A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates.

Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

Relative positioning of classical benzodiazepines to the γ2-subunit of GABAA receptors.

GABAA receptors are the major inhibitory neurotransmitter receptors in the brain. Benzodiazepine exert their action via a high affinity-binding site at the α/γ subunit interface on some of these receptors. Diazepam has sedative, hypnotic, anxiolytic, muscle relaxant, and anticonvulsant effects. It acts by potentiating the current evoked by the agonist GABA. Understanding specific interaction of benzodiazepines in the binding pocket of different GABAA receptor isoforms might help to separate these divergent effects. As a first step, we characterized the interaction between diazepam and the major GABAA receptor isoform α1β2γ2. We mutated several amino acid residues on the γ2-subunit assumed to be located near or in the benzodiazepine binding pocket individually to cysteine and studied the interaction with three ligands that are modified with a cysteine-reactive isothiocyanate group (-NCS). When the reactive NCS group is in apposition to the cysteine residue this leads to a covalent reaction. In this way, three amino acid residues, γ2Tyr58, γ2Asn60, and γ2Val190 were located relative to classical benzodiazepines in their binding pocket on GABAA receptors.

PTT: Progress Test Tiermedizin

Studierende der Tiermedizin fokussieren sich im Studium oft auf den bloßen Wissenserwerb und nehmen dabei weniger wahr, was sie bereits erreicht haben. Mit dem Progress Test Tiermedizin (PTT) kann der Lernfortschritt von Studienanfang bis zum Erreichen des Berufsabschlusses als Tierärztin/Tierarzt dargestellt werden. Das Konzept des PTT soll in diesem Artikel erläutert werden

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm

BACKGROUND AND AIMS The Barcelona Clinic Liver Cancer (BCLC) staging system is the algorithm most widely used to manage patients with hepatocellular carcinoma (HCC). We aimed to investigate the extent to which the BCLC recommendations effectively guide clinical practice and assess the reasons for any deviation from the recommendations. MATERIAL AND METHODS The first-line treatments assigned to patients included in the prospective Bern HCC cohort were analyzed. RESULTS Among 223 patients included in the cohort, 116 were not treated according to the BCLC algorithm. Eighty percent of the patients in BCLC stage 0 (very early HCC) and 60% of the patients in BCLC stage A (early HCC) received recommended curative treatment. Only 29% of the BCLC stage B patients (intermediate HCC) and 33% of the BCLC stage C patients (advanced HCC) were treated according to the algorithm. Eighty-nine percent of the BCLC stage D patients (terminal HCC) were treated with best supportive care, as recommended. In 98 patients (44%) the performance status was disregarded in the stage assignment. CONCLUSION The management of HCC in clinical practice frequently deviates from the BCLC recommendations. Most of the curative therapy options, which have well-defined selection criteria, were allocated according to the recommendations, while the majority of the palliative therapy options were assigned to patients with tumor stages not aligned with the recommendations. The only parameter which is subjective in the algorithm, the performance status, is also the least respected.

Deep water provenance and dynamics of the (de)glacial Atlantic meridional overturning circulation

Reconstructing past modes of ocean circulation is an essential task in paleoclimatology and paleoceanography. To this end, we combine two sedimentary proxies, Nd isotopes (εNd) and the 231Pa/230Th ratio, both of which are not directly involved in the global carbon cycle, but allow the reconstruction of water mass provenance and provide information about the past strength of overturning circulation, respectively. In this study, combined 231Pa/230Th and εNd down-core profiles from six Atlantic Ocean sediment cores are presented. The data set is complemented by the two available combined data sets from the literature. From this we derive a comprehensive picture of spatial and temporal patterns and the dynamic changes of the Atlantic Meridional Overturning Circulation over the past ∼25 ka. Our results provide evidence for a consistent pattern of glacial/stadial advances of Southern Sourced Water along with a northward circulation mode for all cores in the deeper (>3000 m) Atlantic. Results from shallower core sites support an active overturning cell of shoaled Northern Sourced Water during the LGM and the subsequent deglaciation. Furthermore, we report evidence for a short-lived period of intensified AMOC in the early Holocene.

