Microbiome-scale analysis of aerosol facemask contamination during nebulization therapy in hospital.

BACKGROUND: Microbial contamination of aerosol facemasks could be a source of nosocomial infections during nebulization therapy in hospital, prompting efforts to identify these contaminants. Identification of micro-organisms in medical devices has traditionally relied on culture-dependent methods, which are incapable of detecting the majority of these microbial contaminants. This challenge could be overcome with culture-independent sequencing-based techniques that are suited for the profiling of complex microbiomes. AIM: To characterize the microbial contaminants in aerosol facemasks used for nebulization therapy, and identify factors influencing the composition of these microbial contaminants with the acquisition and analysis of comprehensive microbiome-scale profiles using culture-independent high-throughput sequencing. METHODS: Used aerosol facemasks collected from hospitalized patients were analysed with culture-independent 16S rRNA gene-based amplicon sequencing to acquire microbiome-scale comprehensive profiles of the microbial contaminants. Microbiome-based analysis was performed to identify potential sources of microbial contamination in facemasks. FINDINGS: Culture-independent high-throughput sequencing was demonstrated for the capacity to acquire microbiome-scale profiles of microbial contaminants on aerosol facemasks. Microbial source identification enabled by the microbiome-scale profiles linked microbial contamination on aerosol facemasks to the human skin and oral microbiota. Antibiotic treatment with levofloxacin was found to reduce contamination of the facemasks by oral microbiota. CONCLUSION: Sequencing-based microbiome-scale analysis is capable of providing comprehensive characterization of microbial contamination in aerosol facemasks. Insight gained from microbiome-scale analysis facilitates the development of effective strategies for the prevention and mitigation of the risk of nosocomial infections arising from exposure to microbial contamination of aerosol facemasks, such as targeted elimination of potential sources of contamination.

Spatial and Temporal Diversity of Astrocyte Phenotypes in Spinocerebellar Ataxia Type 1 Mice.

While astrocyte heterogeneity is an important feature of the healthy brain, less is understood about spatiotemporal heterogeneity of astrocytes in brain disease. Spinocerebellar ataxia type 1 (SCA1) is a progressive neurodegenerative disease caused by a CAG repeat expansion in the gene Ataxin1 (ATXN1). We characterized astrocytes across disease progression in the four clinically relevant brain regions, cerebellum, brainstem, hippocampus, and motor cortex, of Atxn1154Q/2Q mice, a knock-in mouse model of SCA1. We found brain region-specific changes in astrocyte density and GFAP expression and area, early in the disease and prior to neuronal loss. Expression of astrocytic core homeostatic genes was also altered in a brain region-specific manner and correlated with neuronal activity, indicating that astrocytes may compensate or exacerbate neuronal dysfunction. Late in disease, expression of astrocytic homeostatic genes was reduced in all four brain regions, indicating loss of astrocyte functions. We observed no obvious correlation between spatiotemporal changes in microglia and spatiotemporal astrocyte alterations, indicating a complex orchestration of glial phenotypes in disease. These results support spatiotemporal diversity of glial phenotypes as an important feature of the brain disease that may contribute to SCA1 pathogenesis in a brain region and disease stage-specific manner.

Microbiome-based source identification of microbial contamination in nebulizers used by inpatients.

Nebulizers are essential for the delivery of aerosolized medication for respiratory patients in hospital. Microbial contamination of nebulizers increases the risk of healthcare-associated infections, presenting the critical need to identify sources of contamination in order to develop effective infection prevention and control practices in hospitals. Using an innovative microbiome-based cultivation-independent microbial source identification technique, the hospital indoor environment was identified as a significant source contributing to microbial contaminants in nebulizers, providing important information to develop strategies for targeted decontamination and enhance the effectiveness of infection prevention and control practices.

Finding the fifth intercostal space for chest drain insertion: guidelines and ultrasound.

