report.

INTRODUCTION: Few cases of pulmonary toxicity related to epidermal growth factor receptor-targeted agents have been described. CASE PRESENTATION: We report a case of a 63-year-old white male with stage IV non-small cell lung cancer treated with erlotinib who developed a interstitial lung disease. CONCLUSION: Respiratory symptoms during treatment with erlotinib should alert clinicians to rule out pulmonary toxicity. Early erlotinib withdrawal and corticoid administration were successful.

Políticas públicas para el recurso humano en salud, en Colombia: Elementos para la reflexión / Public Policy for Human Resource in Health in Colombia: Elements for reflection / Políticas públicas para o recurso humano em saúde na Colômbia: Elementos para Refletir

Desde los referentes internacionales soportados en las recomendaciones de la Organización Internacional del Trabajo (OIT), el presente artículo revisa la trascendencia de las políticas y convenios existentes para la protección del trabajador nocturno en general y del trabajador nocturno del área de la salud en particular, se consideran las influencias de los procesos de globalización en la generación de las políticas económicas y su impacto en las políticas sociales. Se analiza la influencia que desde la globalización induce la mercantilización de la fuerza laboral y del capital humano del sector salud y cómo estas presiones ejercen un efecto de carácter biopsicosocial en las personas que laboran en el sector salud y realizan turnos nocturnos. Las políticas públicas toman importancia en este proceso cuando los actores sociales propician el empoderamiento frente a esta situación, y desarrollan propuestas para el manejo de las problemáticas que son producto del trabajo en horario nocturno. Las recomendaciones de la OIT para el trabajo nocturno, surgen como referentes obligados, a pesar de ser optativas, a partir de las consecuencias que este tiene sobre los trabajadores del área de la salud, su responsabilidad social y su compromiso ético y jurídico.

From the International Labour Organization (ILO) guidelines, the present article considers policies and existing agreements for the protection of the general night worker and his projection to the specific health worker, by the understanding of the influence of globalization process in the generation of the economic and political policies. That allows the creation and application of the above mentioned agreements. The requirements of the globalization get the induction of mercantilist view of the laboral force and human resources in the sector of health. It discusses the pressures from globalization induce the commodification of labor and human capital in the health sector and as this pressure exerts an influence of biopsychosocial character in people who work in the health sector who do night shifts. The public policies take importance when the social actors take an empowered of the situation, and they create offers for the managing of the problematic ones.

Desde os referentes internacionais baseados nas recomendações da Organização Internacional do Trabalho (OIT), o presente artigo revisa a transcendência das políticas e convênios vigentes para proteção do trabalhador noturno em geral e do trabalhador noturno da área da saúde particularmente, e considera as influências dos processos de globalização na geração das políticas econômicas e o impacto nas políticas sociais. É analisada a influência que desde a globalização induz a mercantilização da força de trabalho e do capital humano do setor saúde e como essas pressões exercem um efeito de tipo biopsicossocial nos trabalhadores do setor saúde que trabalham de noite. As políticas públicas tornam-se relevantes nesse processo assim que os atores sociais favorecem o empoderamento perante tal situação, desenvolvendo propostas para gestão dos problemas decorrentes do trabalho noturno. As recomendações da OIT para o trabalho noturno surgem como referentes obrigatórios, embora sejam opcionais, a partir do impacto do trabalho noturno sobre os trabalhadores da área da saúde, sua responsabilidade social e seu compromisso ético e jurídico.

Músculo esternalis: variante anatómica que simula neoplasia en mamografía / Sternalis muscle: an anatomical variant simulating a neoplasm in the mammogram

El músculo esternalis es una variante anatómica poco común de la pared torácica. se estima su frecuencia en, aproximadamente, el 8% de la población mundial, se presenta tanto en hombres como en mujeres, y puede ser unilateral o bilateral. Constituye una situación que amerita cuidado, pues puede simular neoplasia maligna en la mamografía. su reconocimiento evita la realización de estudios imagenológicos adicionales innecesarios, incluyendo biopsias guiadas, que generan costos económicos al sistema, y estrés y ansiedad injustificada a las pacientes.

