A model to understand HIV-related stigma and the psychosocial well-being of children orphaned by AIDS: a theory generative approach.

HIV-related stigma has negatively impacted the psychosocial well-being of children who have been orphaned by AIDS-related causes. Response to reducing stigma and ensuring child well-being is hindered by the limited understanding of HIV-related stigma and how it affects the psychosocial well-being of children. Due to the call for a comprehensive understanding of HIV-related stigma, this study aimed to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. The study implemented a mixed method, exploratory, sequential design within a theory generative approach that included concept development, statement development, model description, and model evaluation. The developed model indicated that HIV-related stigma is embedded in social interaction and mediated by children orphaned by AIDS response to stigma. HIV-related stigma and maladaptive coping strategies collectively affect several domains of child psychosocial well-being and elevate psychosocial distress. This is the first model to provide a child-centred understanding of HIV-related stigma and its consequences for psychosocial well-being. The model may be used to guide future research and inform the development of appropriate interventions.

Student readiness for interprofessional learning at a local university in South Africa.

Working effectively with other disciplines has become an important competency as a graduate attribute in higher education institutions. Educational experiences should begin to foster the prerequisite competencies needed to collaborate successfully with other healthcare professionals. The purpose of this study was to determine how ready first year students are for interprofessional learning, and whether this readiness improves along the continuum of learning into their final year of undergraduate studies. First year undergraduate students from ten disciplines completed the Readiness for Interprofessional Learning Scale prior to participating in a compulsory interprofessional module, and the results were compared with that of senior students who completed the same questionnaire. Results for the study show that there were significant differences between first and senior-year level students on the subscales of negative professional identity (0.02 < 0.05); positive professional identity (0.00 < 0.05); and teamwork and collaboration (0.00 < 0.05). There was no significant difference found on the subscale roles and responsibilities (0.54 > 0.05). The results clearly show that senior students are more ready for learning interprofessionally compared to first year students. It is recommended that a scaffolded approach to learning be adopted, to ensure that students attain competence in all Interprofessional Education (IPE) core competencies when reaching their final year of study. This type of curriculum, with its specific activities and assessment methods, should be packaged in the form of an IPE model to create a clear understanding of the type of health profession graduate that will be produced.

Leisure-time physical activity practices and the influencing factors among government office employees in Kigali, Rwanda

Background: Physical inactivity is one of the major risk factors of non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular diseases, obesity, certain cancers, and all-cause mortality. Office employees are particularly exposed to such diseases, due to the nature of their work, which mainly involves passive activities that require less energy expenditure. Objectives: The objective of the study was to assess the leisure-time physical activity participation (LTPAP) among government employees in Kigali, Rwanda, as well as to highlight the factors that motivate, or hinder their participation. Methods: A cross-sectional, descriptive quantitative study was conducted with 600 participants. A stratified sampling technique was used to determine the study sample from the Government of Rwanda's Sports Policy stakeholder institutions. Then, a convenience sample of participants was selected from each stratum to form the final study sample. Data were collected using a three-part customised, self-administered questionnaire to capture demographic data, leisure-time physical activity levels (LTPA) using the Godin-Shephard questionnaire, and the factors that influenced participation. Analysis was done using the Statistical Package for the Social Sciences (SPSS). Descriptive and inferential statistics were employed to summarise and draw meaningful associations between different variables. Results: More than half (61.1%) of the participants were not sufficiently active. Physical activity levels declined significantly with advancing age (p = 0.004) and increasing working experience (p = 0.002); female participants were less active than males. The prevention of diseases and maintenance of good health were the most frequently reported contributors (48.8%) to physical activity participation, while time and tight work schedules were the most frequently reported hindrances (62.2%). Conclusion: The majority of government office employees in Kigali did not engage in sufficient leisure-time physical activity, hence they may be at high risk of developing NCDs. Strategies to increase LTPA among employees should be implemented

Implementing interprofessional education and practice: Lessons from a resource-constrained university.

