Examining reuse and replacement procedures for Ipas manual vacuum aspiration and cannulae in nine countries.

OBJECTIVE: To determine how many times Ipas manual vacuum aspiration (MVA) instruments are reused, for what reasons, when the instruments are replaced and/or discarded, and what the barriers are to replacing them. METHODS: We conducted a mixed-methods cross-sectional study of health care providers who provide MVA services and key stakeholders in the supply chain to understand reuse and replacement of Ipas MVA aspirators and cannulae. Qualitative interviews focused on procurement and replacement of Ipas MVA instruments. RESULTS: The authors interviewed 352 health care providers from nine countries from 2019 to 2021. Providers reported reusing MVA instruments an average of 34.4 times (standard deviation, 45). The reuse averages ranged from one time (Democratic Republic of the Congo) to 500 times (India), with figures varying between providers within the same country. Instrument malfunctioning rather than a specific number of uses drove reuse and subsequent replacement. The decision to replace was most commonly made by the provider during use. Half of the providers said that they knew of no issues with the supply chain, and 85% said they were always able to replace Ipas MVA instruments when needed. CONCLUSION: Tracking reuse of MVA instruments was uncommon at participating providers' health facilities. Providers' estimates revealed great variability in reuse frequency and tracking procedures.

Species distribution and susceptibility of Nocardia isolates in New Zealand 2002-2021.

The aim was to record the distribution and susceptibility of Nocardia species in New Zealand. Local and referred isolates were identified by an evolving approach over the study period including conventional phenotypic methods, susceptibility profiles, matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF) and molecular sequencing. Isolates previously identified as a Nocardia sp. or part of the N. asteroides complex were reidentified by MALDI-TOF and/or molecular methods. Antimicrobial susceptibility to eight antibiotics was performed by standard microbroth dilution. The site of isolation, susceptibility profiles and species distribution were analysed. A total of 383 isolates were tested: N. brasiliensis 23 (6%), N. cyriacigeorgica 42 (11%), N. farcinica 41 (11%), N. nova complex 226 (59%), and 51 (13%) other species/complexes. The respiratory tract was the most common site of infection (244, 64%), with skin and soft tissue the second most common site (104, 27%). All 23 N. brasiliensis isolates were from skin and soft tissue specimens. Almost all isolates (≥98%) were susceptible to amikacin, linezolid and trimethoprim-sulfamethoxazole; 35% and 77% were resistant to clarithromycin and quinolones, respectively. The expected susceptibility profiles of the four common species and complex were observed for most agent-organism parings. Multi-drug resistance was uncommon (3.4%). The spectrum of Nocardia species in New Zealand is similar to overseas reports and our most common group is the N. nova complex. While amikacin, linezolid and trimethoprim-sulfamethoxazole remain good empiric treatment choices, other agents should have their activity confirmed before use.

Nursing's leaky pipeline: Barriers to a diverse nursing workforce.

BACKGROUND: Nursing educational programs have been charged with increasing the diversity of the nursing workforce; however, this depends on having a diverse and qualified applicant pool to select from. PURPOSE: To determine the effects of student losses over time on nursing program diversity. DESIGN AND METHODS: Descriptive longitudinal study. Progression of all students from a single university enrolled as pre-nursing majors from 2012 to 2016 (N = 2498) was tracked over seven key checkpoints during a seven-year time period. RESULTS: Slightly more than half of the students (57%) were lost prior to nursing program application, which occurred at the end of the sophomore year. Losses were higher for minority students (70%), those requiring remedial coursework (65%), and first-generation students (62%). Older students, those with a prior degree, and those who started in another major were more likely to persist through some, but not all, of the checkpoints. CONCLUSIONS: Pre-nursing program losses significantly decreased the diversity of the remaining nursing applicant pool, particularly for African American students. Losses were highest during the freshman level Anatomy and Physiology course. Nursing education programs need to develop early intervention programs to support diverse students during the critical pre-nursing period to increase the diversity of the nursing workforce.

Demographic and behavioural factors associated with antimicrobial susceptibility to azithromycin and ceftriaxone in Neisseria gonorrhoeae.

