Awareness, Perception, and Practice Regarding Needle-Stick Injury and Its Prevention Among Healthcare Workers in a Tertiary Care Hospital in Southern India.

Background Needle stick injuries caused by various sharp and other items like hypodermic needles and intravenous cannulas are important occupational hazards for healthcare workers (HCW). Preventing injuries is the most effective way to protect workers and requires good awareness and perceptions associated with practice on a daily basis. Therefore, we did a descriptive cross-sectional study involving healthcare workers in a tertiary care hospital to find the level of awareness, perception, and practice associated with needle stick injury and its prevention. Methodology A descriptive cross-sectional study was conducted in a tertiary care hospital, in south India. 400 healthcare workers (doctors, nurses, technicians, and housekeeping staff) with more than one year of experience were randomly selected. An anonymous, self-reporting, semi-structured questionnaire was administered. Results are expressed in mean, standard deviation, frequency, and percentages. Results Out of 400 respondents, 89% had good awareness about proper disposal practices. However,44% of the participants had the misbelief that recapping needles was recommended to prevent needle stick injury (NSI), and 30.5% practiced it, with the doctors being the majority. The majority (79.8%) knew that HIV, Hepatitis B & C are blood-borne pathogens that HCWs are most commonly exposed to through needle-stick injury (NSI). However, only 49% knew that Hepatitis B has the highest risk of transmission following a needle prick. 75% were aware of the correct Hepatitis B vaccination doses. Most of the healthcare workers (89.5%) claimed to be aware of the procedure and guidelines to be followed after a needle stick injury and 96% felt that they would report NSI immediately. Awareness regarding Hepatitis C prevention was comparatively poor, with only 47% having knowledge regarding the non-availability of Hepatitis C Vaccination and& 46% about the non-availability of post-exposure prophylaxis for Hepatitis C. Among the healthcare workers, 61% were worried about having needle stick injuries but 56.5% felt that their own personal safety is secondary to patient care. Among the HCWs, 91.3% believed that needle stick injuries can be prevented. Most of the participants (93.5%) ensure that others around them take extra precautions while handling sharp/ needles. The majority, i.e. 88%, utilized a designated container for disposal of sharp items, while only 53% of respondents utilized a needle cutter or shredder. 85% of HCWs had attended specific training programs on the usage of safe devices/sharps in the preceding one-year period and 72.8% had completed the vaccination against Hepatitis B. Conclusion Awareness regarding needle stick injury and its prevention is patchy and not adequate across different sections of healthcare workers. Perceptions regarding needle stick injury and its prevention revealed an overall positive attitude. Practices related to needle stick injury and its prevention seem to be reasonably good except when related to recapping and waiting to dispose of until the completion of the session. Training sessions need to be tailored for specific participant groups and a 'one size fits all' philosophy cannot be followed.

Mite non-reproduction, recapping behavior, and hygienic behavior (freeze-kill method) linked to Varroa destructor infestation levels in selected Apis mellifera colonies.

The genetic selection of honey bees (Apis mellifera) possessing specific social hygienic behaviors offers the beekeeping industry the possibility of controlling the Varroa destructor parasite and thus reducing its dependence on acaricides. However, the links between these behavioral traits are not yet well defined, which limits genetic progress in breeding programs. We measured the following behavioral varroa resistance traits: freeze-kill brood (FKB) and pin-kill brood (PKB) assays, varroa-sensitive hygiene (VSH), pupae removal, mite non-reproduction (MNR), and recapping activity. We found 2 negative and significant relationships: 1) between the recapping of cells infested with varroa and the total number of recapped cells, and 2) between the recapping of cells infested with varroa and VSH. We also selected the best predictive model of varroa infestation levels using the "step-wise" approach based on the Akaike information criterion. Our model revealed that MNR and FKB were significantly related to the varroa population levels, with a negative relationship; recapping was significantly related to mite infestation levels, with a positive relationship. Thus, a higher MNR or FKB score was linked to lower levels of mite infestation in colonies on August 14 (prior to fall infestation treatments); a higher recapping activity was linked to a higher level of mite infestation. Recapping behavior could be a useful trait to aid the selection of varroa-resistant bee lineages.

[Treatment of intraspinal benign tumors in upper cervical vertebrae by modified recapping laminoplasty].

Objective: To evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae. Methods: The clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C 1 and C 2. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded. Results: The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores ( P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation ( P>0.05). Conclusion: The treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.

Evaluating the Potential of Brood Recapping to Select Varroa destructor (Acari: Varroidae) Resistant Honey Bees (Hymenoptera: Apidae).

