Experiences of implementing hand hygiene for Malawian schoolchildren: a qualitative study.

AIM: To explore the experiences of schoolchildren, school personnel and parents who participated in a school-based hand hygiene programme implemented by nurses in Malawi. BACKGROUND: There is low uptake of hand hygiene practice in developing countries due to limited resources available and no standardized hand hygiene policy. INTRODUCTION: Current health policies acknowledge the advantage of investing in disease prevention and health promotion among young children in Malawi. School nurses should adopt good evidence-based practice in promoting school-based hand hygiene programmes which remain a challenge in Malawi. METHODS: In this descriptive qualitative study, 10 focus group discussions were conducted with 23 females and 14 males including schoolchildren, school personnel and parents participating in a school-based hand hygiene programme. The programme was implemented by nurses in three primary schools between May and July 2017 in Malawi. Data from these discussions were coded and analysed using thematic analysis. FINDINGS: The school-based hand hygiene programme was well received by participants. Four themes illustrated effective strategies in implementing the hand hygiene programme from the participants' view, including 'Being committed', 'Sharing responsibilities', 'Disseminating good practice' and 'Appreciating assets'. These are essential resources and strategies that school nurses need to mobilize and integrate when they advocate handwashing policy by delivering hygiene promotion activities. DISCUSSION: School nurses play a significant role in helping to achieve United Nation's Sustainable Development Goal 3 through promoting hand hygiene to minimize transmission of diseases and reduce mortality rate. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: An evidence-based protocol based on study findings is beneficial for school nurses in formulating handwashing policies. It is important for developing countries to formulate the much-need policies for primary care practices.

The 2018 rift eruption and summit collapse of Kilauea Volcano.

In 2018, Kilauea Volcano experienced its largest lower East Rift Zone (LERZ) eruption and caldera collapse in at least 200 years. After collapse of the Pu'u 'O'o vent on 30 April, magma propagated downrift. Eruptive fissures opened in the LERZ on 3 May, eventually extending ~6.8 kilometers. A 4 May earthquake [moment magnitude (M w) 6.9] produced ~5 meters of fault slip. Lava erupted at rates exceeding 100 cubic meters per second, eventually covering 35.5 square kilometers. The summit magma system partially drained, producing minor explosions and near-daily collapses releasing energy equivalent to M w 4.7 to 5.4 earthquakes. Activity declined rapidly on 4 August. Summit collapse and lava flow volume estimates are roughly equivalent-about 0.8 cubic kilometers. Careful historical observation and monitoring of Kilauea enabled successful forecasting of hazardous events.

Factors associated with the quality of life of nursing home residents in Hong Kong.

BACKGROUND: The quality of life of nursing home residents has increasingly become an important dimension when evaluating care in a nursing home. Not a lot is known about the quality of life of nursing home residents in Hong Kong. AIM: To investigate factors associated with the quality of life of nursing home residents to inform care management policies and service delivery. METHODS: This study reports data from 125 nursing home residents. The Hong Kong Chinese version of the World Health Organization's Quality of Life-Brief version was used. Other measures used include the Mini-Mental State Examination, the Mini-Nutritional Assessment, the Geriatric Depression Scale, the Modified STRATIFY Falls Prediction Tool and the Modified Barthel Index. A univariate analysis and a multiple regression analysis were then performed to identify the influencing factors. RESULTS: The participants reported a moderate level of quality of life, with the exception in the domain of social relationships. A univariate analysis found some associations between demographic and clinical characteristics and quality of life. A multiple regression analysis indicated that pain, being younger (65-74 years), having son(s) or daughter(s), and cognitive impairment were negatively associated factors. LIMITATIONS: The smallness of the sample from a single study site limits the generalizability of the findings. CONCLUSION: This study provides information that has hitherto been lacking on the quality of life and associated factors among local nursing home residents in Hong Kong. The preliminary findings can help healthcare staff to identify those at risk of suffering from a low quality of life and to design appropriate care interventions to improve the quality of life of such residents. IMPLICATIONS: Adequate pain relief, family connectedness and special attention to the needs of those with cognitive impairment are important considerations in ensuring a better quality of life for older people in long-term residential care.

