Evaluation of commercial quadrivalent foot-and-mouth disease vaccines against east African virus strains reveals limited immunogenicity and duration of protection.

Foot-and-mouth disease virus (FMDV) causes a contagious disease (FMD) in cloven-hoofed animals. For FMD-endemic countries, vaccination is critical for controlling disease but is rarely monitored, despite substantial funds spent on vaccine purchases. We evaluated antibody responses in cattle to two commercial vaccines each containing antigens of four FMDV serotypes. Sampling was done over 360 days, with serology for each serotype performed using commercially available solid phase competition ELISAs (SPCE) and with virus neutralization tests (VNT) employing regionally relevant test viruses. A primary course of each vaccine was administered to 37 calves, some of which received a second dose after 28 days. Using new production batches of vaccines, all calves received a booster vaccination 180 days post vaccination, while 10 additional naïve calves were also vaccinated using the new batches and followed up for ∼180 days. Simple and general linear models were used to compare antibody responses which varied substantially according to vaccine, dose regime, serotype, and test, but were mostly insufficient to ensure a high likelihood of adequate or sustained probable protection. One of the vaccines administered as a two-dose primary course of vaccination was superior to other options, but even then, data trajectories from VNT responses suggested probable protection of 75 % of calves for 6 months for only one virus serotype. Calves administered with the other vaccine and those given a single primary dose developed low levels of antibodies, offering predicted likely protection lasting less than two months. Individual SPCE results were weakly correlated (r2 = 0.48) to neutralization and associated likelihoods of protection but SPCE and VNT agreed on which vaccine and dose regime performed best. Our findings highlight gaps in immunogenicity of FMD vaccines used in East Africa and reinforce the importance of independent quality control studies to evaluate and improve commercial FMD vaccines and vaccination regimes.

Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Unraveling the epidemiology of Mycobacterium bovis using whole-genome sequencing combined with environmental and demographic data.

When studying the dynamics of a pathogen in a host population, one crucial question is whether it transitioned from an epidemic (i.e., the pathogen population and the number of infected hosts are increasing) to an endemic stable state (i.e., the pathogen population reached an equilibrium). For slow-growing and slow-evolving clonal pathogens such as Mycobacterium bovis, the causative agent of bovine (or animal) and zoonotic tuberculosis, it can be challenging to discriminate between these two states. This is a result of the combination of suboptimal detection tests so that the actual extent of the pathogen prevalence is often unknown, as well as of the low genetic diversity, which can hide the temporal signal provided by the accumulation of mutations in the bacterial DNA. In recent years, the increased availability, efficiency, and reliability of genomic reading techniques, such as whole-genome sequencing (WGS), have significantly increased the amount of information we can use to study infectious diseases, and therefore, it has improved the precision of epidemiological inferences for pathogens such as M. bovis. In this study, we use WGS to gain insights into the epidemiology of M. bovis in Cameroon, a developing country where the pathogen has been reported for decades. A total of 91 high-quality sequences were obtained from tissue samples collected in four abattoirs, 64 of which were with complete metadata. We combined these with environmental, demographic, ecological, and cattle movement data to generate inferences using phylodynamic models. Our findings suggest M. bovis in Cameroon is slowly expanding its epidemiological range over time; therefore, endemic stability is unlikely. This suggests that animal movement plays an important role in transmission. The simultaneous prevalence of M. bovis in co-located cattle and humans highlights the risk of such transmission being zoonotic. Therefore, using genomic tools as part of surveillance would vastly improve our understanding of disease ecology and control strategies.

Development of core competencies for field veterinary epidemiology training programs.