OBJECTIVES: International guidelines exist for chest drain insertion and recommend identifying the fifth intercostal space or above, around the midaxillary line. In a recent study, applying these guidelines in cadavers risked insertion in the 6th intercostal space or below in 80% of cases. However, there are limitations of cadaveric studies and this investigation uses ultrasound to determine the intercostal space identified when applying these guidelines in healthy adult volunteers. METHODS: On each side of the chest wall in 31 volunteers, the position for drain insertion was identified using the European Trauma Course method, Advanced Trauma Life Support (ATLS) method, British Thoracic Society's 'safe triangle' and the 'traditional' method of palpation. Ultrasound imaging was used to determine the relationship of the skin marks with the underlying intercostal spaces. RESULTS: Five methods were assessed on 60 sides. In contrast to the cadaveric study, 94% of skin marks lay over a safe intercostal space. However, the range of intercostal spaces found spanned the second to the seventh space. In 44% of women, the inferior boundary of the 'safe triangle' and the ATLS guidelines located the sixth intercostal space or below. CONCLUSIONS: Current guidelines often identify a safe site for chest drain insertion, although the same site is not reproducibly found. In addition, women appear to be at risk of subdiaphragmatic drain insertion when the nipple is used to identify the fifth intercostal space. Real-time ultrasonography can be used to confirm the intercostal space during this procedure, although a safe guideline is still needed for circumstances in which ultrasound is not possible.

Neuronal Gonadotrophin-Releasing Hormone (GnRH) and Astrocytic Gonadotrophin Inhibitory Hormone (GnIH) Immunoreactivity in the Adult Rat Hippocampus.

Gonadotrophin-releasing hormone (GnRH) and gonadotrophin inhibitory hormone (GnIH) are neuropeptides secreted by the hypothalamus that regulate reproduction. GnRH receptors are not only present in the anterior pituitary, but also are abundantly expressed in the hippocampus of rats, suggesting that GnRH regulates hippocampal function. GnIH inhibits pituitary gonadotrophin secretion and is also expressed in the hippocampus of a songbird; its role outside of the reproductive axis is not well established. In the present study, we employed immunohistochemistry to examine three forms of GnRH [mammalian GnRH-I (mGnRH-I), chicken GnRH-II (cGnRH-II) and lamprey GnRH-III (lGnRH-III)] and GnIH in the adult rat hippocampus. No mGnRH-I and cGnRH-II+ cell bodies were present in the hippocampus. Sparse mGnRH-I and cGnRH-II+ fibres were present within the CA1 and CA3 fields of the hippocampus, along the hippocampal fissure, and within the hilus of the dentate gyrus. No lGnRH-III was present in the rodent hippocampus. GnIH-immunoreactivity was present in the hippocampus in cell bodies that resembled astrocytes. Males had more GnIH+ cells in the hilus of the dentate gyrus than females. To confirm the GnIH+ cell body phenotype, we performed double-label immunofluorescence against GnIH, glial fibrillary acidic protein (GFAP) and NeuN. Immunofluorescence revealed that all GnIH+ cell bodies in the hippocampus also contained GFAP, a marker of astrocytes. Taken together, these data suggest that GnRH does not reach GnRH receptors in the rat hippocampus primarily via synaptic release. By contrast, GnIH might be synthesised locally in the rat hippocampus by astrocytes. These data shed light on the sites of action and possible functions of GnRH and GnIH outside of the hypothalamic-pituitary-gonadal axis.

Impact of introducing practical obstetric multi-professional training (PROMPT) into maternity units in Victoria, Australia.