Wirksamkeit der umfassenden kardiologischen Rehabilitation und Sekundärprävention: klinische und epidemiologische Evidenz

Zusammenfassung Die umfassende kardiologische Rehabilitation ist die Summe von koordinierten Maßnahmen, welche die Folgen von Herzerkrankungen vermindern, die Morbidität und Mortalität reduzieren und die gesundheitsbezogene Lebensqualität einschließlich der psychosozialen Situation der Patienten verbessern sollen. Dazu ist die Bereitstellung strukturierter sekundärpräventiver Strategien besonders wichtig. Schwerpunkte dieser Maßnahmen sind die Trainingstherapie und Aktivitätsberatung sowie Ernährungstherapie und -beratung, Raucherentwöhnung, psychosoziale Intervention und Pharmakotherapie (Ades 2001).

Emergency health care assessment in the Houston-Galveston region 2002--2006

Background. Previous studies show emergency rooms to be over crowded nation wide. With growing attention to this problem, the Houston-Galveston Area Council (H-GAC) initiated a study in 2005 to assess their region's emergency health care system, and continued this effort in 2007. The purpose of this study was to examine recent changes in volume, capacity and performance in the Houston-Galveston region's emergency health care system and determine whether the system has been able to effectively respond to the residents' demands. Methods. Data were collected by the Houston-Galveston Area Council and The Abaris Group using a self-administered 2002-2006 survey completed by administrators of the region's hospitals, EMS providers, and select fire departments that provide EMS services. Data from both studies were combined and matched to examine trends. Results. Volume increased among the reporting hospitals within the Houston-Galveston region from 2002 to 2006; however, capacity remained relatively unchanged. EMS providers reported higher average off load times in 2007 compared to 2005, but the increases were not statistically significant. Hospitals reported transferring a statistically significant greater percentage of patients in 2006 than 2004. There was no statistically significant change in any of the other measures. Conclusion. These findings indicate an increase in demand for the Houston-Galveston region's emergency healthcare services with no change in supply. Additional studies within the area are needed to fully assess and evaluate the impact of these changes on system performance. ^

Organization of the inferotemporal cortex in the macaque monkey: Connections of areas PITv and CITvp

Visual cortex of macaque monkeys consists of a large number of cortical areas that span the occipital, parietal, temporal, and frontal lobes and occupy more than half of cortical surface. Although considerable progress has been made in understanding the contributions of many occipital areas to visual perceptual processing, much less is known concerning the specific functional contributions of higher areas in the temporal and frontal lobes. Previous behavioral and electrophysiological investigations have demonstrated that the inferotemporal cortex (IT) is essential to the animal's ability to recognize and remember visual objects. While it is generally recognized that IT consists of a number of anatomically and functionally distinct visual-processing areas, there remains considerable controversy concerning the precise number, size, and location of these areas. Therefore, the precise delineation of the cortical subdivisions of inferotemporal cortex is critical for any significant progress in the understanding of the specific contributions of inferotemporal areas to visual processing. In this study, anterograde and/or retrograde neuroanatomical tracers were injected into two visual areas in the ventral posterior and central portions of IT (areas PITv and CITvp) to elucidate the corticocortical connections of these areas with well known areas of occipital cortex and with less well understood regions of inferotemporal cortex. The locations of injection sites and the delineation of the borders of many occipital areas were aided by the pattern of interhemispheric connections, revealed following callosal transection and subsequent labeling with HRP. The resultant patterns of connections were represented on two-dimensional computational (CARET) and manual cortical maps and the laminar characteristics and density of the projection fields were quantified. The laminar and density features of these corticocortical connections demonstrate thirteen anatomically distinct subdivisions or areas distributed within the superior temporal sulcus and across the inferotemporal gyrus. These results serve to refine previous descriptions of inferotemporal areas, validate recently identified areas, and provide a new description of the hierarchical relationships among occipitotemporal cortical areas in macaques. ^