Antimicrobial resistance of Neisseria gonorrhoeae (NG) is of global public health concern. The aim of this study was to explore demographic and behavioural factors associated with antimicrobial susceptibility of NG to ceftriaxone and azithromycin. Gonococcal isolates (n = 391) from clients attending the Auckland Sexual Health Service, New Zealand, from July 2014 - June 2015 (n = 206), and July 2017 - June 2018 (n = 185), were tested for susceptibility to ceftriaxone and azithromycin. Laboratory data were linked with behavioural and demographic data. Geometric mean azithromycin MICs increased across the two time periods (0.239 mg/L in 2014/15 to 0.347 mg/L in 2017/18, p < 0.001), and ceftriaxone MICs decreased (0.007 mg/L in 2014/15 to 0.005 mg/L in 2017/18, p < 0.001). Demographic and behavioural factors were not associated with differences in ceftriaxone MICs; however azithromycin MICs were higher in men who have sex with men (0.356 mg/L) compared with the heterosexual study population (0.192 mg/L, p < 0.001) and were lower in Pacific peoples (0.201 mg/L, p < 0.001) and Maori (0.244 mg/L, p = 0.05) compared with those of European ethnicity (0.321 mg/L). Our findings show that azithromycin MICs increased in our region between 2014 and 2018; associations were seen with sexual orientation and ethnicity.

Variability in Azithromycin Susceptibility Results for Neisseria gonorrhoeae Obtained Using Gradient MIC Strip and Agar Dilution Techniques.

Azithromycin is a component of empirical treatment regimens for Neisseria gonorrhoeae infections, but antimicrobial susceptibility testing for this agent is technically challenging. We compared the intertest variability, MIC values, and CLSI/EUCAST categorization of clinical and reference isolates of N. gonorrhoeae treated with azithromycin by testing 107 clinical isolates and nine reference isolates by agar dilution and in duplicates using MIC test strips (Liofilchem, Italy) and Etests (bioMérieux, France). Replicate isolate agreement within 1 log2 between duplicate tests was 87% for MIC test strips and 100% for Etests (P < 0.001). Essential agreement with the agar dilution method was higher for Etests (91%) than for MIC test strips (44%, P < 0.001). The geometric mean MIC was highest for MIC test strips (0.8 mg/liter) and significantly higher than both Etest (0.47 mg/liter, P < 0.001) and agar dilution (0.26 mg/liter, P < 0.001) methods. Etest MICs were higher than those obtained with agar dilution (P < 0.001). Agar dilution, MIC test strip, and Etest methods categorized 96%, 85%, and 95% (P = 0.003) of clinical isolates, respectively, as susceptible/wild type according to CLSI/EUCAST criteria. Our results illustrate the difficulties underlying azithromycin susceptibility testing for N. gonorrhoeae and demonstrate that results can vary using different methods. This variability could influence antimicrobial resistance reporting between laboratories involved in N. gonorrhoeae surveillance programs.

Revised fish aging techniques improve fish contaminant trend analyses in the face of changing Great Lakes food webs.

Incorporation of fish age into the assessment of status and trends for persistent, bioaccumulative and toxic chemicals in the Great Lakes has become an important step for the U.S. EPA's Great Lakes Fish Monitoring and Surveillance Program (GLFMSP). A slowing in the rate of decline for total PCBs in Lake Huron beginning in 2000, led the Program to complete a retrospective analysis to assess how chemical contamination may be influenced by fish age. Analytical results suggest that fish age is an important variable when assessing contaminant trends and that the Program needed to revise its compositing scheme to group fish according to age, rather than by length, prior to homogenization and chemical analysis. An Interlaboratory comparison study of multiple age structures was performed to identify the most appropriate age estimation structure for the Program. The lake trout (Salvelinus namaycush) maxillae was selected, over the otolith, as the most precise, accurate, and rapidly assessed structure for the Program when compared between laboratories and against the known age from the coded wire tag (CWT). Age-normalization practices can now be implemented when assessing contaminant concentrations and trends for the GLFMSP.

Keeping track of antimicrobial resistance for Neisseria gonorrhoeae in Auckland, New Zealand: past, present and future considerations.

AIMS: Neisseria gonorrhoeae (NG) has developed resistance to a wide range of antimicrobials. Population level data is essential to determine empiric treatment regimes. We sought to identify antimicrobial resistance patterns for NG in the Auckland region from 2008-2016, and review the utility of current methods of antimicrobial resistance testing. METHODS: Antimicrobial susceptibilities and demographic data from NG isolates derived from patients attending the Auckland Regional Sexual Health Service and Auckland City Hospital were analysed to determine resistance rates and trends over time. Antimicrobial susceptibility testing was performed by agar dilution using Clinical and Laboratory Standards Institute (CLSI) interpretation criteria. RESULTS: Results for 2,302 isolates from 1,941 patients were analysed. While ciprofloxacin resistance increased between 2008 and 2011, resistance rates for all antibiotics declined from 2013-2016. In 2016, 22% (53) of isolates were resistant to ciprofloxacin, 7% (17) to penicillin, 31% (76) to tetracycline and 0.8% (2) exhibited decreased susceptibility to ceftriaxone. CONCLUSION: Ceftriaxone is still suitable as a component of gonorrhoea treatment in our region but resistance to other agents prohibits their use for empiric treatment regimens. Current methods of detecting antimicrobial resistance for NG needed to be updated so that they are fit for purpose.