OBJECTIVE: To assess the introduction of Practical Obstetric Multi-professional Training (PROMPT) into maternity units and evaluate effects on organisational culture and perinatal outcomes. DESIGN: A retrospective cohort study. SETTING: Maternity units in eight public hospitals in metropolitan and regional Victoria, Australia. POPULATION: Staff in eight maternity units and a total of 43,408 babies born between July 2008 and December 2011. METHODS: Representatives from eight Victorian hospitals underwent a single day of training (Train the Trainer), to conduct PROMPT. Organisational culture was compared before and after PROMPT. Clinical outcomes were evaluated before, during and after PROMPT. MAIN OUTCOME MEASURES: The number of courses run and the proportion of staff trained were determined. Organisational culture was measured using the Safety Attitude Questionnaire. Clinical measures included Apgar scores at 1 and 5 minutes (Apgar 1 and Apgar 5), cord lactate, blood loss and length of baby's stay in hospital. RESULTS: Seven of the eight hospitals conducted PROMPT. Overall about 50% of staff were trained in each year of the study. Significant increases were found in Safety Attitude Questionnaire scores representing domains of teamwork (Hedges' g 0.27, 95% confidence interval [95% CI] 0.13-0.41), safety (Hedges' g 0.28, 95% CI 0.15-0.42) and perception of management (Hedges' g 0.17, 95% CI 0.04-0.31). There were significant improvements in Apgar 1 (OR 0.84, 95% CI 0.77-0.91), cord lactates (odds ratio 0.92, 95% CI 0.85-0.99) and average length of baby's stay in hospital (Hedges' g 0.03, 95% CI 0.01-0.05) during or after training, but no change in Apgar 5 scores or proportion of cases with high blood loss. CONCLUSION: PROMPT can be introduced using the Train the Trainer model. Improvements in organisational culture and some clinical measures were observed following PROMPT.

Oral contraceptive and reproductive risk factors for ovarian cancer within sisters in the breast cancer family registry.

BACKGROUND: Oral contraceptive use has been consistently associated with a reduced risk of ovarian cancer in unrelated, average risk women; however little data exist on whether this benefit extends to higher risk women from cancer families. To examine this, we conducted family-based analyses using the Breast Cancer Family Registry. METHODS: We used generalised estimating equations to obtain the population average effect across all families (n=389 cases, n=5643 controls) and conditional logistic regression to examine within-family differences in a subset with at least two sisters discordant on ovarian cancer status (n=109 cases, n=149 unaffected sister controls). RESULTS: In the multivariable generalised estimating equation model there was a reduced risk of ovarian cancer for ever use of oral contraceptives compared with never use (OR=0.58, 95% CI: 0.37, 0.91), and in the conditional logistic model there was a similar inverse association; however, it was not statistically significant (OR=0.52, 95% CI: 0.23, 1.17). We examined this association by BRCA1/2 status and observed a statistically significant reduced risk in the non-carriers only. CONCLUSION: We observed a decreased risk of ovarian cancer with oral contraceptive use supporting that this association observed in unrelated women extends to related women at higher risk.

Factores de riesgo ambientales no ocupacionales asociados al cáncer vesical / Environmental non-occupational risk factors associated with bladder cancer

Contexto: El carcinoma vesical (CV), por su elevada morbilidad y evolución recidivante, genera importantes costes asistenciales y económicos. Por ello revisaremos los factores de riesgo (FR) ambientales no ocupacionales implicados, con mayor o menor evidencia científica, en la etiopatogenia del CV, pues la implicación de los urológos es fundamental para su prevención. Adquisición de evidencia: Revisión bibliográfica de los últimos 25 años de los mencionados FR asociados al CV, obtenida de MedLine, Science Citation Index y Embase. Los perfiles de búsqueda han sido Risk Factors/Epidemiology/Tobacco-smoking/Diet-nutrition-water-liquids/Infectious/Radiation/Farmacological drugs y Bladder cancer. Síntesis de evidencia: El tabaquismo se asocia al 50% de los CV en ambos sexos. Los fumadores presentan riesgos 2-5 veces superiores, dependiendo de la intensidad y duración de la adicción. El agua potable contaminada con arsénico, subproductos de cloración y cromo, incrementa el riesgo de CV. Consumos altos de carne roja y grasa saturada posiblemente aumenten el riesgo, mientras la ingesta elevada de frutas y verduras lo disminuye. La administración de ciclofosfamida, ifosfamida y radioterapia incrementa el riesgo de CV. El uso frecuente y prolongado de tintes capilares y la infestación por Schistosoma haematobium se asocian a mayores riesgos. Conclusiones: La reducción o eliminación del tabaquismo disminuirá la prevalencia del CV. El consumo de agua sin contaminantes, con el incremento de alimentos vegetales favorece la prevención del CV. Los supervivientes de cánceres tratados con ciclofosfamida, ifosfamida y radioterapia deben ser monitorizados para el diagnóstico precoz del CV (AU)