A workforce with the adequate field epidemiology knowledge, skills and abilities is the foundation of a strong and effective animal health system. Field epidemiology training is conducted in several countries to meet the increased global demand for such a workforce. However, core competencies for field veterinary epidemiology have not been identified and agreed upon globally, leading to the development of different training curricula. Having a set of agreed core competencies can harmonize field veterinary epidemiology training. The Food and Agriculture Organization of the United Nations (FAO) initiated a collective, iterative, and participative process to achieve this and organized two expert consultative workshops in 2018 to develop core competencies for field veterinary epidemiology at the frontline and intermediate levels. Based on these expert discussions, 13 competencies were identified for the frontline and intermediate levels. These competencies were organized into three domains: epidemiological surveillance and studies; field investigation, preparedness and response; and One Health, communication, ethics and professionalism. These competencies can be used to facilitate the development of field epidemiology training curricula for veterinarians, adapted to country training needs, or customized for training other close disciplines. The competencies can also be useful for mentors and employers to monitor and evaluate the progress of their mentees, or to guide the selection process during the recruitment of new staff.

Ranging patterns and factors associated with movement in free-roaming domestic dogs in urban Malawi.

Rabies is a neglected zoonotic disease that causes around 59,000 deaths per year globally. In Africa, rabies virus is mostly maintained in populations of free-roaming domestic dogs (FRDD) that are predominantly owned. Characterizing the roaming behavior of FRDD can provide relevant information to understand disease spread and inform prevention and control interventions. To estimate the home range (HR) of FRDD and identify predictors of HR size, we studied 168 dogs in seven different areas of Blantyre city, Malawi, tracking them with GPS collars for 1-4 days. The median core HR (HR50) of FRDD in Blantyre city was 0.2 ha (range: 0.08-3.95), while the median extended HR (HR95) was 2.14 ha (range: 0.52-23.19). Multivariable linear regression models were built to identify predictors of HR size. Males presented larger HR95 than females. Dogs living in houses with a higher number of adults had smaller HR95, while those living in houses with higher number of children had larger HR95. Animals that received products of animal origin in their diets had larger HR95, and only in the case of females, animals living in low-income areas had larger HR50 and HR95. In contrast, whether male dogs were castrated or not was not found to be associated with HR size. The results of this study may help inform rabies control and prevention interventions in Blantyre city, such as designing risk-based surveillance activities or rabies vaccination campaigns targeting certain FRDD subpopulations. Our findings can also be used in rabies awareness campaigns, particularly to illustrate the close relationship between children and their dogs.

Environmental sampling for the detection of foot-and-mouth disease virus and peste des petits ruminants virus in a live goat market, Nepal.

Livestock markets are considered vital parts of the agricultural economy, particularly in developing countries where livestock keeping contributes to both food security and economic stability. Animals from diverse sources are moved to markets, they mix while they are there and are subsequently redistributed over wide geographic areas. Consequently, markets provide an opportunity for targeted surveillance for circulating pathogens. This study investigated the use of environmental sampling at a live goat market in Nepal for the detection of foot-and-mouth disease virus (FMDV) and peste des petits ruminants virus (PPRV), both of which are endemic. Five visits to the market were carried out between November 2016 and April 2018, with FMDV RNA detected on four visits and PPRV RNA detected on all five visits. Overall, 4.1% of samples (nine out of 217) were positive for FMDV RNA and 60.8% (132 out of 217) were positive for PPRV RNA, though the proportion of positive samples varied amongst visits. These results demonstrate that non-invasive, environmental sampling methods have the potential to be used to detect circulation of high priority livestock diseases at a live animal market and, hence, to contribute to their surveillance and control.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study.

BACKGROUND: International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory. OBJECTIVES: To explore Italian nursing students' attitudes towards caring for dying patients. DESIGN: A multicenter cross-sectional study was conducted. SETTINGS: The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region. PARTICIPANTS: The sample included 1193 students. METHODS: Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression. RESULTS: The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care. CONCLUSIONS: Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.

Diabetic education in nursing: A Rodgers' evolutionary concept analysis.

AIM: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.

The effectiveness of team-based learning in nursing education: A systematic review.