Relationships among spirituality, religious practices, personality factors, and health for five different faith traditions.

To determine: (1) differences in spirituality, religiosity, personality, and health for different faith traditions; and (2) the relative degree to which demographic, spiritual, religious, and personality variables simultaneously predict health outcomes for different faith traditions. Cross-sectional analysis of 160 individuals from five different faith traditions including Buddhists (40), Catholics (41), Jews (22), Muslims (26), and Protestants (31). Brief multidimensional measure of religiousness/spirituality (BMMRS; Fetzer in Multidimensional measurement of religiousness/spirituality for use in health research, Fetzer Institute, Kalamazoo, 1999); NEO-five factor inventory (NEO-FFI; in Revised NEO personality inventory (NEO PI-R) and the NEO-five factor inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, Costa and McCrae 1992); Medical outcomes scale-short form (SF-36; in SF-36 physical and mental health summary scores: A user's manual, The Health Institute, New England Medical Center, Boston, Ware et al. 1994). (1) ANOVAs indicated that there were no significant group differences in health status, but that there were group differences in spirituality and religiosity. (2) Pearson's correlations for the entire sample indicated that better mental health is significantly related to increased spirituality, increased positive personality traits (i.e., extraversion) and decreased personality traits (i.e., neuroticism and conscientiousness). In addition, spirituality is positively correlated with positive personality traits (i.e., extraversion) and negatively with negative personality traits (i.e., neuroticism). (3) Hierarchical regressions indicated that personality predicted a greater proportion of unique variance in health outcomes than spiritual variables. Different faith traditions have similar health status, but differ in terms of spiritual, religious, and personality factors. For all faith traditions, the presence of positive and absence of negative personality traits are primary predictors of positive health (and primarily mental health). Spiritual variables, other than forgiveness, add little to the prediction of unique variance in physical or mental health after considering personality. Spirituality can be conceptualized as a characterological aspect of personality or a distinct construct, but spiritual interventions should continue to be used in clinical practice and investigated in health research.

Randomized prospective study of a work place ergonomic intervention for individuals with rheumatoid arthritis and osteoarthritis.

OBJECTIVE: To conduct a longitudinal randomized controlled trial comparing a work place ergonomic intervention versus a control (i.e., provision of written educational materials) for persons with rheumatoid arthritis (RA) or osteoarthritis (OA) regarding employment, physical, and symptom outcomes. METHODS: Eighty-nine participants (mean age 50.54 years, 87% women, 38% with RA, 62% with OA) were randomized into the intervention or control group. Seventy-five participants completed baseline, 12-month, and 24-month evaluations. Outcome measures included Arthritis Impact Measurement Scales 2 (AIMS2) physical, symptom (i.e., pain), and role scores (i.e., impact of arthritis on employment); Job Satisfaction Survey (JSS); and Brief Symptom Inventory Global Severity Index. The study design was a 2-factor (treatment and time) with repeated measures on 1 factor (time) design used with baseline as a covariate for 12- and 24-month data. RESULTS: Between-group analyses indicated differences at 24 months for the AIMS2 role score (P < 0.03), with the intervention group reporting less arthritis-related impact on their work. Within-group analyses indicated significant improvements for the intervention group in AIMS2 change scores for physical functioning and symptom variables at 12 months (P < 0.04 and P < 0.01, respectively) and 24 months (P < 0.01 and P < 0.01, respectively). Job satisfaction (JSS) decreased at 12 months for both the intervention (P < 0.01) and control groups (P < 0.01), and at 24 months for the control group (P < 0.01). CONCLUSION: An ergonomic work place intervention (versus a control) is associated with decreased arthritis-related work difficulties over 2 years for individuals with OA and RA, as well as improvements in physical functioning and pain.

Convergent/Divergent validity of the brief multidimensional measure of religiousness/spirituality: empirical support for emotional connectedness as a "spiritual" construct.

The objective of this article is to determine the convergent/divergent validity of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; Fetzer Institute & National Institute on Aging Working Group 1999) subscales by correlating it with the Temperament and Character Inventory (TCI) Self-Transcendence subscales (i.e., Mysticism, Transpersonal Identification, Self-Forgetfulness; Cloninger et al. 1994). The cross-sectional analysis of 97 undergraduate/graduate students from a Midwestern university was made. The results are (1) all five BMMRS spirituality subscales were significantly correlated with the TCI Mysticism scale; (2) two BMMRS scales (i.e., Daily Spiritual Experiences, Values/Beliefs) were significantly correlated with the TCI Transpersonal Identification scales; (3) no BMMRS spiritual subscales were significantly correlated with the TCI Self-Forgetfulness scale; and (4) of the BMMRS religion scales, only the Organizational Religiousness subscale was correlated with any TCI subscale (i.e., Mysticism). The BMMRS appears to have adequate convergent/divergent validity, although the need exists to determine specific dimensions of spirituality. Inspection of the specific items of the BMMRS and TCI spiritual subscales that were most consistently correlated (i.e., BMMRS Daily Spiritual Experiences, Values/Beliefs; TCI Mysticism, Transpersonal Identification) suggests the existence of a distinct spiritual construct that is best conceptualized as the experience of emotional connectedness to the divine, nature, and/or others.