Context: Bladder carcinoma (BC), due its high morbidity and relapsing course, generates significant economic and health care costs. Accordingly, review the environmental nonoccupational risk factors (RF), more or less evidence-based, in the etiology and pathogenesis of BC, because the involvement of urologists is essential for prevention. Acquisition of evidence: Review of the peer-reviewed literature (1987-2012) on nonoccupational environmental RF associated with BC retrieved from Medline, Embase and Science Citation Index. The search profiles have been «Risk factors/Epidemiology/Tobacco-smoking/Diet-nutrition-water-liquids/Radiation/Infectious/Farmacological drugs» and «Bladder cancer». Synthesis of evidence: Smoking was associated with 50% of BC in both sexes. Smokers have a 2-5 times higher risk than nonsmokers, directly proportional to the amount and duration of addiction. Drinking water contaminated with arsenic and chromium chlorination byproducts increases the risk of BC. High consumption of red meat and saturated fat may increase the risk, while high intake of fruits and vegetables decreases it. Patients treated with cyclophosphamide, ifosfamide and ionizing radiation have an increased risk of BC. Frequent and prolonged use of hair dyes and Schistosoma haematobium infestation increases the risk of BC. Conclusions: The reduction or the cessation of smoking decrease BC. The contaminant-free water consumption with the increase of vegetal foods favour BC prevention. Cancer survivors treated with cyclophosphamide, ifosfamide and radiation therapy should be monitored for early diagnosis of BC (AU)

Factores de riesgo constitucionales y ocupacionales asociados al cáncer vesical / Constitutional and occupational risk factors associated with bladder cancer

Objetivo: En los países occidentales el carcinoma vesical (CV) es el 4.° cáncer más frecuente en varones, siendo la prevención primaria un reto sanitario importante. Se revisan los factores de riesgo (FR) constitucionales y ocupacionales implicados, con mayor o menor evidencia científica, en la etiopatogenia del CV. Material y métodos: Revisión bibliográfica de los últimos 25 años de los FR constitucionales y ocupacionales asociados al CP, obtenida de MedLine, CancerLit, Science Citation Index y Embase. Los perfiles de búsqueda han sido Risk factors/Genetic factors/Genetic polymorphisms/Epidemiology/Occupational factors y Bladder cancer. Resultados: Los principales FR son: a) edad y sexo (se diagnostica en mayores de 65 años con una relación hombre/mujer de 4/1); b) étnico-raciales y geográficos (predominio en caucásicos y los países del Sur de Europa); c) genéticos (las mutaciones del gen N-acetil-transferasa 2 y el Glutation-S-transferasa-M1, incrementan significativamente el riesgo de CV); d) los FR ocupacionales representan el 5-10%; y f) las profesiones con mayores riesgos de CV son la producción de aluminio, manufactura de tintes, pinturas y colorantes, industria del caucho y la extracción y usos industriales de combustibles fósiles. Conclusiones: El CV es el resultado final de la combinación variable de los FR constitucionales y ambientales. Desconocemos la mayoría de FR implicados en los CV. Los FR constitucionales más decisivos son la edad y el sexo, los étnico-raciales-geográficos y los polimorfismos genéticos. Los principales FR ocupacionales corresponden a exposiciones a aminas aromáticas e hidrocarburos policíclicos aromáticos (AU)