AIM: Team-Based Learning (TBL) is an active teaching methodology, recently implemented also in the field of nursing education. The main objective of this study was to identify, appraise and summarize primary studies on the effectiveness of TBL in achieving learning outcomes in undergraduate nursing students. The secondary objective was to explore the generic competencies the students developed, and their reactions and attitudes. STUDY DESIGN: A systematic review of experimental and quasi-experimental studies. DATABASES SOURCES: Cochrane Library, Pubmed/Medline, Cinahl, PsycINFO, and Eric; Google Scholar was used to search for grey literature and the reference lists of the retrieved papers. REVIEW METHODS: A research protocol was developed according to the PRISMA-P guidelines. Two reviewers conducted the selection process. The "JBI Critical Appraisal Checklist" was used to check the quality of the selected studies. RESULTS: We included 12 studies: 2 monocentric randomized controlled trials and 10 quasi-experimental studies. Nine out of 12 studies produced significant results in favour of TBL in terms of academic performance and skills development, however results were divergent when TBL was compared with other teaching methods. The results of 7 studies highlighted the effectiveness of TBL in improving the development of communication skills, interprofessional learning, and self-directed learning. Divergent results were obtained with regard to problem solving and critical thinking skills. TBL promoted classroom engagement, however it did not seem to be associated with better learning outcomes. CONCLUSIONS: Overall, TBL was found to be effective in achieving undergraduate nursing students' learning outcomes, but evidence was not sufficiently strong to warrant that it is more effective than other teaching methods. The results of this review are in favour of the implementation of TBL in nursing education, however studies with more rigorous methods and with a mixed method design are required to improve the transferability of results.

Efficacy of the DigniCap System in preventing chemotherapy-induced alopecia in breast cancer patients is not related to patient characteristics or side effects of the device.

BACKGROUND: The DigniCap System is an effective scalp cooling device for the prevention of chemotherapy-induced alopecia in early breast cancer patients. AIM: This prospective study was designed to confirm the efficacy and tolerability of the device, to explore potential factors associated with its efficacy and to collect data on patient perceptions and satisfaction. METHODS: Between January 2016 and June 2018, 163 early breast cancer patients eligible for adjuvant chemotherapy were enrolled. Hair loss was assessed using the Dean scale, where a score of 0-2 (hair loss ≤50%) was defined as successful. RESULTS: Hair preservation was successful in 57% of patients in the overall series. The proportion was even higher (81%) in the patient subgroup treated with a paclitaxel and trastuzumab regimen. Side effects (feeling cold, headache, head heaviness, scalp and cervical pain) were mild to moderate and did not correlate with the rate of hair loss. Lifestyle, anthropometric factors and hair characteristics failed to be associated with device efficacy. CONCLUSIONS: The DigniCap System was well tolerated and found to be effective in preventing alopecia in early breast cancer patients. Our study failed to identify factors other than type of chemotherapy regimen associated with hair preservation.

Influence of Free Fatty Acids on Lipid Membrane-Nisin Interaction.

The influence of free fatty acids (FFAs) on the nisin-membrane interaction was investigated through micro-DSC and fluorescence spectroscopy. A simple but informative model membrane was prepared (5.7 DMPC:3.8 DPPS:0.5 DOPC molar ratio) by considering the presence of different phospholipid headgroups in charge and size and different phospholipid tails in length and unsaturation level, allowing the discrimination of the combined interaction of nisin and FFAs with the single phospholipid constituents. The effects of six FFAs on membrane stability were evaluated, namely two saturated FFAs (palmitic acid and stearic acid), two monounsaturated FFAs (cis-unsaturated oleic acid and trans-unsaturated elaidic acid) and two cis-polyunsaturated FFAs (ω-6 linoleic acid and ω-3 docosahexaenoic acid). The results permitted assessment of a thermodynamic picture of such interactions which indicates that the peptide-membrane interaction does not overlook the presence of FFAs within the lipid bilayer since both FFAs and nisin are able to selectively promote thermodynamic phase separations as well as a general lipid reorganization within the host membrane. Furthermore, the magnitude of the effects may be different depending on the FFA chemical structure as well as the membrane lipid composition.

[School nurse in the restrain of pandemics and the re-opening school. An integrative review]. / L'infermiere scolastico, la prevenzione della diffusione delle malattie infettive e la riapertura delle scuole nell'era della pandemia da SARS-Cov2. Revisione integrativa della letteratura.

