Equine infection with Leishmania spp. in Costa Rica: Study of five cases.

BACKGROUND: Cutaneous forms of leishmaniosis due to Leishmania braziliensis have been reported in horses in the New World. Domestic animals play a role in the transmission of the disease. In Costa Rica, human cases of L. braziliensis, L. panamensis and L. infantum have been reported. OBJECTIVES: The present report describes five cases of equine cutaneous leishmaniosis in Costa Rica. The aetiological diagnosis was based on the presence of the parasite within the lesions. METHODS: Skin biopsies were used to perform histopathological analyses of the lesions. Immunohistochemistry was used to detect the presence of the Leishmania spp. antigens in tissue sections. Laser-capture micro-dissection and quantitative real-time PCR techniques were carried out to detect the pathogen nucleic acid within the microscopic lesions. RESULTS: Histopathological analyses showed a granulomatous inflammation within the dermis, with multi-nucleated giant cells, macrophages, lymphocytes and few neutrophils and eosinophils. We detected the parasite by immunohistochemistry, using a rabbit polyclonal antibody raised against Leishmania spp. However, we could not identify Leishmania spp. by quantitative real-time PCR in formalin-fixed paraffin-embedded tissues, using specific primers for the conserved region in the minicircle of the Leishmania DNA kinetoplast. CONCLUSIONS: Our results emphasise the importance of Leishmania spp. not only as a causative agent of equine cutaneous disease in the New World, but also as a possible emerging pathogen. Leishmaniosis is one of the most prevalent parasitic public health problems worldwide, and equines may have a role in the epidemiology of the disease.

Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

BACKGROUND: Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a "Train-the-Trainers" (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. METHODS: We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. RESULTS: Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. CONCLUSIONS: The TTT in hand hygiene model proved to be effective in enhancing participant's knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

Pensamiento crítico en enfermería: de la racionalidad técnica a la práctica reflexiva / Critical Thinking in Nursing: From Technical Rationality to Reflective Practice / Pensamento crítico em enfermagem: da racionalidade técnica à prática reflexiva

Objetivos: identificar la evolución de la enfermería española desde la racionalidad técnica a la práctica reflexiva. Mostrar evidencia respecto al pensamiento crítico y la práctica reflexiva identificando sus paralelismos con la enfermería sociocrítica. Clarificar la influencia histórica de los paradigmas imperantes en España durante la segunda mitad del siglo XX. Materiales y métodos: se realizó una revisión temática descriptiva. Se utilizaron fuentes primarias: Compte, Hume, Bacon, Habermas, Foucault y Horkheimer, y fuentes secundarias relacionadas con la profesión como: Index, SciELO. Resultado: la evolución de la racionalidad técnica a la práctica reflexiva se produjo con los cambios de pensamiento dominantes en cada época. La práctica reflexiva y el pensamiento crítico se muestran necesarios para entender la enfermería sociocrítica. La situación histórica española determinó los cambios en la enfermería de este país. Conclusiones: la evolución del pensamiento enfermero en España siguió la evolución de los paradigmas de pensamiento dominantes. La práctica reflexiva y el pensamiento crítico descrito por Habermas permiten la emancipación y, por extensión, la autonomía del paciente por la vía de la participación activa en la solución de sus problemas de salud. Este proceso se origina con la toma de conciencia del papel que deben desempeñar el profesional y el ciudadano/paciente en la planificación de los cuidados de salud. Tanto el perfil de la mujer fraguado por el franquismo, como la llegada de la democracia a España, fueron determinantes para la evolución estudiada, el primero actuando como asfixiante y la segunda como motor.

Purpose: This is a multi-purpose study intended to identify how Spanish nursing evolved from technical rationality to reflective practice and to show evidence of critical thinking and reflective practice by identifying their parallels with socio-critical nursing. Another objective was to explain the historical influence of the paradigms prevailing in Spain during the second half of the twentieth century. Study Materials and Methods: A descriptive thematic review was conducted. Compte, Hume, Bacon, Habermas, Foucault and Horkheimer were the primary sources used, along with secondary sources related to the profession; namely, Index and SciELO. Results: The evolution from technical rationality to reflective practice occurred with the changes in prevailing thought during each period. Reflective practice and critical thinking are shown as being necessary to understanding socio-critical nursing. Spain's history determined the changes in nursing in that country. Conclusions: The evolution of nursing thought in Spain followed the changes in the dominant paradigms in Spanish society. Reflective practice and critical thinking, as described by Habermas, allow for emancipation and, by extension, the patient's autonomy, through active participation in solving their health problems. This process begins with an awareness of the role to be played by the nursing professional and the citizen/patient in planning health care. The profile of women set by the Franco regime and the arrival of democracy in Spain were decisive to this evolution. The former was stifling, while the latter was a driving force.

Objetivos: identificar a evolução da enfermagem espanhola desde a racionalidade técnica à prática reflexiva. Mostrar evidência a respeito do pensamento crítico e da prática reflexiva identificando seus paralelismos com a enfermagem sociocrítica. Esclarecer a influência histórica dos paradigmas imperantes na Espanha durante a segunda metade do século XX. Materiais e métodos: realizou-se uma revisão temática descritiva. Utilizaram-se fontes primárias: Compte, Hume, Bacon, Habermas, Foucault e Horkheimer, além de fontes secundárias relacionadas com a profissão como: Index, SciELO. Resultado: a evolução da racionalidade técnica à prática reflexiva foi produzida com as mudanças de pensamento dominantes em cada época. A prática reflexiva e o pensamento crítico se mostram necessários para entender a enfermagem sociocrítica. A situação histórica espanhola determinou as mudanças na enfermagem desse país. Conclusões: a evolução do pensamento enfermeiro na Espanha segue a evolução dos paradigmas de pensamento dominantes. A prática reflexiva e o pensamento crítico descrito por Habermas permitem a emancipação e, por extensão, a autonomia do paciente pela via da participação ativa na solução de seus problemas de saúde. Esse processo se origina com a conscientização do papel que o profissional e o cidadão/paciente devem desempenhar no planejamento dos cuidados de saúde. Tanto o perfil da mulher, forjado pelo franquismo, quanto a chegada da democracia à Espanha foram determinantes para a evolução estudada; o primeiro atuando como asfixiante e a segunda, como motor.

Photothermal analysis of polymeric dye laser materials excited at different pump rates.

The photothermal properties and heat diffusion of polymeric lasers, made up from solutions of Rhodamine 6G in solid matrices of poly(2-hydroxyethyl methacrylate) with different amounts of the cross-linking monomer ethylene glycol dimethacrylate and copolymers of 2-hydroxyethyl methacrylate and methyl methacrylate have been studied through photothermal deflection spectroscopy. The heat load that is due to the pumping process was quantified as a function of the pump excitation repetition frequency (0.25-10 Hz), determining the time-dependent temperature changes at different locations within the laser matrix. A theoretical model, which reproduces these changes with high accuracy, was developed on the basis of the heat-diffusion equation of optically dense fluids. The observed thermal effects became important for impairing the laser stability at pump repetition frequencies higher than 1 Hz. In addition, the irreversible optical changes produced in the laser matrices at high pump fluence values (>1 J/cm2) were also analyzed. These effects originate, most likely, from a two-step photothermal mechanism.