THE INCIDENCE OF PELVIC ENDOMETRIOSIS IN ROCHESTER, MINNESOTA, 1970-1979

The primary objectives of the study were to measure the incidence of pelvic endometriosis among white females of reproductive age (15-49 years) in Rochester, Minnesota, during the period 1970-1979 and to determine the risk of endometriosis by age, marital status, nun status, and educational attainment in this population. An historical prospective design was used. Incident (newly diagnosed) cases were identified from community medical records, and person-years of risk in the study population were estimated from census data.^ Almost two-thirds of the incident cases had surgically verified endometriosis, while the remainder were diagnosed by clinical findings alone. Incidence rates were prepared first with histologically confirmed cases only and then with the successive inclusion of less certain cases: surgically visualized, clinically probable, and clinically possible. On this basis, overall incidence rates were 108.8 to 246.9 newly diagnosed cases per 100,000 person-years. The incidence of pelvic endometriosis was lowest for women 15-19 years of age, increased markedly through age 44, and then declined for women 45-49 years of age. A significantly greater risk of pelvic endometriosis in never married women was detected only when the numerator was limited to histologically confirmed cases. Among never married women 20-49 years of age, no significant difference in the risk of pelvic endometriosis by nun status was detected, but a trend toward a lower incidence in nuns was observed. Women with education beyond high school had a significantly higher incidence of endometriosis than women with less education.^ Cases in the four diagnostic groups differed greatly by age and marital status but were similar with respect to virtually all other characteristics, once age differences were considered. Reproductive history characteristics described included: age of menarche; history of menopause; total pregnancies; ages of first pregnancy, marriage, and sexual intercourse; years from menarche to first intercourse; years of ovulatory cycling; difficulty becoming pregnant; and delay of the first pregnancy by choice. How these characteristics of incident cases differ from those of women free of endometriosis needs to be studied in future research. ^

Concepciones acerca de la discapacidad de los niños y jóvenes de las escuelas de Misiones. 16H291

Elaborar trabajos para un evento científico y para su publicación en una revista científica: Escribir un artículo sobre los avances de la indagación y remitir-lo a una revista especializada para su publicación. Elaborar trabajos para presentar en un evento científico relevante. Diseñar instrumentos: Redactar los protocolos y el guión correspondiente, a los Grupos Focales. Seleccionar las unidades de análisis: Seleccionar las instituciones educativas y los sujetos que participarán de los Grupos Focales. Planificar y gestionar el ingreso al campo: Establecer el vínculo con las instituciones educativas, para garantizar el desarrollo del trabajo de campo. Recopilar datos empíricos: Desarrollar el trabajo de campo (grupos focales). Sistematizar los datos: Desgrabar las sesiones de los Grupos Focales y codificar los aspectos relevantes. Desarrollar de la investigación biográfica (Primera Parte): Iniciar las entrevistas para el desarrollo de la investigación biográfico-narrativa, en el marco de la Beca CEDIT de una de las integrantes del equipo. Diseñar otra investigación paralela sobre estado de la inclusión en el sistema educativo de Misiones: Elaborar un Plan de Trabajo sobre la temática, que complemente los restantes aspectos de la investigación, que se desarrollará en el caso de que otra integrante del equipo acceda a una Beca CIN o a una Beca de la FHyCS-UNaM.