INTRODUCTION: School nurse is present today in many countries around the world. Its contribution within schools is described in the literature especially with regard to the management of chronic diseases and health education interventions. The Sars-CoV2 pandemic has forced many states to close schools, involving major psycho-social problems. The reopening of schools is a great challenge, in this regard this work has the goal of evaluating the literature that identifies the figure of the school nurse as a strength in containing the spread of contagious diseases and the actions that can be effective for this purpose. METHODS: An integrative literature review was conducted by interrogating the main international medical-nursing databases, all research articles were included, editorials and letters were excluded. Results were screened independently by two investigators. RESULTS: 10 articles were included, the main purpose of which was to describe outbreak cases and strategies for their management. The major nursing interventions highlighted are surveillance, case reporting, education, management of relationships with families, collaboration with other professionals. DISCUSSION: Although the identified literature was quantitatively poor, it is clear that the school nurse is central to syndromic surveillance, educational role, decision making, clinical management, collaboration with the team of experts and management of communication.

Inherent Biophysical Properties Modulate the Toxicity of Soluble Amyloidogenic Light Chains.

In light chain amyloidosis (AL), fibrillar deposition of monoclonal immunoglobulin light chains (LCs) in vital organs, such as heart, is associated with their severe dysfunction. In addition to the cellular damage caused by fibril deposition, direct toxicity of soluble prefibrillar amyloidogenic proteins has been reported, in particular, for cardiotoxicity. However, the molecular bases of proteotoxicity by soluble LCs have not been clarified. Here, to address this issue, we rationally engineered the amino acid sequence of the highly cardiotoxic LC H6 by introducing three residue mutations, designed to reduce the dynamics of its native state. The resulting mutant (mH6) is less toxic than its parent H6 to human cardiac fibroblasts and C. elegans. The high sequence and structural similarity, together with the different toxicity, make H6 and its non-toxic designed variant mH6 a test case to shed light on the molecular properties underlying soluble toxicity. Our comparative structural and biochemical study of H6 and mH6 shows closely matching crystal structures, whereas spectroscopic data and limited proteolysis indicate that H6 displays poorly cooperative fold, higher flexibility, and kinetic instability, and a higher dynamic state in its native fold. Taken together, the results of this study show a strong correlation between the overall conformational properties of the native fold and the proteotoxicity of cardiotropic LCs.

Caring relationship: a qualitative research through the narratives of the students of the Bachelor of Science in Nursing degree.

BACKGROUND: The caring relationship is a complex phenomenon, that is considered as a fundamental patient-centred care activity. It is a nursing skill that is neither directly visible nor measurable and can be taught to students only by referring to other equally abstract and com- plex concepts. Issues such as care, communication, counselling, narrative nursing and empathy are addressed within specific modules under the Study Plan and dedicated to the caring relationship. However doubts persist on the experience of the students about caring relationship. OBJECTIVES: The aim of the study was understand caring relationship meanings and experiences in basic nursing education. DESIGN: A qualitative research according to the interpretative theory was conducted. Partecipants: The study involved second-year students of the Bachelor of Science in Nursing degree (BSN): at an University of northern Italy. METHODS: Data were collected through narratives of actual caring relationship experiences that students had during their clinical internships. RESULTS: The themes emerged from the accounts of 24 students were communication and the emotions related thereto. In particular, the perception of the loneliness of the patients, the characteristics associated with the ability of nurses to grasp this state and the feeling of well-being that is established in both people involved in a significant caring relationship, often based on active listening by the students. CONCLUSIONS: This study allowed us to understand the main characteristics of the students' experiences as they develop the ability to relate in a therapeutic way.

Characterizing Livestock Markets, Primary Diseases, and Key Management Practices Along the Livestock Supply Chain in Cameroon.