Several resistance traits have been proposed to select honey bees (Apis mellifera L.) that can survive in the presence of parasitic mite Varroa destructor (Anderson and Trueman) and enable a more sustainable apiculture. The interest for uncapping-recapping has recently increased following its identification in several naturally surviving honey bee populations, yet the utility of this trait for human-mediated selection is poorly known. Here, we evaluated the repeatability of recapping and its correlations with mite infestation levels, and assessed the expression of the trait in the often neglected drone brood. We also calculated correlations between recapping, mite infertility, and mite fecundity, expressed either at the level of individual brood cells or of the whole colony. Recapping measured in worker brood showed moderate repeatability (ranging between 0.30 and 0.46). Depending on sample, recapping slightly correlated negatively with colony infestation values. Recapping was also measured in drone brood, with values often comparable to recapping in worker brood, but no significant correlations were obtained between castes. At cell level, recapped cells in drone brood (but not in workers) were significantly less infested than nonrecapped cells, whereas in workers (but not in drones), recapped cells hosted mites with significantly lower fecundity. At colony level, with a few exceptions, recapping did not significantly correlate with mite infertility and fecundity, caste, sample, or number of infested cells considered. These results indicate limited possibilities of impeding mite reproduction and possibly mite infestation of honey bee colonies by recapping, which would need to be confirmed on larger, different populations.

Reported Injuries from Sharp Objects among Healthcare Workers in Central Greece.

Sharp injuries (SIs) are incidents or accidents caused by a needle, blades (such as scalpels) or other medical instruments which penetrate the skin. They are among the major work-related injuries in healthcare professionals. The purpose of this study is to estimate SIs in healthcare workers (HCWs) in Central Greece. METHOD: A cross-sectional descriptive study through an online survey in healthcare facilities in Central Greece was conducted. Snowball sampling contributed to further dissemination of the survey among the target population. The modified version of the EPINet questionnaire was used with self-reported answers of the participants via electronic Google form. RESULTS: Analysis of collected data indicated that 74.1% of the participants had at least one injury, with the highest number of injuries occurring in nursing staff at 65.1% and 62.3% of injuries recorded in the morning shift. With respect to the site of the injury, participants reported 33.1% of the injuries in the patient's room, 11.8% in the nurse's station, 9.6% in the Emergency Department (ED), 9.2% in the Intensive Care Unit (ICU), 8.4% in blood sampling, 8.4% in surgery, and only 7.8% in laboratories or other places. Additionally, hands were the most frequently affected body part (96%), while 69.6% of the workers did not report the injury and 53% of them did not apply the procedures and guidelines defined by the healthcare organization (employer). Relative factors to the injury are age, level of education, shifts, and possibly sex. CONCLUSIONS: SIs are the "Achilles heel" of health workers. The high incidence and low reporting rate of SIs highlights the need for specialized training and education. Age, work experience, and shift appear to significantly affect the incidence of injury.

Two quantitative trait loci are associated with recapping of Varroa destructor-infested brood cells in Apis mellifera mellifera.

Recapping of Varroa destructor-infested brood cells is a trait that has recently attracted interest in honey bee breeding to select mite-resistant Apis mellifera colonies. To investigate the genetic architecture of this trait, we evaluated a sample of A. mellifera mellifera colonies (N = 155) from Switzerland and France and performed a genome-wide association study, using a pool of 500 workers per colony for next-generation sequencing. The results revealed that two QTL were significantly (P < 0.05) associated with recapping of V. destructor-infested brood cells. The best-associated QTL is located on chromosome 5 in a region previously found to be associated with grooming behaviour, a resistance trait against V. destructor, in A. mellifera and Apis cerana. The second best-associated QTL is located on chromosome 4 in an intron of the Dscam gene, which is involved in neuronal wiring. Previous research demonstrated that genes involved in neuronal wiring are associated with recapping and varroa sensitive hygiene. Therefore, our study confirms the role of a gene region on chromosome 5 in social immunity and simultaneously provides novel insights into genetic interactions between common mite resistance traits in honey bees.

Parallel evolution of Varroa resistance in honey bees: a common mechanism across continents?

The near-globally distributed ecto-parasitic mite of the Apis mellifera honeybee, Varroa destructor, has formed a lethal association with Deformed wing virus, a once rare and benign RNA virus. In concert, the two have killed millions of wild and managed colonies, particularly across the Northern Hemisphere, forcing the need for regular acaricide application to ensure colony survival. However, despite the short association (in evolutionary terms), a small but increasing number of A. mellifera populations across the globe have been surviving many years without any mite control methods. This long-term survival, or Varroa resistance, is consistently associated with the same suite of traits (recapping, brood removal and reduced mite reproduction) irrespective of location. Here we conduct an analysis of data extracted from 60 papers to illustrate how these traits connect together to explain decades of mite resistance data. We have potentially a unified understanding of natural Varroa resistance that will help the global industry achieve widespread miticide-free beekeeping and indicate how different honeybee populations across four continents have resolved a recent threat using the same suite of behaviours.

