Effect of a multifaceted intervention on adherence to hand hygiene among healthcare workers:A cluster-randomized trial

OBJECTIVES. Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN. Cluster-randomized controlled trial. SETTING. Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada. INTERVENTION. After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008. RESULTS. We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P <.001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group. CONCLUSION. Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.

DNA damage responses following exposure to modulated radiation fields

During the delivery of advanced radiotherapy treatment techniques modulated beams are utilised to increase dose conformity across the target volume. Recent investigations have highlighted differential cellular responses to modulated radiation fields particularly in areas outside the primary treatment field that cannot be accounted for by scattered dose alone. In the present study, we determined the DNA damage response within the normal human fibroblast AG0-1522B and the prostate cancer cell line DU-145 utilising the DNA damage assay. Cells plated in slide flasks were exposed to 1 Gy uniform or modulated radiation fields. Modulated fields were delivered by shielding 25%, 50% or 75% of the flask during irradiation. The average number of 53BP1 or ?H2AX foci was measured in 2 mm intervals across the slide area. Following 30 minutes after modulated radiation field exposure an increase in the average number of foci out-of-field was observed when compared to non-irradiated controls. In-field, a non-uniform response was observed with a significant decrease in the average number of foci compared to uniformly irradiated cells. Following 24 hrs after exposure there is evidence for two populations of responding cells to bystander signals in-and out-of-field. There was no significant difference in DNA damage response between 25%, 50% or 75% modulated fields. The response was dependent on cellular secreted intercellular signalling as physical inhibition of intercellular communication abrogated the observed response. Elevated residual DNA damage observed within out-of-field regions decreased following addition of an inducible nitric oxide synthase inhibitor (Aminoguanidine). These data show, for the first time, differential DNA damage responses in-and out-of-field following modulated radiation field delivery. This study provides further evidence for a role of intercellular communication in mediating cellular radiobiological response to modulated radiation fields and may inform the refinement of existing radiobiological models for the optimization of advanced radiotherapy treatment plans. © 2012 Trainor et al.

Chemical Exposures of Women Workers in the Plastics Industry with Particular Reference to Breast Cancer and Reproductive Hazards.

Despite concern about the harmful effects of substances contained in various
plastic consumer products, little attention has focused on the more heavily
exposed women working in the plastics industry. Through a review of the
toxicology, industrial hygiene, and epidemiology literatures in conjunction
with qualitative research, this article explores occupational exposures in producing
plastics and health risks to workers, particularly women, who make up
a large part of the workforce. The review demonstrates that workers are
exposed to chemicals that have been identified as mammary carcinogens and
endocrine disrupting chemicals, and that the work environment is heavily
contaminated with dust and fumes. Consequently, plastics workers have a
body burden that far exceeds that found in the general public.

Ion Acceleration in Multispecies Targets Driven by Intense Laser Radiation Pressure

The acceleration of ions from ultrathin foils has been investigated by using 250 TW, subpicosecond laser pulses, focused to intensities of up to 3 X 10(20) W cm(-2). The ion spectra show the appearance of narrow-band features for protons and carbon ions peaked at higher energies (in the 5-10 MeV/nucleon range) and with significantly higher flux than previously reported. The spectral features and their scaling with laser and target parameters provide evidence of a multispecies scenario of radiation pressure acceleration in the light sail mode, as confirmed by analytical estimates and 2D particle-in-cell simulations. The scaling indicates that monoenergetic peaks with more than 100 MeV/nucleon are obtainable with moderate improvements of the target and laser characteristics, which are within reach of ongoing technical developments.

The effect of radiation technique and bladder filling on the acute toxicity of pelvic radiotherapy for localized high risk prostate cancer

Purpose: The goal of this project was to see if using IMRT to deliver elective pelvic nodal irradiation (EPNI) for prostate cancer reduced acute treatment toxicity.