Interprofessional education is seen as a vehicle to facilitate collaborative practice and, therefore, address the complex health needs of populations. A number of concerns have, however, been raised with the implementation of interprofessional education. The three core concerns raised in the literature and addressed in the article include the lack of an explicit framework, challenges operationalising interprofessional education and practice, and the lack of critical mass in terms of human resources to drive activities related to interprofessional education and practice. This article aims to present lessons learnt when attempting to overcome the main challenges and implementing interprofessional education activities in a resource-constrained higher education setting in South Africa. Boyer's model of scholarship, which incorporates research, teaching integration, and application, was used to address the challenge of a lack of a framework in which to conceptualise the activities of interprofressional education. In addition, a scaffolding approach to teaching activities within a curriculum was used to operationalise interprofessional education and practice. Faculty development initiatives were additionally used to develop a critical mass that focused on driving interprofessional education. Lessons learnt highlighted that if a conceptual model is agreed upon by all, it allows for a more focused approach, and both human and financial resources may be channelled towards a common goal which may assist resource-constrained institutions in successfully implementing interprofessional activities.

Angle-of-incidence performance of random anti-reflection structures on curved surfaces.

Random anti-reflection structured surfaces (rARSS) have been reported to improve transmittance of optical-grade fused silica planar substrates to values greater than 99%. These textures are fabricated directly on the substrates using reactive-ion etching techniques, and often result in transmitted spectra with no measurable interference effects (fringes) for a wide range of wavelengths. The inductively coupled reactive-ion plasma (ICP-RIE) used in the fabrication process to etch the rARSS is anisotropic and thus well suited for planar components. The improvement in spectral transmission has been found to be independent of optical incidence angles for values from 0° to ±30°. Qualifying and quantifying the rARSS performance on curved substrates, such as convex lenses, is required to optimize the fabrication of the desired AR effect on optical-power elements. In this work, rARSS was fabricated on fused silica plano-convex lenses using a planar-substrate optimized ICP-RIE process to maximize optical transmission in the range from 500 to 1100 nm. Results are presented from optical transmission tests of rARSS lenses for both TE and TM incident polarizations at a wavelength of 633 nm and over a 70° full field of view. These results suggest optimization of the fabrication process to account for anisotropy is not required, mainly due to the wide angle-of-incidence AR tolerance performance of the rARSS lenses.

Snakebite! Crotalinae Envenomation of a Man in Rhode Island.

The incidence of poisonous snakebites has regional variance. Health care providers' knowledge and comfort in treating these envenomated patients depends on the density of poisonous snakes in their environment, with practitioners in the southern U.S. typically treating more exposed patients than those in colder regions in the North. We present a rare case of a confirmed copperhead snakebite that occurred in Rhode Island. We will review Copperhead bites, clinical management and treatment options.

Perceptions of undergraduate dental students at maker ere college of health sciences; Kampala; Uganda towards patient record keeping

Background. The creating; maintenance and storage of patients' medical records is an important competence for the professional training of a dental student. Objective. Owing to the unsatisfactory state of dental records at the students' clinic; the objective of this study was to obtain information from undergraduate dental students on the factors that affect this process and elicit recommendations for improvement. Methods. This qualitative cross-sectional study used focus group discussions with 4th- and 5th-year dental students for data collection. Data were captured through a written transcript and an audio recorder. The data were transcribed and analysed manually through developing themes; which were compared with the literature and interpreted. Results. Three themes emerged: (i) Poorly designed clerking forms. The clerking forms were deemed to have a poor design with inadequate space for clinical notes. It was recommended that they be redesigned. (ii) Inadequate storage space. Space for storing patient records was deemed inadequate and a referencing system for file retrieval was lacking. It was recommended that more space be allocated for storage; with a referencing system for easy file retrieval. (iii) Poor maintenance of records. Patients' records; especially radiographs; were not well labelled and stored. It was recommended that drug envelopes be utilised to store radiographs. An electronic system was deemed the ultimate solution to this problem. Conclusion. The general perception was that the current paper-based record system at the clinic was unsatisfactory. Therefore; there is a need to improve the maintenance and storage of records; and to change to a more efficient electronic system. The students' attitude towards record keeping was found to be questionable; with a need to be addressed as part of teaching and learning in the curriculum. Lecturers were deemed to have a bigger role to play in the record-keeping process

High mobility group box 1 protein (HMGB-1): a pathogenic role in preeclampsia?

We evaluated whether preeclampsia is associated with elevated circulating levels of High mobility group box 1 protein (HMGB-1), a nuclear protein with proinflammatory effects when released extracellularly. We enrolled 48 women, 32 in third trimester pregnancy (16 with, 16 without preeclampsia), and 16 healthy non pregnant. In the peripheral blood of pregnant women, HMGB-1 concentration was assessed serially, before and after delivery. With or without preeclampsia, third trimester pregnancy was associated with elevated levels of HMGB-1. This elevation is exaggerated in preeclampsia. The source of HMGB-1 observed in these conditions is likely to involve tissues other than the placenta itself.