The effect of a structured adolescent health summer programme: a quasi-experimental intervention.

BACKGROUND: It is important to integrate adolescent health domains into pre-service nursing education in order to enhance undergraduate nursing students' competencies in promoting adolescent health. AIM: To determine the effectiveness of a structured adolescent health summer programme for Chinese undergraduate nursing students. METHODS: A quasi-experimental design was used to evaluate differences in the Chinese undergraduate nursing students' perceived competency in promoting adolescent health. A stand-alone adolescent health course was implemented as an intervention with pre- and post-tests of a 2-week intensive summer programme in 2010. The questionnaire included demographics, adolescent health competency checklist and programme evaluation. Descriptive statistics with the Wilcoxon signed-ranks test and the Mann-Whitney U-test were used for data analysis. RESULTS: Of the 113 nursing students, seniors perceived higher adolescent health competence mean scores than the juniors in the post-test phase. Majority of nursing students revealed the increasing awareness of the importance in promoting healthy lifestyle behaviours and psychosocial well-being after attending the summer programme. They agreed that nurses do have a role to play. LIMITATIONS: This 2-week summer programme may only have short-term impacts on students' perception. CONCLUSIONS: A stand-alone adolescent health summer programme can prepare nursing students to respond to the health issues of adolescents by enhancing their competence in health need assessment and service delivery. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues.

Recurring BALB/c mouse lung inflammatory responses to episodic allergen exposure.

This study detailed the sequence of recurring inflammatory events associated with episodic allergen exposures of mice resulting in airway hyperreactivity, sustained inflammation, goblet-cell hyperplasia, and fibrogenesis that characterize a lung with chronic asthma. Ovalbumin (OVA)-sensitized female BALB/c mice were exposed to saline-control or OVA aerosols for 1 h per day for episodes of 3 d/wk for up to 8 wk. Lung inflammation was assessed by inflammatory cell recoveries using bronchoalveolar lavages (BAL) and tissue collagenase dispersions. Cell accumulations were observed within airway submucosal and associated perivascular spaces using immunohistochemical and tinctorial staining methods. Airway responsiveness to methacholine aerosols were elevated after 2 wk and further enhanced to a sustained level after wk 4 and 8. Although by wk 8 diminished OVA-induced accumulations of eosinophils, neutrophils, and monocyte-macrophages were observed, suggesting diminished responsiveness, the BAL recovery of lymphocytes remained elevated. Airway but not perivascular lesions persisted with a proliferating cell population, epithelial goblet-cell hyperplasia, and evidence of enhanced collagen deposition. Examination of lung inflammatory cell content before the onset of the first, second, and fourth OVA exposure episodes demonstrated enhancements in residual BAL lymphocyte and BAL and tissue eosinophil recoveries with each exposure episode. Although tissue monocyte-macrophage numbers returned to baseline prior to each exposure episode, the greatest level of accumulation was observed after wk 4. These results provide the basis for establishing the inflammatory and exposure criteria by which episodic environmental exposures to allergen might result in the development of a remodeled lung in asthma.

A novel cationic cardiolipin analogue for gene delivery.

The optically active R and S isomers of cationic cardiolipin analogues (CCA) were synthesized and evaluated as a liposome based transfection reagent. Both isomers form stable liposomes with mean diameters of about 120 nm without any additional lipid ingredients. No significant change in particle size distribution profile was observed over one-month storage at room temperature (20-25 degrees C). The gel to liquid crystalline phase transition temperature (Tm) of cationic liposomes comprised of both R and S isomers was approximately 2 degrees C, as measured by differential scanning calorimetry (DSC). Both isomers also formed stable liposomes when combined with DOPE. In vitro transfection efficiency of the CCA/DOPE liposomes complexed to plasmid DNA was evaluated using a luciferase reporter gene. Both liposomes composed of R and S isomers of the cationic cardiolipin displayed higher transfection efficiency than commercially available Lipofectin. Further in vivo studies are warranted.