Live animal markets are common hotspots for the dispersal of multiple infectious diseases in various production systems globally. In Cameroon livestock trade occurs predominantly via a system of livestock markets. Improving the understanding of the risks associated with livestock trade systems and markets is, therefore, key to design targeted and evidence-based interventions. In the current study, official transaction records for a 12-month period were collected from 62 livestock markets across Central and Southern Cameroon, in combination with a questionnaire-based survey with the livestock markets stakeholders. The available information collected at these markets was used to characterize their structural and functional organization. Based on trade volume, cattle price and the intensity of stakeholder attendance, four main classes of livestock markets were identified. Despite an evident hierarchical structure of the system, a relatively limited pool of infectious diseases was consistently reported as predominant across market classes, highlighting homogeneous disease risks along the livestock supply chain. Conversely, the variable livestock management practices reported (e.g., traded species, husbandry practices, and transhumance habits) highlighted diverse potential risks for disease dissemination among market classes. Making use of readily available commercial information at livestock markets, this study describes a rapid approach for market characterization and classification. Simultaneously, this study identifies primary diseases and management practices at risk and provides the opportunity to inform evidence-based and strategic communication, surveillance and control approaches aiming at mitigating these risks for diseases dissemination through the livestock supply chain in Cameroon.

A framework for reviewing livestock disease reporting systems in high-risk areas: assessing performance and perceptions towards foot and mouth disease reporting in the Thrace region of Greece, Bulgaria and Turkey.

Disease reporting is an essential frontline component of surveillance systems, particularly for detecting incursions of new and emerging diseases. It has the advantages of being comprehensive and continuous, with the potential to reduce the time of disease detection and the extent of consequent spread. A number of exotic diseases, including sheep and goat pox, lumpy skin disease, peste des petits ruminants and foot and mouth disease have historically entered into south-eastern Europe through the Thrace region, which extends across neighbouring areas of Greece, Bulgaria and Turkey. In this high-risk area, multiple factors can reduce the sensitivity of disease reporting across the diverse production systems and animal health services need robust and effective disease reporting systems. While describing a training exercise designed to provide animal health services of the three countries with the knowledge and skills for conducting comprehensive in-country assessments, we provide an initial evaluation of the sensitivity of foot and mouth disease reporting and identify gaps and constraints in the Thrace region. An expert elicitation approach was used to consult official veterinarians from central and local animal health authorities of the three countries, and scenario trees modelling was applied to analyse the collected data. The reported sensitivity of disease reporting often varied between the central and local veterinary authorities within the three countries. Awareness of clinical disease, of reporting procedures and of biosecurity measures affected the early stages of disease reporting, particularly in the production systems identified at lower reporting sensitivity such as small ruminant's herds, mixed bovine herds and backyard herds. Despite its limitations this training exercise provided an effective framework (a) to develop capacities of the veterinary services in the region and (b) to supply initial evidence for guiding further interventions targeting those sectors and stakeholders at lower reporting sensitivity to reduce risks of disease introduction.

Properties of l-amino acid deaminase: En route to optimize bioconversion reactions.

Interest is rising in the agrochemical and pharmaceutical industries concerning the use of enantiomerically pure amino acids. l-Amino acids are easily produced by deracemization of D,L-mixtures or by stereoinversion of d-amino acids, employing the flavoenzyme d-amino acid oxidase. On the other hand, the production of the D-enantiomers is hampered by the lack of a suitable enzyme with reversed stereoselectivity. In recent years, the enzyme l-amino acid deaminase has been proposed as an alternative to l-amino acid oxidase. l-Amino acid deaminase from Proteus myxofaciens (PmaLAAD) is a membrane-bound flavoprotein that catalyzes the deamination of l-amino acids to the corresponding α-keto acids and ammonia without producing hydrogen peroxide since the electrons are transferred from the reduced cofactor to a b-type cytochrome. For this reason, purified PmaLAAD has no significant enzymatic activity; this can be recovered by adding exogenous E. coli membranes. In order to circumvent the use of membranes, we analyzed the ability of PmaLAAD to use alternative electron acceptors, as well as detergents, to reproduce the hydrophobic environment. With phenazine methosulfate (PMS) and anionic detergents, at concentrations lower than the critical micellar concentration, higher enzymatic activity can be reached than with membranes. The effect on stability, protein conformation, oligomeric state and activity of temperature, pH, ionic strength, and detergents was also investigated. By optimizing the reaction conditions (namely, using 0.8 mM PMS and 0.1 mM SDS) the rate of l-leucine bioconversion was improved.