Why some women deliver in health institutions and others do not: a cross sectional study of married women in Ghana, 2008.

Existing inequalities in an environment where men wield so much authority can have negative implications for women's reproductive health outcomes. Using a quantitative approach, the study explores the relationship between some selected socioeconomic variables, women's status and choice of place of delivery. All three indicators of status employed by the study were significantly associated with whether a woman had an institutional delivery or not. This association however diminished after controlling for other confounding socio-economic variables. The findings indicate that a woman's status does not act independently to affect her choice of place of delivery but these effects are channelled through some socio-economic variables. Wealth and educational status of the women and their partners emerged predictors of choice of place of delivery. Expansion of economic opportunities for women, as well as female education must be encouraged. In addition, these should not be done in neglect of male education.

Environmental impact propagated by cross-system subsidy: chronic stream pollution controls riparian spider populations.

Resource subsidies between habitats are common and create the potential for the propagation of environmental impacts across system boundaries. However, recent understanding of the potential for subsidy-mediated cross-system impact propagations is limited and primarily based on passive flows of nutrients and detritus or short-term effects. Here, we assess the effects of sustained alterations in aquatic insect emergence (active subsidy pathway), due to chronic stream pollution, for riparian spiders. The sustained reduction in aquatic insect densities at the polluted reaches resulted in a marked decline in web spider population density and a shift in spider community composition. Our results provide the first evidence that stream pollution can control populations and community structure of terrestrial predators via sustained alterations in aquatic subsidies, emphasizing the role of subtle trophic linkages in the transmission of environmental impacts across ecosystem boundaries.

Neuropsychological decline/improvement in opsoclonus myoclonus ataxia.

Opsoclonus myoclonus ataxia (OMA) is a rare neurological disorder (incidence = approximately 1/5 million) primarily associated with involuntary conjugate saccadic eye movements, involuntary muscle jerks, cerebellar ataxia, and neuropsychological impairments. Unfortunately, there is limited published data regarding the nature and course of neuropsychological impairments following OMA diagnosis and treatment. This study presents neuropsychological data obtained at 1, 4, and 18 months post-diagnosis of a 52-year-old male with OMA. The patient initially demonstrated significant global neurocognitive, psychomotor, and psychological difficulties with substantial improvement over time. Treatment included medication management, physical rehabilitation, and psychological intervention.

Ethylene as a possible cue for seed germination of Schoenoplectus hallii (Cyperaceae), a rare summer annual of occasionally flooded sites.

The purpose of our research was to determine why seeds of Schoenoplectus hallii germinate only in some wet years. Seeds mature in autumn, at which time they are dormant. Seeds come out of dormancy during winter, if buried in nonflooded, moist soil, but they remain dormant if buried in flooded soil. Nondormant seeds require flooding, light, and exposure to ethylene to germinate. One piece of apple in water (1/12 of an apple in 125 mL of water in a glass jar for a depth of 5 cm) or a 1-µmol/L solution of ethephon elicited very similar (high) germination percentages and vigor of seedlings. Apple, which was shown to produce ethylene in the air space of the jar, was used in a series of experiments to better understand germination. Seeds germinated to 72% if apple was removed from the water after 1 d of incubation, and they germinated to 97% if seeds were washed and placed in fresh water after 3 d of exposure to apple. No seeds germinated in control with no apple. Seeds incubated in apple leachate for 5 d and then transferred to filter paper moistened with distilled water germinated to 90%. Minimum depth of flooding in apple leachate (no soil in jars) for optimum germination was ≥3 cm. Buried seeds of S. hallii exhibited an annual conditional dormancy/nondormancy cycle. Regardless of the month in which seeds were exhumed, they germinated to 59-100% in light in water with apple at daily alternating temperature regimes of 25°/15°, 30°/15°, and 35°/20°C, but germination at 20°/10°C (and to some extent at 15°/6°C) tended to peak in autumn to spring. Thus, seeds can germinate throughout the summer if flooded (ethylene production) and exposed to light. An ethylene cue for germination serves as a "flood-detecting" mechanism and may serve as an indirect signal that water is available for completion of the life cycle and competing species are absent.