Exploring Two Honey Bee Traits for Improving Resistance Against Varroa destructor: Development and Genetic Evaluation.

For the development of novel selection traits in honey bees, applicability under field conditions is crucial. We thus evaluated two novel traits intended to provide resistance against the ectoparasitic mite Varroa destructor and to allow for their straightforward implementation in honey bee selection. These traits are new field estimates of already-described colony traits: brood recapping rate ('Recapping') and solidness ('Solidness'). 'Recapping' refers to a specific worker characteristic wherein they reseal a capped and partly opened cell containing a pupa, whilst 'Solidness' assesses the percentage of capped brood in a predefined area. According to the literature and beekeepers' experiences, a higher recapping rate and higher solidness could be related to resistance to V. destructor. During a four-year field trial in Switzerland, the two resistance traits were assessed in a total of 121 colonies of Apis mellifera mellifera. We estimated the repeatability and the heritability of the two traits and determined their phenotypic correlations with commonly applied selection traits, including other putative resistance traits. Both traits showed low repeatability between different measurements within each year. 'Recapping' had a low heritability (h2 = 0.04 to 0.05, depending on the selected model) and a negative phenotypic correlation to non-removal of pin-killed brood (r = -0.23). The heritability of 'Solidness' was moderate (h2 = 0.24 to 0.25) and did not significantly correlate with resistance traits. The two traits did not show an association with V. destructor infestation levels. Further research is needed to confirm the results, as only a small number of colonies was evaluated.

Evaluation of Traits for the Selection of Apis Mellifera for Resistance against Varroa Destructor.

Infestation with Varroa destructor is a serious cause of bee colony (Apis mellifera) losses on a global level. However, the presence of untreated survivor populations in many different regions supports the idea that selection for resistance can be successful. As colony survival is difficult or impossible to measure, differences in mite infestation levels and tests for specific behavioral traits are used for selective breeding for Varroa resistance. In this paper we looked into different definitions of mite infestation and linked these with brood hygiene (pin test), brood recapping and suppressed mite reproduction. We based our analyses on datasets of Apis mellifera carnica from three countries: Austria (147 records), Croatia (135) and Germany (207). We concluded that bee infestation in summer, adjusted for the level of natural mite fall in spring, is a suitable trait in the breeding objective, and also suggested including brood infestation rate and the increase rate of bee infestation in summer. Repeatability for bee infestation rate was about 0.55, for cells opened in pin test about 0.33, for recapping 0.35 and for suppressed mite reproduction (SMR) virtually zero. Although in most cases we observed correlations with the expected sign between infestation parameters and behavioral traits, the values were generally low (<0.2) and often not significantly different from zero.

Natural selection, selective breeding, and the evolution of resistance of honeybees (Apis mellifera) against Varroa.

We examine evidence for natural selection resulting in Apis mellifera becoming tolerant or resistant to Varroa mites in different bee populations. We discuss traits implicated in Varroa resistance and how they can be measured. We show that some of the measurements used are ambiguous, as they measure a combination of traits. In addition to behavioural traits, such as removal of infested pupae, grooming to remove mites from bees or larval odours, small colony size, frequent swarming, and smaller brood cell size may also help to reduce reproductive rates of Varroa. Finally, bees may be tolerant of high Varroa infections when they are resistant or tolerant to viruses implicated in colony collapse. We provide evidence that honeybees are an extremely outbreeding species. Mating structure is important for how natural selection operates. Evidence for successful natural selection of resistance traits against Varroa comes from South Africa and from Africanized honeybees in South America. Initially, Varroa was present in high densities and killed about 30% of the colonies, but soon after its spread, numbers per hive decreased and colonies survived without treatment. This shows that natural selection can result in resistance in large panmictic populations when a large proportion of the population survives the initial Varroa invasion. Natural selection in Europe and North America has not resulted in large-scale resistance. Upon arrival of Varroa, the frequency of traits to counter mites and associated viruses in European honey bees was low. This forced beekeepers to protect bees by chemical treatment, hampering natural selection. In a Swedish experiment on natural selection in an isolated mating population, only 7% of the colonies survived, resulting in strong inbreeding. Other experiments with untreated, surviving colonies failed because outbreeding counteracted the effects of selection. If loss of genetic variation is prevented, colony level selection in closed mating populations can proceed more easily, as natural selection is not counteracted by the dispersal of resistance genes. In large panmictic populations, selective breeding can be used to increase the level of resistance to a threshold level at which natural selection can be expected to take over.

mRNA 5' ends targeted by cytoplasmic recapping cluster at CAGE tags and select transcripts are alternatively spliced.