A simplified one-pot synthesis of 9-[(3-[18F]fluoro-1-hydroxy-2-propoxy)methyl]guanine([18F]FHPG) and 9-(4-[18F]fluoro-3-hydroxymethylbutyl)guanine ([18F]FHBG) for gene therapy.

9-[(3-[18F]Fluoro-1-hydroxy-2-propoxy)methyl]guanine ([18F]FHPG, 2) has been synthesized by nucleophilic substitution of N(2)-(p-anisyldiphenylmethyl)-9-[[1-(p-anisyldiphenylmethoxy)-3-toluenesulfonyloxy-2-propoxy]methyl]guanine (1) with potassium [18F]fluoride/Kryptofix 2.2.2 followed by deprotection with 1 N HCl and purification with different methods in variable yields. When both the nucleophilic substitution and deprotection were carried out at 90 degrees C and the product was purified by HPLC (method A), the yield of compound 2 was 5-10% and the synthesis time was 90 min from EOB. However, if both the nucleophilic substitution and deprotection were carried out at 120 degrees C and the product was purified by HPLC, the yield of compound 2 decreased to 2%. When compound 2 was synthesized at 90 degrees C and purified by Silica Sep-Pak (method B), the yield increased to 10-15% and the synthesis time was 60 min from EOB. Similarly, 9-(4-[18F]fluoro-3-hydroxymethylbutyl)guanine ([18F]FHBG, 4) was synthesized with method A and method B in 9% and 10-15% yield, respectively, in a synthesis time of 90 and 60 min, respectively, from EOB. Compound 2 was relatively unstable in acidic medium at 120 degrees C while compound 4 was stable under the same condition. Both compound 2 and compound 4 had low lipid/water partition coefficient (0.126 +/- 0.022, n=5 and 0.165 +/- 0.023, n=5, respectively). Although it contains non-radioactive ganciclovir ( approximately 5-30 microg) as a chemical by-product, compound 2 synthesized by method B has a similar uptake in 9L glioma cells as that synthesized by method A, and is a potential tracer for imaging herpes simplex virus thymidine kinase gene expression in tumors using PET. Similarly, compound 4 synthesized by method B contains approximately 10-25 microg of penciclovir as a chemical by-product. Thus, the simplified one pot synthesis (method B) is a useful method for synthesizing both compound 2 and compound 4 in good yield for routine clinical use, and the method is readily amenable for automation.

Color and spectral analysis of daylight in southern Europe.

We have analyzed the colorimetric and spectral characteristics of 2600 daylight spectra (global spectral irradiances on a horizontal surface) measured for all sky states during a 2-year period at Granada, Spain. We describe in detail the chromaticity coordinates, correlated color temperatures (CCT), luminous efficacies, and relative UV and IR contents of Granada daylight. The chromaticity coordinates of Granada daylight lie far above the CIE locus at high CCTs (>9,000 K), and a CCT of 5,700 K best typifies this daylight. Our principal-components analysis shows that Granada daylight spectra can be adequately represented by using six-dimensional linear models in the visible, whereas seven-dimensional models are required if we include the UV or near-IR. Yet on average only three-dimensional models are needed to reconstruct spectra that are colorimetrically indistinguishable from the original spectra.

Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.

BACKGROUND: Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms. METHODS: We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee osteoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. Weightbearing, anteroposterior radiographs of each knee in full extension were taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial compartment of the tibiofemoral joint was assessed by digital image analysis, whereas minimum joint-space width--ie, at the narrowest point--was measured by visual inspection with a magnifying lens. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. FINDINGS: The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0.31 mm (95% CI -0.48 to -0.13). There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0.06 mm (-0.22 to 0.09). Similar results were reported with minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened slightly in patients on placebo compared with the improvement observed after treatment with glucosamine sulphate. There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups. INTERPRETATION: The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.