Tungiasis in Haiti: a case series of 383 patients.

BACKGROUND: Tungiasis is endemic in poverty-stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. This study is the first formal investigation of tungiasis in Haiti. METHODS: A total of 383 patients in four regions (Belle Fontaine, Vallue, Savanette, Cerca Carvajal) were examined and interviewed to determine disease prevalence, demographics and clinical presentation, and tungiasis-related behaviors. RESULTS: Prevalences of tungiasis ranged from 10.6 to 81.8% across the four regions. The overall prevalence of tungiasis in the patients examined was 31.1%. Of the affected patients, 63% were male and 37% were female, 37% were aged 0-10 years, and 100% reported pain and pruritus. Lesions occurred on the feet in 93.3% and on the hands in 22.7% of affected patients. The most common complications observed were chronic inflammation (54.2%) and hyperkeratosis (48.2%). CONCLUSIONS: This study establishes tungiasis as endemic in four regions of Haiti and reveals disease characteristics similar to those reported previously, suggesting that there are common factors underlying this disease in various regions, which are likely to be poverty-related. These findings emphasize the need to acknowledge tungiasis as a clinically relevant public health issue in order to decrease the frequency of tungiasis-related morbidity in endemic areas.

Physical activity and health promotion strategies among physiotherapists in Rwanda.

BACKGROUND: Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. Physiotherapists are in a position to combat inactivity and effectively promote physical activity to their clients. OBJECTIVES: To establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. METHODS: A sequential mixed method design was used by means of a self-administered questionnaire (n=92) and a focus group discussion comprising of 10 purposively selected physiotherapists. Descriptive statistics were employed to summarize demographic information. Inferential statistics was used to test the associations between different categorical variables (p<0.05). Tape recorded interviews were transcribed. Thematic analysis was then done. RESULTS: The findings revealed that 64% of the participants were physically active both within the work and recreation domains and 65% of the participants had good physical activity promoting practices. Discussing physical activity and giving out information regarding physical activity were most common methods used in promotion of physical activity. Policies on physical activity, cultural influence, and nature of work, time management as well as the environment were the barriers highlighted. CONCLUSION: Although physiotherapists experience barriers to promoting physical activity, they have good physical activity promoting practices.

Development of a sensitive RT-PCR method for amplifying and sequencing near full-length HCV genotype 1 RNA from patient samples.

BACKGROUND: Direct-acting antiviral (DAAs) agents for hepatitis C virus (HCV) span a variety of targets, including proteins encoded by the NS3/4A, NS4B, NS5A, and NS5B genes. Treatment with DAAs has been shown to select variants with sequence changes in the HCV genome encoding amino acids that may confer resistance to the treatment. In order to assess these effects in patients, a Reverse Transcription Polymerase Chain Reaction (RT-PCR) method was developed to sequence these regions of HCV from patient plasma. METHODS: A method was developed to amplify and sequence genotype 1 HCV RNA from patient plasma. Optimization of HCV RNA isolation, cDNA synthesis, and nested PCR steps were performed. The optimization of HCV RNA isolation, design of RT-PCR primers, optimization of RT-PCR amplification conditions and reagents, and the evaluation of the RT-PCR method performance is described. RESULTS: The optimized method is able to successfully, accurately, and reproducibly amplify near full-length genotype 1 HCV RNA containing a wide range of concentrations (103 to 108 IU/mL) with a success rate of 97%. The lower limit of detection was determined to be 1000 IU/mL HCV RNA. CONCLUSIONS: This assay allows viral sequencing of all regions targeted by the most common DAAs currently in development, as well as the possibility to determine linkage between variants conferring resistance to multiple DAAs used in combination therapy.

Use of in situ simulation and human factors engineering to assess and improve emergency department clinical systems for timely telemetry-based detection of life-threatening arrhythmias.