Methods: Two hundred and thirty patients were enrolled into prospective trials delivering EPNI with a concomitant hypofractionated IMRT boost to the prostate. During accrual, the method of EPNI delivery changed as new literature emerged. Three methods were used (1) 4FB, (2) IMRT with 2 cm CTV margins around the pelvic vessels as suggested by Shih et al. (2005) [7] (IMRT-Shih), and (3) IMRT with nodal volumes suggested by the RTOG (IMRT-RTOG). Initially patients were treated with an empty bladder, with the remainder treated with bladder full.

Results: Patients in the 4FB group had higher rates of grade 2 acute GI toxicities compared to the IMRT-Shih and IMRT-RTOG groups (31.9% vs 20.8% vs 7.2%, p = 0.0009). Patients in the 4FB group had higher rates of grade 3 urinary frequency compared to the two IMRT groups (8.5% vs 0% vs 0%, p = 0.027). However, multivariate analysis suggested the factor that most influenced toxicity was bladder filling followed by IMRT.

Conclusions: Bladder filling appeared to be the dominant factor which predicted for acute toxicity, followed by the use of IMRT.

Systematically Identifying Relevant Research : Case Study on Child Protection Social workers' Resilience

Context: The development of a consolidated knowledge base for social work requires rigorous approaches to identifying relevant research. Method: The quality of 10 databases and a web search engine were appraised by systematically searching for research articles on resilience and burnout in child protection social workers. Results: Applied Social Sciences Index and Abstracts, Social Services Abstracts and Social Sciences Citation Index (SSCI) had greatest sensitivity, each retrieving more than double than any other database. PsycINFO and Cumulative Index to Nursing and Allied Health (CINAHL) had highest precision. Google Scholar had modest sensitivity and good precision in relation to the first 100 items. SSCI, Google Scholar, Medline, and CINAHL retrieved the highest number of hits not retrieved by any other database. Conclusion: A range of databases is required for even modestly comprehensive searching. Advanced database searching methods are being developed but the profession requires greater standardization of terminology to assist in information retrieval.

A Kinetic-Based Model of Radiation-Induced Intercellular Signalling

It is now widely accepted that intercellular communication can cause significant variations in cellular responses to genotoxic stress. The radiation-induced bystander effect is a prime example of this effect, where cells shielded from radiation exposure see a significant reduction in survival when cultured with irradiated cells. However, there is a lack of robust, quantitative models of this effect which are widely applicable. In this work, we present a novel mathematical model of radiation-induced intercellular signalling which incorporates signal production and response kinetics together with the effects of direct irradiation, and test it against published data sets, including modulated field exposures. This model suggests that these so-called "bystander" effects play a significant role in determining cellular survival, even in directly irradiated populations, meaning that the inclusion of intercellular communication may be essential to produce robust models of radio-biological outcomes in clinically relevant in vivo situations.

Radiation-Pressure Acceleration of Ion Beams Driven by Circularly Polarized Laser Pulses

We present experimental studies on ion acceleration from ultrathin diamondlike carbon foils irradiated by ultrahigh contrast laser pulses of energy 0.7 J focused to peak intensities of 5×1019  W/cm2. A reduction in electron heating is observed when the laser polarization is changed from linear to circular, leading to a pronounced peak in the fully ionized carbon spectrum at the optimum foil thickness of 5.3 nm. Two-dimensional particle-in-cell simulations reveal that those C6+ ions are for the first time dominantly accelerated in a phase-stable way by the laser radiation pressure.

Rayleigh-Taylor Instability of an Ultrathin Foil Accelerated by the Radiation Pressure of an Intense Laser

We report experimental evidence for a Rayleigh-Taylor-like instability driven by radiation pressure of an ultraintense (1021W/cm2) laser pulse. The instability is witnessed by the highly modulated profile of the accelerated proton beam produced when the laser irradiates a 5 nm diamondlike carbon (90% C, 10% H) target. Clear anticorrelation between bubblelike modulations of the proton beam and transmitted laser profile further demonstrate the role of the radiation pressure in modulating the foil. Measurements of the modulation wavelength, and of the acceleration from Doppler-broadening of back-reflected light, agree quantitatively with particle-in-cell simulations performed for our experimental parameters and which confirm the existence of this instability. © 2012 American Physical Society.