Objective: Bladder carcinoma (BC) is the fourth most common type of cancer in males from Western countries, with primary prevention an important healthcare challenge. We review the associated constitutional and occupational risk factors (RF), with greater or lesser scientific evidence, in the aetiology of BC. Material and methods: Literature review of the last 25 years of the constitutional and occupational RF associated with BC, conducted on MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Risk factors/Genetic factors/Genetic polymorphisms/Epidemiology/Occupational factors and Bladder cancer. Results: The main RF were a) age and gender (diagnosed at age 65 and over, with a 4:1 ratio of males to females); b) race, ethnicity and geographic location (predominantly in Caucasians and in Southern European countries); c) genetic (N-acetyltransferase-2 and glutathione s-transferase M1 gene mutations, which significantly increase the risk for BC); d) occupational, which represent 5%-10% of BC RF; and f) occupations with high BC risk, such as aluminium production, the manufacture of dyes, paints and colourings, the rubber industry and the extraction and industrial use of fossil fuels. Conclusions: BC is the end result of the variable combination of constitutional and environmental RF, the majority of which are unknown. The most significant constitutional RF are related to age, gender, race, ethnicity geographic location and genetic polymorphisms. The main occupational RF are those related to aromatic amines and polycyclic aromatic hydrocarbons (AU)

Constitutional and occupational risk factors associated with bladder cancer.

OBJECTIVE: Bladder carcinoma (BC) is the fourth most common type of cancer in males from Western countries, with primary prevention an important healthcare challenge. We review the associated constitutional and occupational risk factors (RF), with greater or lesser scientific evidence, in the aetiology of BC. MATERIAL AND METHODS: Literature review of the last 25 years of the constitutional and occupational RF associated with BC, conducted on MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Risk factors/Genetic factors/Genetic polymorphisms/Epidemiology/Occupational factors and Bladder cancer. RESULTS: The main RF were a) age and gender (diagnosed at age 65 and over, with a 4:1 ratio of males to females); b) race, ethnicity and geographic location (predominantly in Caucasians and in Southern European countries); c) genetic (N-acetyltransferase-2 and glutathione s-transferase M1 gene mutations, which significantly increase the risk for BC); d) occupational, which represent 5%-10% of BC RF; and f) occupations with high BC risk, such as aluminium production, the manufacture of dyes, paints and colourings, the rubber industry and the extraction and industrial use of fossil fuels. CONCLUSIONS: BC is the end result of the variable combination of constitutional and environmental RF, the majority of which are unknown. The most significant constitutional RF are related to age, gender, race, ethnicity geographic location and genetic polymorphisms. The main occupational RF are those related to aromatic amines and polycyclic aromatic hydrocarbons.

Environmental non-occupational risk factors associated with bladder cancer.

CONTEXT: Bladder carcinoma (BC), due its high morbidity and relapsing course, generates significant economic and health care costs. Accordingly, review the environmental nonoccupational risk factors (RF), more or less evidence-based, in the etiology and pathogenesis of BC, because the involvement of urologists is essential for prevention. ACQUISITION OF EVIDENCE: Review of the peer-reviewed literature (1987-2012) on nonoccupational environmental RF associated with BC retrieved from Medline, Embase and Science Citation Index. The search profiles have been "Risk factors/Epidemiology/Tobacco-smoking/Diet-nutrition-water-liquids/Radiation/Infectious/Farmacological drugs" and "Bladder cancer". SYNTHESIS OF EVIDENCE: Smoking was associated with 50% of BC in both sexes. Smokers have a 2-5 times higher risk than nonsmokers, directly proportional to the amount and duration of addiction. Drinking water contaminated with arsenic and chromium chlorination byproducts increases the risk of BC. High consumption of red meat and saturated fat may increase the risk, while high intake of fruits and vegetables decreases it. Patients treated with cyclophosphamide, ifosfamide and ionizing radiation have an increased risk of BC. Frequent and prolonged use of hair dyes and Schistosoma haematobium infestation increases the risk of BC. CONCLUSIONS: The reduction or the cessation of smoking decrease BC. The contaminant-free water consumption with the increase of vegetal foods favour BC prevention. Cancer survivors treated with cyclophosphamide, ifosfamide and radiation therapy should be monitored for early diagnosis of BC.