BACKGROUND AND OBJECTIVES: Medical simulation and human factors engineering (HFE) may help investigate and improve clinical telemetry systems. Investigators sought to (1) determine the baseline performance characteristics of an Emergency Department (ED) telemetry system implementation at detecting simulated arrhythmias and (2) improve system performance through HFE-based intervention. METHODS: The prospective study was conducted in a regional referral ED over three 2-week periods from 2010 to 2012. Subjects were clinical providers working at the time of unannounced simulation sessions. Three-minute episodes of sinus bradycardia (SB) and of ventricular tachycardia (VT) were simulated. An experimental HFE-based multi-element intervention was developed to (1) improve system accessibility, (2) increase system relevance and utility for ED clinical practice and (3) establish organisational processes for system maintenance and user base cultivation. The primary outcome variable was overall simulated arrhythmia detection. Pre-intervention system characterisation, post-intervention end-user feedback and real-world correlates of system performance were secondary outcome measures. RESULTS: Baseline HFE assessment revealed limited accessibility, suboptimal usability, poor utility and general neglect of the telemetry system; one simulated VT episode (5%) was detected during 20 pre-intervention sessions. Systems testing during intervention implementation recorded detection of 4 out of 10 arrhythmia simulations (p=0.03). Twenty post-intervention sessions revealed more VT detections (8 of 10) than SB detections (3 of 10) for a 55% overall simulated arrhythmia detection rate (p=0.001). CONCLUSIONS: Experimental investigations helped reveal and mitigate weaknesses in an ED clinical telemetry system implementation. In situ simulation and HFE methodologies can facilitate the assessment and abatement of patient safety hazards in healthcare environments.

Low-temperature deposition of BaCuSF, a visible through mid-infrared p-type transparent conductor.

Barium copper sulfur fluoride (BaCuSF) is a p-type transparent conductor (p-TC) that, when doped with potassium, exhibits exceptionally high conductivity. The results of a detailed optical and electronic characterization of BaCuSF thin films deposited at a substrate temperature of 100 °C are presented. X-ray diffractometry shows the presence of a cubic BaCuSF phase. Spectroscopic measurements demonstrate that the films transmit from the visible through the mid-infrared with a band gap of 1.8 eV. Hall measurements indicate that the material is a degenerate semiconductor. As deposited, the films exhibit conductivity at room temperature of approximately 260 S/cm - among the highest reported room temperature conductivities for p-TCs. After post-deposition treatment in water, their conductivity increases to as high as 800 S/cm, and their band gap is reduced to 1.5 eV. The potential for low temperature deposition of p-type films with high conductivity and optical transmittance makes BaCuSF promising for several applications including flexible electronics and photovoltaics.

The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda.

The accessibility of high active antiretroviral therapy (HAART) for local human immunodeficiency virus (HIV) patients is improving in Rwanda. It is well known that this therapy is associated with serious adverse effects, such as metabolic and morphologic changes. One of the recommended preventive modalities for these complications is participation in physical activity. The current study aims to determine the anthropometric profile and physical activity levels among people living with HIV and receiving HAART in Kigali, Rwanda. The study was a cross-sectional, descriptive quantitative survey. The participant's levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire for 407 clients passing through the clinics. Of the participants, approximately 70% were inactive and in addition, 40% were obese and 43% overweight. Obesity was found to be strongly associated with inactivity. Lack of motivation, and time as well as fear of worsening the disease were found to be barriers to participation in physical activity.

The effect of occupationally related low back pain on functional activities among male manual workers in a construction company in Cape Town; South Africa

This study determined the prevalence as well as the effect of occupationally-related low back pain on the functional activities of workers in a construction company in Cape Town. A cross-sectional; descriptive survey using a validated questionnaire was carried out. The questionnaire comprising demographic data; low back pain symptoms information; functional limitations scale and the participation restriction scale was used as a closed ended interview guide. Workers suffered physical; emotional; fi nancial and functional problems with 41.5 reporting sickness absence. Lifting and bending were the most affected activities associated to low back pain (p0.05) while walking/running; recreational activities and carrying out of everyday tasks were among the restricted activities. The one year prevalence of low back pain was 25 ; comparable with that of developed countries. Occupationally-related low back pain is a challenge among construction workers which they perceive to cause serious functional activity limitation. All stakeholders must be procured for the prevention and management of occupationally-related low back pain in order to prevent functional activity limitations among construction workers. Physiotherapists should raise the levels of awareness and monitor construction activities on site in order to prevent disability at primary level

LINGO-1, a transmembrane signaling protein, inhibits oligodendrocyte differentiation and myelination through intercellular self-interactions.