The sternalis muscle is a rare anatomical variant of the chest wall. Its frequency is estimated at approximately 8% of the world population, both in men and women, and can be unilateral or bilateral. Its importance is due to the fact that it can simulate malignancy on mammography. Recognizing it avoids performing unnecessary additional imaging studies, including guided biopsies involving extra financial costs to the system, as well as undue stress and anxiety in patients.

Management of ventilator-associated pneumonia caused by multiresistant bacteria.

PURPOSE OF REVIEW: The inappropriate choice of antibiotics (in nearly one third of episodes) is the most important risk factor for death. Traditionally, a narrow-spectrum drug was used first, and the most potent drugs were reserved for subsequent use. RECENT FINDINGS: As multidrug resistance increases in the intensive care unit in patients treated for nosocomial pneumonia, costs, mortality, and morbidity are rising. Although methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii are frequently considered together, they have different virulence, risk factors and susceptibilities, requiring different antimicrobial choices. Assessment of clinical resolution should be differentiated in the presence of acute lung injury. In the absence of biochemical markers, oxygenation and core temperature should guide therapeutic decisions. SUMMARY: As ventilator-associated pneumonia increases, empiric therapy should be based on local pathogen etiology and antibiotic resistant patterns. A new approach to consider is to start with a high-dose, broad-spectrum antibiotic and then tailor the individual therapy based on microbiological results and clinical resolution. With the use of broad-spectrum antibiotics available in empiric therapy tailored after reassessment of the patient, there is hope for reducing costs, length of stay and mortality whereas the emergence of resistance will be minimized.

Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: A study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia.

OBJECTIVE: To assess whether bacteremic ventilator-associated pneumonia (B-VAP) differs in terms of risk factors, organisms, and outcomes from nonbacteremic VAP (NB-VAP). DESIGN: A retrospective, single-center, observational, cohort study. SETTING: Multidisciplinary teaching intensive care unit. PATIENTS: Adult patients requiring mechanical ventilation, identified as having VAP in a 44-month prospective surveillance database. INTERVENTIONS: Each B-VAP patient was matched with two controls with VAP and negative blood cultures based on the microbial etiology responsible for VAP, Acute Physiology and Chronic Health Evaluation II score on admission (+/-3 points), diagnostic category, and length of stay before pneumonia onset. MEASUREMENTS AND MAIN RESULTS: B-VAP was documented in 35 (17.6%) of 199 microbiologically confirmed VAP episodes. B-VAP developed later (median 8 vs. 5 days, p = .03) and was more frequent in previously hospitalized patients (34.3% vs. 11.0%, p < .01) and in older patients (57.4 +/- 15.2 vs. 49.5 +/- 19.3 yrs, p = .02). B-VAP was more often caused by methicillin-resistant Staphylococcus aureus (12 [20.7%] vs. 13 [5.1%] episodes, p < .01), whereas Haemophilus influenzae was associated with NB-VAP (52 [20.4%] vs. 0, p < .01). Multivariate analysis confirmed an association between B-VAP and both methicillin-resistant S. aureus (odds ratio 3.18; 95% confidence interval 1.15-8.76, p < .01) and prior hospitalization (odds ratio 2.56; 95% confidence interval 1.01-6.54, p = .05). After adjustment for potential confounders, B-VAP (hazard ratio for death 2.55; 95% confidence interval 1.25-5.23, p = .01) and vasopressor use (hazard ratio 2.43; 95% confidence interval 1.23-4.82, p = .01) remained associated with mortality. The estimated relative risk of death for bacteremic cases was 2.86 (95% confidence interval 1.09-7.51), since mortality for cases and matched NB-VAP controls was 40.6% (13 of 32) and 19.3% (11 of 57), respectively. CONCLUSIONS: B-VAP occurs later during intensive care unit stay, is more frequent in previously hospitalized patients, is more often caused by methicillin-resistant S. aureus, and is independently associated with increased intensive care unit mortality.

