Key beliefs of hospital nurses’ hand-hygiene behaviour: Protecting your peers and needing effective reminders

Issues addressed: Hand hygiene in hospitals is vital to limit the spread of infections. This study aimed to identify key beliefs underlying hospital nurses’ hand-hygiene decisions to consolidate strategies that encourage compliance. Methods: Informed by a theory of planned behaviour belief framework, nurses from 50 Australian hospitals (n = 797) responded to how likely behavioural beliefs (advantages and disadvantages), normative beliefs (important referents) and control beliefs (barriers) impacted on their hand-hygiene decisions following the introduction of a national ‘5 moments for hand hygiene’ initiative. Two weeks after completing the survey, they reported their hand-hygiene adherence. Stepwise regression analyses identified key beliefs that determined nurses’ hand-hygiene behaviour. Results: Reducing the chance of infection for co-workers influenced nurses’ hygiene behaviour, with lack of time and forgetfulness identified as barriers. Conclusions: Future efforts to improve hand hygiene should highlight the potential impact on colleagues and consider strategies to combat time constraints, as well as implementing workplace reminders to prompt greater hand-hygiene compliance. So what? Rather than emphasising the health of self and patients in efforts to encourage hand-hygiene practices, a focus on peer protection should be adopted and more effective workplace reminders should be implemented to combat forgetting.

Reliability and reproducibility of a handheld videorefractor

PURPOSE To assess the performance of the 2Win eccentric videorefractor in relation to subjective refraction and table-mounted autorefraction. METHODS Eighty-six eyes of 86 adults (46 male and 40 female subjects) aged between 20 and 25 years were examined. Subjective refraction and autorefraction using the table-mounted Topcon KR8800 and the handheld 2Win videorefractor were carried out in a randomized fashion by three different masked examiners. Measurements were repeated about 1 week after to assess instrument reproducibility, and the intertest variability was compared between techniques. Agreement of the 2Win videorefractor with subjective refraction and autorefraction was assessed for sphere and for cylindrical vectors at 0 degrees (J0) and 45 degrees (J45). RESULTS Reproducibility coefficients for sphere values measured by subjective refraction, Topcon KR8800, and 2Win (±0.42, ±0.70, and ±1.18, respectively) were better than their corresponding J0 (±1.0, ±0.85, and ±1.66) and J45 (±1.01, ±0.87, and ±1.31) vector components. The Topcon KR8800 showed the most reproducible values for mean spherical equivalent refraction and the J0 and J45 vector components, whereas reproducibility of spherical component was best for subjective refraction. The 2Win videorefractor measurements were the least reproducible for all measures. All refractive components measured by the 2Win videorefractor did not differ significantly from those of subjective refraction, in both sessions (p > 0.05). The Topcon KR8800 autorefractometer and the 2Win videorefractor measured significantly more positive spheres and mean spherical equivalent refraction (p < 0.0001), but the J0 and J45 vector components were similar (p > 0.05), in both sessions. CONCLUSIONS The 2Win videorefractor compares well, on average, with subjective refraction. The reproducibility values for the 2Win videorefractor were considerably worse than either subjective refraction or autorefraction. The wide limits of reproducibility of the 2Win videorefractor probably limit its usefulness as a primary screening device.

Participatory action research for civic engagement

The future of civic engagement is characterised by both technological innovation as well as new technological user practices that are fuelled by trends towards mobile, personal devices; broadband connectivity; open data; urban interfaces; and, cloud computing. These technology trends are progressing at a rapid pace, and have led global technology vendors to package and sell the ‘Smart City’ as a centralized service delivery platform predicted to optimize and enhance cities’ key performance indicators – and generate a profitable market. The top-down deployment of these large and proprietary technology platforms have helped sectors such as energy, transport, and healthcare to increase efficiencies. However, an increasing number of scholars and commentators warn of another ‘IT bubble’ emerging. Along with some city leaders, they argue that the top-down approach does not fit the governance dynamics and values of a liberal democracy when applied across sectors. A thorough understanding is required, of the socio-cultural nuances of how people work, live, play across different environments, and how they employ social media and mobile devices to interact with, engage in, and constitute public realms. Although the term ‘slacktivism’ is sometimes used to denote a watered down version of civic engagement and activism that is reduced to clicking a ‘Like’ button and signing online petitions, we believe that we are far from witnessing another Biedermeier period that saw people focus on the domestic and the non-political. There is plenty of evidence to the contrary, such as post-election violence in Kenya in 2008, the Occupy movements in New York, Hong Kong and elsewhere, the Arab Spring, Stuttgart 21, Fukushima, the Taksim Gezi Park in Istanbul, and the Vinegar Movement in Brazil in 2013. These examples of civic action shape the dynamics of governments, and in turn, call for new processes to be incorporated into governance structures. Participatory research into these new processes across the triad of people, place and technology is a significant and timely investment to foster productive, sustainable, and livable human habitats. With this chapter, we want to reframe the current debates in academia and priorities in industry and government to allow citizens and civic actors to take their rightful centerpiece place in civic movements. This calls for new participatory approaches for co-inquiry and co-design. It is an evolving process with an explicit agenda to facilitate change, and we propose participatory action research (PAR) as an indispensable component in the journey to develop new governance infrastructures and practices for civic engagement. This chapter proposes participatory action research as a useful and fitting research paradigm to guide methodological considerations surrounding the study, design, development, and evaluation of civic technologies. We do not limit our definition of civic technologies to tools specifically designed to simply enhance government and governance, such as renewing your car registration online or casting your vote electronically on election day. Rather, we are interested in civic media and technologies that foster citizen engagement in the widest sense, and particularly the participatory design of such civic technologies that strive to involve citizens in political debate and action as well as question conventional approaches to political issues (DiSalvo, 2012; Dourish, 2010; Foth et al., 2013). Following an outline of some underlying principles and assumptions behind participatory action research, especially as it applies to cities, we will critically review case studies to illustrate the application of this approach with a view to engender robust, inclusive, and dynamic societies built on the principles of engaged liberal democracy. The rationale for this approach is an alternative to smart cities in a ‘perpetual tomorrow,’ (cf. e.g. Dourish & Bell, 2011), based on many weak and strong signals of civic actions revolving around technology seen today. It seeks to emphasize and direct attention to active citizenry over passive consumerism, human actors over human factors, culture over infrastructure, and prosperity over efficiency. First, we will have a look at some fundamental issues arising from applying simplistic smart city visions to the kind of a problem a city is (cf. Jacobs, 1961). We focus on the touch points between “the city” and its civic body, the citizens. In order to provide for meaningful civic engagement, the city must provide appropriate interfaces.