Eight-week interval in flushing and locking port-a-cath in cancer patients: A single-institution experience and systematic review.

Port-a-cath (PAC) system is one of the most frequently employed venous accesses for administration of chemotherapy and supportive care. To prevent late complications, the latest guidelines recommend flushing/locking procedures every four weeks. In this retrospective study, we evaluate the frequencies of late complications with a eight-week flushing/locking procedure compared to the standard one. This study retrospectively compares the frequency of complications occurred using standard versus delayed flushing schedules. We performed a systematic review of the published studies about PAC complications associated with longer flushing intervals. Three hundred and ninety fully available patients were enrolled. One hundred and six patients had their PAC flushed/locked every month, 347 patients performed the flushing/locking procedures every eight weeks, 63 patients switched from the four to the eight-week schedule. No difference was seen in the number of occlusions, infections and mechanical dysfunctions between the two patient groups. The systematic literature review confirmed, in a total of 1,347 patients, the absence of an increased proportion of complications with delayed schedules. PAC flushing and locking every eight weeks are feasible and safe. This delayed schedule may improve patients' quality of life and decrease both nursing workload and costs for the national health system.

[The evaluation of qualitative research published in nursing journals: protocol of a cross-sectional study]. / La valutazione della ricerca qualitativa pubblicata nelle riviste infermieristiche: protocollo di studio.

INTRODUCTION: The nature of nursing has prompted researchers nurses to use a large number of qualitative methodology research. The trend showed a substantial increase in its production between 1997 and 2000 to settle back down in the following years although until recently the qualitative methodology was considered a non-scientific research. The growing number of publications with qualitative design is paid concern to verify the rigor and credibility of studies using this method. The use of the quality assessment tools showed that the methodological precision of studies with a qualitative design has grown over time. AIM: Assessing, using the tool Critical Appraisal Skills Programme, the quality of qualitative studies published in the last five years by international nursing journals with higher impact factor. METHOD: We will search the qualitative articles published on the ten most influential nursing journals that will be submitted by two independent researchers at the Critical Appraisal Skills Programme tool in its original version. EXPECTED RESULTS: The results make it possible to observe whether the qualitative research produced in the field of nursing uses a rigorous methodology in the drafting of the report, assuming that the quality has grown in the past five years than in previous years. CONCLUSION: The study will help researchers assess which level reached nurses in the development of qualitative research.

Cattle transhumance and agropastoral nomadic herding practices in Central Cameroon.

BACKGROUND: In sub-Saharan Africa, livestock transhumance represents a key adaptation strategy to environmental variability. In this context, seasonal livestock transhumance also plays an important role in driving the dynamics of multiple livestock infectious diseases. In Cameroon, cattle transhumance is a common practice during the dry season across all the main livestock production zones. Currently, the little recorded information of the migratory routes, grazing locations and nomadic herding practices adopted by pastoralists, limits our understanding of pastoral cattle movements in the country. GPS-tracking technology in combination with a questionnaire based-survey were used to study a limited pool of 10 cattle herds from the Adamawa Region of Cameroon during their seasonal migration, between October 2014 and May 2015. The data were used to analyse the trajectories and movement patterns, and to characterize the key animal health aspects related to this seasonal migration in Cameroon. RESULTS: Several administrative Regions of the country were visited by the transhumant herds over more than 6 months. Herds travelled between 53 and 170 km to their transhumance grazing areas adopting different strategies, some travelling directly to their destination areas while others having multiple resting periods and grazing areas. Despite their limitations, these are among the first detailed data available on transhumance in Cameroon. These reports highlight key livestock health issues and the potential for multiple types of interactions between transhumant herds and other domestic and wild animals, as well as with the formal livestock trading system. CONCLUSION: Overall, these findings provide useful insights into transhumance patterns and into the related animal health implications recorded in Cameroon. This knowledge could better inform evidence-based approaches for designing infectious diseases surveillance and control measures and help driving further studies to improve the understanding of risks associated with livestock movements in the region.