Colorimetric and spectroradiometric characteristics of narrow-field-of-view clear skylight in Granada, Spain.

As part of our ongoing research into the clear daytime sky's visible structure, we analyze over 1,500 skylight spectra measured during a seven-month period in Granada, Spain. We use spectral radiances measured within 3 degrees fields of view (FOV's) to define colorimetric characteristics along four sky meridians: the solar meridian and three meridians at azimuths of 45 degrees, 90 degrees, and 315 degrees relative to it. The resulting clear-sky chromaticities in 44 different view directions (1) are close to but do not coincide with the CIE daylight locus, (2) form V-shaped meridional chromaticity curves along it (as expected from theory), and (3) have correlated color temperatures (CCT's) ranging from 3,800 K to infinity K. We also routinely observe that sky color and luminance are asymmetric about the solar meridian, usually perceptibly so. A principal-components analysis shows that three vectors are required for accurate clear-sky colorimetry, whereas six are needed for spectral analyses.

Standardized head position and reference planes for dento-facial aesthetics.

The angulations of the anterior teeth in the sagittal view are important for diagnosing lip support for pleasing smiles and proper facial profiles (Figure 19). In Figure 20, the slant of the occlusal plane (incisal-canine line), the off-center tilted midline, and the asymmetry of the gingival line (contours) of this patient in the frontal view are now obvious. A diagnosis can now be made for possible correction using the horizontal and vertical frames of the articulator as a bioesthetic guide.

Receptor-targeted gene delivery via folate-conjugated polyethylenimine.

A novel synthetic gene transfer vector was evaluated for tumor cell-specific targeted gene delivery. The folate receptor is a tumor marker overexpressed in more than 90% of ovarian carcinomas and large percentages of other human tumors. Folic acid is a high affinity ligand for the folate receptor that retains its binding affinity upon derivatization via its gamma carboxyl. Folate conjugation, therefore, presents a potential strategy for tumor-selective targeted gene delivery. In the current study, we investigated a series of folate conjugates of the cationic polymer polyethylenimine (PEI) for potential use in gene delivery. A plasmid containing a luciferase reporter gene (pCMV-Luc) and the folate receptor expressing human oral cancer KB cells were used to monitor gene transfer efficiency in vitro. Transfection activity of polyplexes containing unmodified polyethylenimine was highly dependent on the positive to negative charge (or the N/P) ratio. Folate directly attached to PEI did not significantly alter the transfection activity of its DNA complexes compared to unmodified PEI. Modification of PEI by polyethyleneglycol (PEG) led to a partial inhibition of gene delivery compared to unmodified PEI. Attaching folates to the distal termini of PEG-modified PEI greatly enhanced the transfection activity of the corresponding DNA complexes over the polyplexes containing PEG-modified PEI. The enhancements were observed at all N/P ratios tested and could be blocked partially by co-incubation with 200 microM free folic acid, which suggested the involvement of folate receptor in gene transfer. Targeted vectors based on the folate-PEG-PEI conjugate are potentially useful as simple tumor-specific vehicles of therapeutic genes.

Calculating correlated color temperatures across the entire gamut of daylight and skylight chromaticities.

Natural outdoor illumination daily undergoes large changes in its correlated color temperature (CCT), yet existing equations for calculating CCT from chromaticity coordinates span only part of this range. To improve both the gamut and accuracy of these CCT calculations, we use chromaticities calculated from our measurements of nearly 7000 daylight and skylight spectra to test an equation that accurately maps CIE 1931 chromaticities x and y into CCT. We extend the work of McCamy [Color Res. Appl. 12, 285-287 (1992)] by using a chromaticity epicenter for CCT and the inverse slope of the line that connects it to x and y. With two epicenters for different CCT ranges, our simple equation is accurate across wide chromaticity and CCT ranges (3000-10(6) K) spanned by daylight and skylight.