Misiones en el contexto transfronterizo con Paraguay y Brasil. Representaciones identitarias a partir de la memoria construida y difundida. “Pasos” con historia y diversas prácticas sociales cotidianas. 16H317

Actividades realizadas por el equipo de investigación durante el período 2011- 2012. 1. Revisión del Marco Teórico y cotejo de las categorías teóricas. 2. Trabajo de campo y reajuste de la información. 3. Selección y revisión bibliográfica 4. Lectura y análisis de la producción periodística en la provincia de Misiones y en las zonas fronterizas estudiadas. 5. Revisión de los problemas preliminares planteados para la investigación. 6. Elección y recorte temático sobre la vida cotidiana en el borde, puntos de vista que se relacionen con las experiencias significativas del lugar. 7. Realización de informes de avance de la investigación. 8. Realización del informe final de la investigación. Los ítems 7, 8, y 9 se transcriben en forma integral aunque respetando las tareas de cada investigador que lo hace desde sus aportes disciplinarios, y desde los diferentes sitios geográficos de la frontera de Misiones con Paraguay y Brasil.

Concepciones acerca de la discapacidad de los niños y jóvenes de las escuelas de Misiones. 16H291

Las actuales políticas educativas, se inscriben dentro de la denominada “perspectiva de derechos.” Hoy se considera a la educación como un derecho básico y debe garantizarse que todos los niños, jóvenes y adultos que la requieran, accedan a ella. En relación con la cuestión de garantizar accesibilidad e igualdad de oportunidades para todos, se inscribe la denominada “educación inclusiva.” En este marco, las escuelas se comprometerían a dar cabida a todos los niños, independientemente de sus condiciones físicas, intelectuales, sociales, emocionales, lingüísticas o de otro tipo; pasando a funcionar como “escuelas inclusivas.” Como consecuencia de esto, algunos/as niños/as y jóvenes con discapacidad, (que cumplen con ciertos requisitos) inician procesos de inclusión en escuelas comunes, para desarrollar en ellas su escolaridad. La mayoría de las investigaciones referidas a estas experiencias, se centran en los discursos y perspectivas acerca de las mismas, de los docentes que participan en ellas: tanto los docentes de Educación Común, como los docentes de Educación Especial. Pero se desconocen investigaciones sobre la percepción y las concepciones, desde la perspectiva de los alumnos/as de las escuelas en las que se implementan proyectos de inclusión, siendo que son parte fundamental de estos procesos, en tanto conforman el grupo que recibirá a los sujetos que se desea incluir y serán su pares durante las actividades escolares. Creemos que estudiando las cuestiones vinculares y valorativas, que se ponen en juego durante los procesos de inclusión, se podrá intervenir en ellas de modo de facilitar el proceso de inclusión escolar de niños y jóvenes con discapacidad. El abordaje metodológico será cualitativo, mediante grupos focales y entrevistas.

Misiones en el contexto transfronterizo con Paraguay y Brasil. Representaciones identitarias a partir de la memoria construida y difundida. “Pasos” con historia y diversas prácticas sociales cotidianas. 16H317

El proyecto se inscribe en el análisis del territorio y bordes transfronterizos de Misiones con Paraguay y Brasil como escenario de diferentes relaciones sociales, imaginarios e interacciones locales, espacios de poder, gestión del Estado, individuos y grupos. Consideramos que nuevas prácticas se sucedieron desde el 80 hasta la actualidad y requieren comprender la frontera desde otras perspectivas. A través del abordaje de diferentes formas históricas de construcción se pretende mostrar que las fronteras no han sido y no son sólo objeto de conflicto, sino que también resultan ámbitos geográficos de definición de alianzas, de intercambio y de convivencia. Los bordes de las fronteras son únicos y demandan estudios localizados que den cuenta de la enorme variedad de usos y significados simbólicos así como la diversidad de características y relaciones geográficas. Vivimos en la Zona de frontera con límites y bordes diferentes y semejantes porque en todos los lugares siempre estamos nosotros y los otros. En una primera aproximación identificamos algunos asentamientos urbanos como centros de servicios con desiguales flujos sociales, económicos y culturales: Iguazú en las tres fronteras del Alto Paraná; Posadas -Encarnación; El Soberbio - Porto Soberbo en el Alto Uruguay; Bernardo de Irigoyen- Dionisio Cerqueira-Barracón en el Nordeste de Misiones.