Until cytoplasmic recapping was discovered, decapping was thought to irreversibly destine an mRNA to degradation. Contradicting this idea, we readily observe mRNAs targeted by cytoplasmic capping in uncapped, yet stable forms. 5' rapid amplification of cDNA ends (RACE) shows that nearly all uncapped ends correspond to capped analysis of gene expression tags and that the recapping of ZNF207 mRNA may be restricted to a single splice isoform. Here, a modified RACE approach detected uncapped 5' RNA ends mapping to 46 mRNAs in cells expressing a dominant negative cytoplasmic capping enzyme and in normal cells. Eleven of 46 cloned mRNAs also contained splice isoform-limiting sequences. Collectively, these data reinforce earlier work and suggest that alternative splicing may play a role in targeting transcripts for - and/or determining the position of - cytoplasmic capping.

Successful treatment of a diffuse type tenosynovial giant cell tumor in the thoracic spine mimicking spinal metastasis by frozen recapping laminoplasty in a patient with thyroid cancer.

PURPOSE: Tenosynovial giant cell tumor of the diffuse type (TGCT-D) involving the spine is rare. Its differential diagnosis includes metastatic disease; however, there have been few reports of spinal TGCT-D mimicking spinal metastasis in patients with a history of malignancy. METHODS: We report on a 35-year-old woman with a history of papillary thyroid cancer who was diagnosed with TGCT-D of the thoracic spine mimicking spinal metastasis. Preoperative computed tomography (CT) revealed a 1.0 × 1.0-cm lytic bone lesion involving the left T7 vertebral lamina, pedicle, and the T6-7 facet joint; the thoracic spine lesion was markedly fluorodeoxyglucose-avid on positron-emission tomography/computed tomography (PET/CT). RESULTS: Spinal metastasis was initially suspected given the patient's history of papillary thyroid cancer. Total excision was performed with recapping laminoplasty. The resected lamina was frozen in liquid nitrogen and used as a frozen autograft (frozen recapping laminoplasty) for spinal reconstruction with posterior instrumentation. Histological findings supported a diagnosis of TGCT-D. The patient had no evidence of local recurrence 2 years post-surgery. Bone union was achieved 3 years post-surgery. CONCLUSIONS: TGCT-D can mimic metastasis in PET/CT and should be included in the differential diagnosis if a lytic lesion affecting the posterior elements of the vertebrae involves the facet joints. CT-guided biopsy is recommended for accurate diagnosis when an occult tumor, such as TGCT, is incidentally detected on PET-CT, even in patients with a history of malignant neoplasm. Frozen recapping laminoplasty is useful for complete resection of a spinal tumor, preventing local recurrence, and preservation of the posterior spinal elements.

Detection and Identification of Uncapped RNA by Ligation-Mediated Reverse Transcription Polymerase Chain Reaction.

The 5'-cap structure is an essential feature in eukaryotic mRNA required for mRNA stability and enhancement of translation. Ceratin transcripts are selectively silenced by decapping in the cytoplasm and later become translationally active again by acquiring the cap structure to regenerate translatable mRNAs. Identification of uncapped mRNA transcripts will reveal how gene expression is regulated by the mRNA recapping pathway. What follows is a sensitive method to detect and identify the uncapped mRNA from the cells. The technique consists of three parts: selective ligation of anchor RNA to the 5'-end of monophosphate RNA by double-strand RNA ligase, conversion of ligated RNA product into cDNA by reverse transcription, and amplification of a specific cDNA by polymerase chain reaction.

Solitary thoracic intramedullary spinal neurofibroma microsurgically extirpated via recapping T-saw laminoplasty.

We report the case of a 40-year-old female presenting with back pain that was complicated by a solitary intramedullary spinal cord mass at the T10-11 levels, confirmed by magnetic resonance imaging and computed tomography myelography. Microsurgical en bloc extirpation of the tumor approached through a recapping T-saw laminoplasty of T10 was done, and histopathology findings revealed a diagnosis of neurofibroma. Solitary spinal neurofibroma is one of the rarest tumors involving the spinal cord and is very adherent for the lack of a well-defined capsule, requiring careful dissection under microscope magnification for successful en bloc resection. Recapping T-saw laminoplasty affords both maximal exposure and anatomic reconstruction postextirpation, avoiding most postoperative spinal complications.