Overcoming remyelination failure is a major goal of new therapies for demyelinating diseases like multiple sclerosis. LINGO-1, a key negative regulator of myelination, is a transmembrane signaling protein expressed in both neurons and oligodendrocytes. In neurons, LINGO-1 is an integral component of the Nogo receptor complex, which inhibits axonal growth via RhoA. Because the only ligand-binding subunit of this complex, the Nogo receptor, is absent in oligodendrocytes, the extracellular signals that inhibit myelination through a LINGO-1-mediated mechanism are unknown. Here we show that LINGO-1 inhibits oligodendrocyte terminal differentiation through intercellular interactions and is capable of a self-association in trans. Consistent with previous reports, overexpression of full-length LINGO-1 inhibited differentiation of oligodendrocyte precursor cells (OPCs). Unexpectedly, treatment with a soluble recombinant LINGO-1 ectodomain also had an inhibitory effect on OPCs and decreased myelinated axonal segments in cocultures with neurons from dorsal root ganglia. We demonstrated LINGO-1-mediated inhibition of OPCs through intercellular signaling by using a surface-bound LINGO-1 construct expressed ectopically in astrocytes. Further investigation showed that the soluble LINGO-1 ectodomain can interact with itself in trans by binding to CHO cells expressing full-length LINGO-1. Finally, we observed that soluble LINGO-1 could activate RhoA in OPCs. We propose that LINGO-1 acts as both a ligand and a receptor and that the mechanism by which it negatively regulates OPC differentiation and myelination is mediated by a homophilic intercellular interaction. Disruption of this protein-protein interaction could lead to a decrease of LINGO-1 inhibition and an increase in myelination.

Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients.

INTRODUCTION: Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. METHODS: Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. RESULTS: A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62) and 33% (95% CI, 31-35), respectively. In all, 51% (95% CI, 48-54) received stress testing (52% nuclear stress, 39% stress echocardiogram, 5% exercise, 4% other). In all, 0.9% patients (n = 10, 95% CI, 0.4-1.5) were diagnosed with a non-ST elevation myocardial infarction and 2.2% (n = 23, 95% CI, 1.3-3) with acute coronary syndrome. There was 1 (95% CI, 0%-0.3%) case of a 30-day major adverse cardiovascular events. The 51% stress test utilization rate was less than the range reported in previous CPU studies (P < 0.05). CONCLUSIONS: Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates.

Web survey and embedded intervention on emergency department personnel perceptions of role in patient experience.

Investigators examined emergency department (ED) personnel's perceived job responsibilities and insights into determinants of patient experience. Surveys queried subjects on their perceptions of select clinical care-related actions (CCAs) to assess discipline-specific and service-specific CCA ownership and valuation. Investigators surveyed 153 of 634 ED personnel. A total of 3047 responses to 3802 queries indicated that a specified CCA was 'always' (58.2%) or 'sometimes' (21.9%) the subject's responsibility. A total of 3645 of 3797 responses indicated the CCA specified was 'always' (84.2%) or 'sometimes' (11.8%) important to the patient experience. Twelve percent of subjects reported not being responsible for monitoring or correcting medical errors. After exposure to survey queries, subjects indicated changing or re-considering how they communicate with patients (28.1%), deliver clinical care (20.2%), and arrange disposition/follow-up (20.3%). ED personnel's perceptions of CCA ownership and importance to patient experience were assessed. Subjects reported detectable levels of anticipated job-related behavioral changes traceable to survey-embedded intervention.

Color-coding and human factors engineering to improve patient safety characteristics of paper-based emergency department clinical documentation.

OBJECTIVE: Investigators studied an emergency department (ED) physical chart system and identified inconsistent, small font labeling; a single-color scheme; and an absence of human factors engineering (HFE) cues. A case study and description of the methodology with which surrogate measures of chart-related patient safety were studied and subsequently used to reduce latent hazards are presented. BACKGROUND: Medical records present a challenge to patient safety in EDs. Application of HFE can improve specific aspects of existing medical chart organization systems as they pertain to patient safety in acute care environments. METHODS: During 10 random audits over 5 consecutive days (573 data points), 56 (9.8%) chart binders (range 0.0-23%) were found to be either misplaced or improperly positioned relative to other chart binders; 12 (21%) were in the critical care area. HFE principles were applied to develop an experimental chart binder system with alternating color-based chart groupings, simple and prominent identifiers, and embedded visual cues. RESULTS: Post-intervention audits revealed significant reductions in chart binder location problems overall (p < 0.01), for Urgent Care A and B pods (6.4% to 1.2%; p < 0.05), Fast Track C pod (19.3% to 0.0%; p < 0.05) and Behavioral/Substance Abuse D pod (15.7% to 0.0%; p < 0.05) areas of the ED. The critical care room area did not display an improvement (11.4% to 13.2%; p = 0.40). CONCLUSIONS: Application of HFE methods may aid the development, assessment, and modification of acute care clinical environments through evidence-based design methodologies and contribute to safe patient care delivery.