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.

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.

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.

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.

The role of biotransformation in organic mercury neurotoxicity.

Although the clinical patterns of organic and inorganic mercury poisoning are very different, systemic toxicity experiments have shown that the histological changes in the kidneys and dorsal root ganglia neurones are identical with the 2 classes of compounds. It has been further suggested that the toxicity of organic mercurials is the result of biotransformation to inorganic mercury. To test this hypothesis, between 10(-7) and 10(-10) mol of mercuric chloride and methyl mercuric acetate were injected directly into the cerebrum of rats. The comparative size of lesions was estimated anatomically and by reference to blood brain barrier dysfunction. Inorganic lesions were only slightly larger than those produced by equimolar amounts of organic mercury. Consequently both organic and inorganic mercury must be regarded as neurotoxic in their own right. Conversion of organic mercury certainly occurs but is not the only mechanism by which organic mercury exerts its toxicological effect.

Effects of intrathecal administration of 8-OH-DPAT on genital reflexes and mating behavior in male rats.

Systemic administration of the 5HT1A receptor agonist, 8-OH-DPAT, consistently decreases the threshold of ejaculatory behavior and enhances some aspects of arousal. Previous findings by others demonstrated the in copula ejaculatory behavior effect using intrathecal (IT) injection at the level of the lumbosacral spinal cord, but the dose used was in the range that produced results systemically. This study aimed at a) a more comprehensive study of the sexual effects of 8-OH-DPAT and b) use of IT doses of 8-OH-DPAT below those effective when administered systemically. The ex copula genital reflex test showed severe inhibition. At doses of 5 micrograms or more, significant inhibition of the percentage of rats displaying ejaculation occurred, and the two highest doses also significantly reduced the percentage of rats displaying erection. In the in copula mating test, 20 and 80 micrograms IT 8-OH-DPAT, significantly reduced ejaculation latency, intromission frequency and intercopulatory interval. Copulatory plugs, collected at the highest dose only, showed a trend towards weight reduction. We conclude that the facilitation of ejaculatory behavior and some measure of arousal by 8-OH-DPAT can be mediated directly via the lumbosacral spinal cord. An hypothesis for explaining the inhibitory effect on ejaculation ex copula is presented, but the inhibitory effect on erectile reflexes is without interpretation.

A component analysis of the effects of DPAT on male rat sexual behavior.

Male rat sexual behavior was examined in a variety of tests following a single acute IP injection of the serotonin1A (5-HT1A) receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (DPAT). The objective was to determine the effects of 5-HT1A receptor stimulation on the components of sexual behavior (arousal/motivation, erection and ejaculation) using this prototypical 5-HT1A ligand. In the ex copula genital reflex test, DPAT dramatically inhibited ejaculation and the display of penile erections. When examined in the mating behavior test, DPAT caused a significant reduction in intromission frequency (IF), ejaculation latency (EL), intercopulatory intervals (ICI) and postejaculatory interval (PEI). The decrease in IF and EL indicated a lowering of the behavioral-ejaculatory threshold, while the reduction in ICI and PEI indicated a stimulation of two aspects of sexual arousal. Further tests, however, revealed complexities. Using the mounting test (with genital anesthesia) as an assessment of sexual arousal, no effect of DPAT was found. Collection and examination of the coagulated ejaculates resulting from mating (copulatory plugs) provided evidence of an impairment in ejaculation, as a result of DPAT treatment. The data suggests that 5-HT1A receptor stimulation lowers the behavioral-ejaculatory threshold despite inhibition of ejaculation in and ex copula; as well as stimulating specific aspects of sexual arousal. It remains to be determined whether the effects on arousal were either due to nonselectivity as currently believed or because 5-HT1A receptor stimulation affects alpha 2-adrenoceptor activity by some as yet undefined mechanism; and as a result modulates sexual arousal.

Alpha 2-adrenoceptor antagonists and male sexual behavior: II. Erectile and ejaculatory reflexes.

Three alpha 2-adrenoceptor antagonists, yohimbine, idazoxan, and imiloxan, all shown to have stimulatory effects on sexual arousal/motivation, were studied to identify their possible effects on the other two major components of male copulatory behavior: erection and ejaculation. Genital reflex ex copula tests were used in order to assess these two responses without the confounding factors of mating behavior. Dose ranges were yohimbine: 0.25-4.0 mg/kg; idazoxan: 1.0-8.0 mg/kg; and imiloxan: 12.5-50.0 mg/kg. Lower doses of two of the drugs significantly enhanced the frequency of erections, while the third (yohimbine) showed a strong trend in that direction. At higher doses, all three alpha 2-antagonists produced significant reductions in the number of rats showing penile reflexes, including both erections and ejaculations. In those rats which did show penile reflexes, higher doses of yohimbine (4.0 mg/kg) inhibited the frequency of erections, while the higher dose of idazoxan showed a trend towards such inhibition. Thus, profound, largely inhibitory effects of these agents were demonstrated at dose ranges which have been shown to enhance sexual arousal. These data indicate that within the nervous system alpha 2-adrenoceptor antagonists can modulate erectile and ejaculatory mechanisms quite independently from effects on arousal/motivation.