Digital imaging of clear-sky polarization.

If digital images of clear daytime or twilight skies are acquired through a linear polarizing filter, they can be combined to produce high-resolution maps of skylight polarization. Here polarization P and normalized Stokes parameter Q are measured near sunset at one inland and two coastal sites. Maps that include the principal plane consistently show that the familiar Arago and Babinet neutral points are part of broader areas in which skylight polarization is often indistinguishably different from zero. A simple multiple-scattering model helps explain some of these polarization patterns.

Mie theory, airy theory, and the natural rainbow.

Compared with Mie scattering theory, Airy rainbow theory clearly miscalculates some monochromatic details of scattering by small water drops. Yet when monodisperse Airy theory is measured by perceptual (rather than purely physical) standards such as chromaticity and luminance contrast, it differs very little from Mie theory. Considering only the angular positions of luminance extrema, Airy theory's errors are largest for small droplets such as those that dominate cloudbows and fogbows. However, integrating over a realistic drop-size distribution for these bows eliminates most perceptible color and luminance differences between the two theories.

Image processing assessment of femoral osteopenia.

Visual assessment of femoral osteopenia (the radiographic presentation of osteoporosis) is unreliable. Many of the short-comings of observer grading can be overcome by digital image analysis. Our group has developed algorithms to make automatic assessment of osteopenia from clinical radiographs. Texture Analysis Models (TA) commonly used in image analysis were investigated as measures of osteopenia. Unlike densitometric methods, TA characterizes properties of the structure of the image (ie, trabecular patterns). A group of women were analyzed whose subjects ranged from those at risk of osteoporosis (n = 24) to normal (n = 40). Using an IBM PC, frame-grabber, camera, and light-box, we appraised five statistical TA algorithms for assessment of the femoral neck in standard pelvic radiographs: (1) Fractal Signature (FS) describes the image's fractal nature. (2) Auto-Correlation of unaltered and Sobel Edge Transformed images (ACSE) measures image spatial self-similarity. (3) Co-occurrence Matrices (CM) gives the joint probability of greylevels with distance/direction and describes statistical relationships of image variation. (4) Textural Spectrum (TS) neighborhood pixel relationships measure regional directional and pixel-inversion properties. (5) Eular Numbers (EN) describe texture by properties (such as connectivity) of binary images. Good reproducibility from repeated analysis of radiographs was shown using both paired t-tests and Altman-Bland's methods. We have shown a correlation between femoral neck bone mineral density (BMD-the "gold standard" of osteoporosis assessment) and textural measures for all five algorithms. Significant measures of osteopenia were: ACSE (r = 0.6, P < .001), CM (r = -0.69, P < .001), FS (r = 0.35, P < .01), TS (r = 0.52, P < .001) and EN (r = -0.39, P < .01). Relationships were also found between textural characteristics and age/weight. TA techniques characterize the radiographic changes of bone in osteoporosis. Technology based on these ideas may have a place alongside BMD measurements in the assessment of this condition.

Isolation and chromosomal mapping of a mouse homolog of the Batten disease gene CLN3.

We describe the isolation and chromosomal mapping of a mouse homolog of the Batten disease gene, CLN3. Like its human counterpart, the mouse cDNA contains an open reading frame of 1314 bp encoding a predicted protein product of 438 amino acids. The mouse and human coding regions are 82 and 85% identical at the nucleic acid and amino acid levels, respectively. The mouse gene maps to distal Chromosome 7, in a region containing genes whose homologs are on human chromosome 16p12, where CLN3 maps. Isolation of a mouse CLN3 homolog will facilitate the creation of a mouse model of Batten disease.