Small angle neutron scattering on an absolute intensity scale and the internal surface of diatom frustules from three species of differing morphologies.

The internal nanostructure of the diatoms Cyclotella meneghiniana, Seminavis robusta and Achnanthes subsessilis was investigated using small angle neutron scattering (SANS) to examine thin biosilica samples, consisting of isotropic (powder) from their isolated cell walls. The interpretation of SANS data was assisted by several other measurements. The N2 adsorption, interpreted within the Branuer-Emmet-Teller isotherm, yielded the specific surface area of the material. Fourier transform infrared (FTIR) and Raman spectroscopy indicates that the isolated material is amorphous silica with small amounts of organic cell wall materials acting as a filling material between the silica particles. A two-phase (air and amorphous silica) model was used to interpret small angle neutron scattering data. After correction for instrumental resolution, the measurements on two SANS instruments covered an extended range of scattering vectors 0.0011 nm(-1) < q < 5.6 nm(-1), giving an almost continuous SANS curve over a range of scattering vectors, q, on an absolute scale of intensity for each sample. Each of the samples gave a characteristic scattering curve where log (intensity) versus log (q) has a -4 dependence, with other features superimposed. In the high-q regime, departure from this behaviour was observed at a length-scales equivalent to the proposed unitary silica particle. The limiting Porod scattering law was used to determine the specific area per unit of volume of each sample illuminated by the neutron beam. The Porod behaviour, and divergence from this behaviour, is discussed in terms of various structural features and the proposed mechanisms for the bio-assembly of unitary silica particles in frustules.

Are sexual problems more common in women who have had a tubal ligation? A population-based study of Australian women.

OBJECTIVE: To investigate whether women who have had a tubal ligation are more likely to experience sexual problems than other women. DESIGN: Population-based telephone survey. SETTING: Australia-wide, including cities, regional towns, and rural areas. POPULATION: A total of 3448 Australian women aged between 16 and 64 years. METHODS: Women were surveyed using random-digit dialling throughout 2004 and 2005. MAIN OUTCOME MEASURES: Prevalence of sexual problems and ratings of sexual satisfaction, relationship satisfaction, and sexual pleasure. RESULTS: From a weighted sample of 2721 women, 447 (16.4%) reported having had a tubal ligation, with 85.0% currently aged between 40 and 64 years. Having a tubal ligation was not associated with any specific sexual problem, such as physical pain during sex or an inability to reach orgasm. In fact, after controlling for age and other sociodemographic differences, sterilised women were significantly less likely than non-sterilised women to lack an interest in having sex (OR 0.69, 95% CI 0.54-0.89), to take 'too long' to reach orgasm (OR 0.69, 95% CI 0.50-0.96), to experience vaginal dryness during sex (OR 0.70, 95% CI 0.50-0.96), and to find sex unpleasurable (OR 0.64, 95% CI 0.46-0.90). Sterilised women were also more likely to experience extremely high levels of sexual satisfaction (OR 1.66, 95% CI 1.27-2.18), relationship satisfaction (OR 1.29, 95% CI 1.01-1.67), and sexual pleasure (OR 1.59, 95% CI 1.20-2.12). CONCLUSIONS: Our findings suggest no adverse effects, and possibly some benefits, for the sexual lives of women undergoing tubal ligation. These findings should be included with other educational material for couples considering sterilisation as a contraception option.

Social psychophysiological compliance in a four-person research team.

A continuous, non-invasive and objective measure of teamwork effectiveness could be very useful to the human factors design community. Social psychophysiological compliance (SPC), estimated by scoring the extent that heart rate variation was synchronous across team members, was explored as a predictor of teamwork effectiveness during 20 real planning meetings over a 6-month period. Speech activity and heart rate variability of all four (2 male, 2 female) team members were continuously monitored. Exploratory analyses tested if team member ratings of various aspects of teamwork effectiveness were predicted by SPC scored (1) over whole meetings, (2) during one team member's speech, (3) during periods in which two team members spoke in sequence or (4) over 30-s periods and averaging highest values. SPC during periods of sequential speech negatively predicted team members' ratings of Team productivity, Quality of communication, and Ability to work together. SPC shows potential as an objective, non-invasive means to monitor teamwork effectiveness but this relationship warrants further investigation and replication before use in ergonomics applications.

Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005).

BACKGROUND: Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. OBJECTIVES: We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. DESIGN: Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). MEASUREMENTS: Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. RESULTS: Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). CONCLUSION: A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.

Assessing practitioner's knowledge of evaluation: initial psychometrics of the Practice Evaluation Knowledge Scale.

Practice evaluation is an important component in the implementation of evidence-based practice. Until recently it has been difficult to assess practitioner knowledge in evaluation in the field. This study discusses the development and initial psychometrics of an 8-item scale to assess practitioner competency in evaluation. The Practice Evaluation Knowledge Scale demonstrated excellent internal consistency (alpha = .925) and validity. Results indicate that this scale shows promise as a valid measure of social work practitioner knowledge of practice evaluation.

Helicon plasma generator-assisted surface conversion ion source for the production of H(-) ion beams at the Los Alamos Neutron Science Center.

The converter-type negative ion source currently employed at the Los Alamos Neutron Science Center (LANSCE) is based on cesium enhanced surface production of H(-) ion beams in a filament-driven discharge. In this kind of an ion source the extracted H(-) beam current is limited by the achievable plasma density which depends primarily on the electron emission current from the filaments. The emission current can be increased by increasing the filament temperature but, unfortunately, this leads not only to shorter filament lifetime but also to an increase in metal evaporation from the filament, which deposits on the H(-) converter surface and degrades its performance. Therefore, we have started an ion source development project focused on replacing these thermionic cathodes (filaments) of the converter source by a helicon plasma generator capable of producing high-density hydrogen plasmas with low electron energy. In our studies which have so far shown that the plasma density of the surface conversion source can be increased significantly by exciting a helicon wave in the plasma, and we expect to improve the performance of the surface converter H(-) ion source in terms of beam brightness and time between services. The design of this new source and preliminary results are presented, along with a discussion of physical processes relevant for H(-) ion beam production with this novel design. Ultimately, we perceive this approach as an interim step towards our long-term goal, combining a helicon plasma generator with an SNS-type main discharge chamber, which will allow us to individually optimize the plasma properties of the plasma cathode (helicon) and H(-) production (main discharge) in order to further improve the brightness of extracted H(-) ion beams.

Independent sector treatment centres (ISTCS): early experience from an ophthalmology perspective.

In 2001, the NHS plan concluded that there was a significant lack of capacity within current NHS structures to deliver adequate volumes of cataract surgery for England and Wales. The initial central 'solution' for this was to invite in overseas surgical teams to existing NHS centres for short-term surgical initiatives. However, with the advent of the Waiting, Booking and Choice Strategy, a target was set for treatment centers (TCs) to be carrying out an additional 250 000 inpatient/day-case episodes, across all specialties, by 2005. This paper outlines how these Ophthalmology TCs were commissioned, and some of the policy and medical agendas that surrounded their evolution. The concept of 'take or pay' contracts, which placed the onus on local Primary Care Trust organisations to provide the promised number of suitable cataract patients for the TCs, and the 'additionality' of medical and nursing staff are discussed. In September 2003, Netcare was awarded the contract to carry out 41 600 cataract procedures over a 5-year period in a mixture of mobile and fixed site units. Netcare's proposed patient care pathways are examined, as is the reality of its interaction with local Ophthalmology Departments and the response of the Royal College of Ophthalmologists to its standards of patient care. Although Netcare TCs may have contributed to reduced waiting times for cataract surgery in some districts, the quality of care provided by the Netcare TCs has yet to be established. There are ongoing concerns about both the continuity of care and the management of postoperative complications, as well as the economics of neighbouring NHS units.