The messenger RNA decapping and recapping pathway in Trypanosoma.

The 5' terminus of trypanosome mRNA is protected by a hypermethylated cap 4 derived from spliced leader (SL) RNA. Trypanosoma brucei nuclear capping enzyme with cap guanylyltransferase and methyltransferase activities (TbCgm1) modifies the 5'-diphosphate RNA (ppRNA) end to generate an m7G SL RNA cap. Here we show that T. brucei cytoplasmic capping enzyme (TbCe1) is a bifunctional 5'-RNA kinase and guanylyltransferase that transfers a γ-phosphate from ATP to pRNA to form ppRNA, which is then capped by transfer of GMP from GTP to the RNA ß-phosphate. A Walker A-box motif in the N-terminal domain is essential for the RNA kinase activity and is targeted preferentially to a SL RNA sequence with a 5'-terminal methylated nucleoside. Silencing of TbCe1 leads to accumulation of uncapped mRNAs, consistent with selective capping of mRNA that has undergone trans-splicing and decapping. We identify T. brucei mRNA decapping enzyme (TbDcp2) that cleaves m7GDP from capped RNA to generate pRNA, a substrate for TbCe1. TbDcp2 can also remove GDP from unmethylated capped RNA but is less active at a mature cap 4 end and thus may function in RNA cap quality surveillance. Our results establish the enzymology and relevant protein catalysts of a cytoplasmic recapping pathway that has broad implications for the functional reactivation of processed mRNA ends.

Sharps injury reduction: a six-year, three-phase study comparing use of a small patient-room sharps disposal container with a larger engineered container.

A 350-bed Sydney hospital noted excessive container-associated sharps injuries (CASI) using small sharps containers and compared the effect from 2004 to 2010 of using a larger container engineered to reduce CASI. In Phase 1 (Ph1), disposable 1.4L containers (BD Australia) were carried to/from patients' rooms. In Phase 2 (Ph2), this stopped and a safety-engineered 32L reusable container (the Device; Sharpsmart, SteriHealth) was mounted in medication stations only and sharps were carried to and from patient rooms using kidney dishes. In Phase 3 (Ph3), the Device was wall-mounted in patient rooms. Sharps injuries were categorised as 'during-procedure', 'after-procedure but before disposal', 'CASI', and 'improper disposal SI'. Disposal-related SI comprised CASI plus improper-disposal SI. Injuries per 100 full-time-equivalent staff were analysed using Chi2; p ≤ 0.05; and relative risk and 95% confidence limits were calculated. In Ph1 (small containers) 19.4% of SI were CASI and transport injuries were zero. In Ph2 (Device in medication station) CASI fell 94.9% (p <0.001); Disposal-related SI fell 71.1% (p=0.002) but transport injuries rose significantly. In Ph3 (Device in patient room) zero CASI occurred (p<0.001); Disposal-related SI fell 83.1% (p=0.001). Recapping SI fell 85.1% (p=0.01) with the Device. The Device's volume, large aperture, passive overfill-protection and close-at-hand siting are postulated as SI reduction factors.

Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette.

OBJECTIVE: The authors present a novel method of the recapping hemilaminoplasty in a retrospective study of patients with spinal surgical disorders. This report describes the surgical technique and the results of hemilaminoplasty using an ultrasonic bone curette. The aim of this study was to examine the safety and effectiveness of the hemilaminoplasty technique with ultrasonic bone curette. METHODS: Between April 2003 and July 2011, 33 patients with various spinal diseases (17 spinal tumors, 5 dural arteriovenous fistulas, 3 syringomyelia, 2 sacral perineural cysts, and 2 arachnoid cysts) were treated microsurgically by using an ultrasonic bone curette with scalpel blade and lightweight handpiece. The ultrasonic bone curette was used for division of lamina. After resection of the lesion, the excised lamina was replaced exactly in situ to its original anatomic position with a titanium plate and screw. Additional fusion technique was not required and the device was easy to handle. All patients were observed both neurologically and radiologically by dynamic plain radiographs and computed tomography (CT) scan. RESULTS: The operation was performed successfully and there were no instrument-related complications such as dural laceration, nerve root injury, and vessels injury. The mean number of resected and restored lamina was 1.7. CT confirmed primary bone fusion in all patients by 12 months after surgery. CONCLUSION: The ultrasonic bone curette is a useful instrument for recapping hemilaminoplasty in various spinal surgeries. This method allows anatomical reconstruction of the excised bone to preserve the posterior surrounding tissues.