Alpha 2-adrenoceptor antagonists and male sexual behavior: I. Mating behavior.

Three alpha 2-adrenoceptor antagonists yohimbine, idazoxan, and imiloxan were compared by examining the effects of a single injection on male rat copulatory behavior. Dose ranges were: yohimbine: 0.25-8.0 mg/kg; idazoxan: 0.25-8.0 mg/kg; imiloxan: 12.5-50.0 mg/kg. Yohimbine and idazoxan administration produced significant increases in the number of animals copulating to ejaculation and all three drugs increased the rate of copulation as evidenced by reductions in ejaculation latency and intercopulatory interval. Only yohimbine significantly reduced mount latency and postejaculatory interval, but yohimbine and imiloxan significantly reduced intromission latency and idazoxan showed a similar trend. The highest yohimbine dose suppressed sexual activity. A time-course experiment with yohimbine (2.0 mg/kg) and idazoxan (4.0 mg/kg) showed stimulation at 75 min and a trend at 5. To further explore the arousal-stimulating capacity of the two more effective drugs, a mounting test with genital anesthetization was used. Yohimbine but not idazoxan showed marked increases in mounting at 1.0-4.0 mg/kg. Both drugs had a suppressive effect at the highest doses. These data support the involvement of alpha 2-adrenoceptors in the regulation of male sexual behavior, specifically by facilitating sexual arousal, with no effects on ejaculatory threshold, as measured by intromission frequency. Yohimbine is the most globally effective agent and it is likely that factors other than yohimbine's alpha 2-antagonism may play a role in its unique, consistent and broad behavioral effects.

Alternative systems in Malaysian drug rehabilitation: organization and control in comparative perspective.

This paper examines four drug rehabilitation systems in Malaysia from an organizational perspective. It focuses on authority structures in rehabilitation centres and their impact on rehabilitees' identities. The findings show that there are important differences between government-run and private centres in terms of administration and approach to therapy. Some policy implications are derived from a comparison of these systems.

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.

The impact of the new subsidy regime in general practice in New Zealand.

The first substantial change in the New Zealand health care reforms was the introduction in February 1992 of a new subsidy and charging regime in general practice. The paper reports on a comparison of data collected before and after the changes, drawing on GP-patient encounter information. Overall, seasonally adjusted levels of utilisation were maintained in the stage before the introduction of the new regime, declined 15% immediately following the changeover and stabilised thereafter. All patient groups were affected by the decline. Although the elderly were temporarily exempt from the changes, their consultations fell by 10%. Utilisation among beneficiaries--minor gainers from the changes--dropped by 30%. Children were more affected overall, adults less so. There was also some suggestion of greater falls for the lowest socio-economic groups. Activities under the direct control of the practitioner--prescribing and the ordering of tests--showed either little turbulence or no clear pattern of change. It is concluded that, although primary care subsidies and charges had been reshaped to favour poorer people, six months after the introduction of these changes there had been no corresponding redistribution of medical care consumed. Indeed, there is a suggestion that some of the groups ostensibly the target of increased assistance may have been adversely affected by the overall decline in utilisation.

Nasal vasomotor oscillations in the cat associated with the respiratory rhythm.

Asymmetrical nasal vasomotor oscillations mediated via the cervical sympathetic nerve have been observed in the spontaneously breathing cat. The vasomotor activity persists after abolition of spontaneous respiration with a neuromotor relaxant agent indicating that the vasomotor activity originates in the respiratory areas of the brain and is not due to any of the mechanical effects of respiration. The nasal vasomotor activity is abolished on hyperventilation indicating that it may be driven from a central respiratory oscillator. The vasomotor activity exhibits a reciprocal activity with oscillations in sympathetic activity alternating from one nasal passage to the other and this may be due to a direct relationship with a nasal cycle in the cat.

The sociocultural dynamics of mass hysteria: a case study of social conflict in West Malaysia.

This discussion of an episode of mass hysteria in a Malay college in West Malaysia examines stress and conflict in relation to the interpretive process within a specific social setting. Unlike previous studies, which conceptualize mass hysteria as a cathartic response to accumulated stress, the present study treats stress as a matter of definition in a specific sociocultural context rather than as an objective given from which predictions can be made. Objections are raised to the logic of explanations that attribute mass hysteria to environmental stress. What is of concern is how meanings are assigned to events that are experienced as stressful, how participants and observers explain these events, and the consequences that follow from their interpretations.

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.