Electropolymerization and characterization of polyaniline films using a spectroelectrochemical flow cell.

A new spectroelectrochemical flow cell is presented and its capability to provide a better understanding of reaction mechanisms is illustrated with the study of the electrosynthesis and characterization of a conducting polymer, polyaniline (PANI). A spectroelectrochemical study of electropolymerization of aniline under flow conditions has been performed for the first time. The significant influence that the flow rate of feeding monomer solution has on the electropolymerization process and, consequently, on the electrochromic properties of the resulting polymer has been demonstrated.

Analysis and speciation of arsenic by stripping potentiometry: a review.

This paper provides a review that summarizes several examples of the literature from 1980 to 2003, to illustrate the applications of stripping potentiometry for the determination and speciation of arsenic in several samples. A discussion on the main advantages of stripping potentiometry in comparison with other electrochemical methods employed for arsenic determination is presented. Special attention is devoted to stripping modes (constant current or chemical stripping) and to issues related to the choice of working electrodes and supporting electrolyte. This approach has been also applied at arsenic determination in flow systems. A section is dedicated to speciation of arsenic and total arsenic determination and other to analytical characteristic of method and their interferences. An extensive compilation, organize by experimental and analytical parameters and real sample studied is presented.

Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides.

OBJECTIVE: To determine whether ventilator-associated pneumonia caused by oxacillin-resistant Staphylococcus aureus (VAP-ORSA) treated with glycopeptides is associated with an increased mortality rate. DESIGN: Retrospective matched cohort study. SETTING: Four intensive care units in teaching hospitals. PATIENTS: Seventy-five patients were matched to 75 controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All adult intensive care unit patients with microbiologically documented VAP-ORSA were matched to intubated controls who did not develop VAP-ORSA, based on disease severity (Acute Physiology and Chronic Health Evaluation II score) at admission (+/-3 points), diagnostic category, and length of stay before pneumonia onset. Population characteristics and intensive care unit mortality rates of patients with VAP-ORSA and their controls without pneumonia were compared. Attributable mortality was determined by subtracting the crude mortality rate of controls from the crude mortality rate of VAP-ORSA patients. Thirty-six of the 75 matched VAP-ORSA patients died, representing a crude mortality rate of 48%, whereas 19 of the 75 controls died, a crude mortality rate of 25.3% (p < .01). Excess mortality was estimated to be 22.7% (95% confidence interval, 2.4-42.9%). Median length of intensive care unit stay in the surviving pairs was 33 days (interquartile range, 25-75%: 25-45 days) for VAP-ORSA patients and 21 days (interquartile range, 25-75%: 15-34.75 days) days for controls (p = .054). CONCLUSIONS: Despite appropriate glycopeptide therapy, there is an increased attributable mortality for pneumonia by ORSA, after careful adjustment for disease severity and diagnostic category.

A continuous flow system design for simultaneous determination of heavy metals in river water samples.

A new design of a continuous flow system applied to the simultaneous determination of the concentration of zinc(II), cadmium(II), lead(II), copper(II), nickel(II), cobalt(II) and chromium(VI) in river water is described. A flow cell made in the laboratory, which has been patented, based on a 'wall-jet' configuration with a three-electrode system is described. Optimum conditions for the determination of the metal ions are reported. The detection limits and relative standard deviation values were 4.01x10(-9) M and 0.078 for Zn(II), 1.76x10(-10) M and 0.056 for Cd(II), 4.69x10(-10) M and 0.134 for Pb(II), 2.29x10(-10) M and 0.138 for Cu(II), 1.61x10(-9) M and 0.093 for Ni(II), 1.91x10(-9) M and 0.113 for Co(II), and 1.35x10(-9) M and 0.081 for Cr(VI). The procedure was applied to a sample of water from the Arlanzón river and the results were compared with inductively coupled mass plasma spectrometry (ICP-MS) as reference method. The final aim of this work is to design a flow system, which can be automated.