Monte Carlo radiation hydrodynamics:Methods, tests and application to Type Ia supernova ejecta

In astrophysical systems, radiation-matter interactions are important in transferring energy and momentum between the radiation field and the surrounding material. This coupling often makes it necessary to consider the role of radiation when modelling the dynamics of astrophysical fluids. During the last few years, there have been rapid developments in the use of Monte Carlo methods for numerical radiative transfer simulations. Here, we present an approach to radiation hydrodynamics that is based on coupling Monte Carlo radiative transfer techniques with finite-volume hydrodynamical methods in an operator-split manner. In particular, we adopt an indivisible packet formalism to discretize the radiation field into an ensemble of Monte Carlo packets and employ volume-based estimators to reconstruct the radiation field characteristics. In this paper the numerical tools of this method are presented and their accuracy is verified in a series of test calculations. Finally, as a practical example, we use our approach to study the influence of the radiation-matter coupling on the homologous expansion phase and the bolometric light curve of Type Ia supernova explosions. © 2012 The Authors Monthly Notices of the Royal Astronomical Society © 2012 RAS.

nero- a post-maximum supernova radiation transport code

The interpretation of supernova (SN) spectra is essential for deriving SN ejecta properties such as density and composition, which in turn can tell us about their progenitors and the explosion mechanism. A very large number of atomic processes are important for spectrum formation. Several tools for calculating SN spectra exist, but they mainly focus on the very early or late epochs. The intermediate phase, which requires a non-local thermodynamic equilibrium (NLTE) treatment of radiation transport has rarely been studied. In this paper, we present a new SN radiation transport code, nero, which can look at those epochs. All the atomic processes are treated in full NLTE, under a steady-state assumption. This is a valid approach between roughly 50 and 500days after the explosion depending on SN type. This covers the post-maximum photospheric and the early and the intermediate nebular phase. As a test, we compare nero to the radiation transport code of Jerkstrand, Fransson & Kozma and to the nebular code of Mazzali et al. All three codes have been developed independently and a comparison provides a valuable opportunity to investigate their reliability. Currently, nero is one-dimensional and can be used for predicting spectra of synthetic explosion models or for deriving SN properties by spectral modelling. To demonstrate this, we study the spectra of the 'normal' Type Ia supernova (SN Ia) 2005cf between 50 and 350 days after the explosion and identify most of the common SN Ia line features at post-maximum epochs. © 2011 The Authors Monthly Notices of the Royal Astronomical Society © 2011 RAS.

Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents’, community workers’ and service providers’ perspectives.

The impact of community stigmatisation upon service usage has been largely overlooked from a social identity perspective. Specifically, the social identity-mediated mechanisms by which stigmatisation hinders service use remain unspecified. The present study examines how service providers, community workers and residents recount their experience of the stigmatisation of local community identity and how this shapes residents’ uptake of welfare, education and community support services. Twenty individual and group interviews with 10 residents, 16 community workers and six statutory service providers in economically disadvantaged communities in Limerick, Ireland, were thematically analysed.Analysis indicates that statutory service providers endorsed negative stereotypes of disadvantaged areas as separate and anti-social. The awareness of this perceived division and the experience of ‘stigma consciousness’ was reported by residents and community workers to undermine trust, leading to under-utilisation of community and government services. We argue that stigmatisation acts as a ‘social curse’ by undermining shared identity between service users and providers and so turning a potentially cooperative intragroup relationship into a fraught intergroup one. We suggest that tackling stigma in order to foster a sense of shared identity is important in creating positive and cooperative service interactions for both service users and providers.