The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review

Background The benefits associated with some cancer treatments do not come without risk. A serious side effect of some common cancer treatments is cardiotoxicity. Increased recognition of the public health implications of cancer treatment-induced cardiotoxicity has resulted in a proliferation of systematic reviews in this field to guide practice. Quality appraisal of these reviews is likely to limit the influence of biased conclusions from systematic reviews that have used poor methodology related to clinical decision-making. The aim of this meta-review is to appraise and synthesise evidence from only high quality systematic reviews focused on the prevention, detection or management of cancer treatment-induced cardiotoxicity. Methods Using Cochrane methodology, we searched databases, citations and hand-searched bibliographies. Two reviewers independently appraised reviews and extracted findings. A total of 18 high quality systematic reviews were subsequently analysed, 67 % (n = 12) of these comprised meta-analyses. Results One systematic review concluded that there is insufficient evidence regarding the utility of cardiac biomarkers for the detection of cardiotoxicity. The following strategies might reduce the risk of cardiotoxicity: 1) The concomitant administration of dexrazoxane with anthracylines; 2) The avoidance of anthracyclines where possible; 3) The continuous administration of anthracyclines (>6 h) rather than bolus dosing; and 4) The administration of anthracycline derivatives such as epirubicin or liposomal-encapsulated doxorubicin instead of doxorubicin. In terms of management, one review focused on medical interventions for treating anthracycline-induced cardiotoxicity during or after treatment of childhood cancer. Neither intervention (enalapril and phosphocreatine) was associated with statistically significant improvement in ejection fraction or mortality. Conclusion This review highlights the lack of high level evidence to guide clinical decision-making with respect to the detection and management of cancer treatment-associated cardiotoxicity. There is more evidence with respect to the prevention of this adverse effect of cancer treatment. This evidence, however, only applies to anthracycline-based chemotherapy in a predominantly adult population. There is no high-level evidence to guide clinical decision-making regarding the prevention, detection or management of radiation-induced cardiotoxicity.

Seasonal variations of outdoor air pollution and factors driving them in the school environment in rural Bhutan

A quantitative understanding of outdoor air quality in school environments is crucial given that air pollution levels inside classrooms are significantly influenced by outdoor pollution sources. To date, only a handful of studies have been conducted on this important topic in developing countries. The aim of this study was to quantify pollutant levels in the outdoor environment of a school in Bhutan and assess the factors driving them. Measurements were conducted for 16 weeks, spanning the wet and dry seasons, in a rural school in Bhutan. PM10, PM2.5, particle number (PN) and CO were measured daily using real-time instruments, while weekly samples for volatile organic compounds (VOCs), carbonyls and NO2 were collected using a passive sampling method. Overall mean PM10 and PM2.5 concentrations (µg/m3) were 27 and 13 for the wet, and 36 and 29 for the dry season, respectively. Only wet season data were available for PN concentrations, with a mean of 2.56 × 103 particles/cm3. Mean CO concentrations were below the detection limit of the instrumentation for the entire measurement period. Only low levels of eight VOCs were detected in both the wet and dry seasons, which presented different seasonal patterns in terms of the concentration of different compounds. The notable carbonyls were formaldehyde and hexaldehyde, with mean concentrations (µg/m3) of 2.37 and 2.41 for the wet, and 6.22 and 0.34 for the dry season, respectively. Mean NO2 cocentration for the dry season was 1.7 µg/m3, while it was below the detection limit of the instrumentation for the wet season. The pollutant concentrations were associated with a number of factors, such as cleaning and combustion activities in and around the school. A comparison with other school studies showed comparable results with a few of the studies, but in general, we found lower pollutant concentrations in the present study.

Two-dimensional bow and stern flows in a finite-depth fluid with constant vorticity

This thesis is concerned with two-dimensional free surface flows past semi-infinite surface-piercing bodies in a fluid of finite-depth. Throughout the study, it is assumed that the fluid in question is incompressible, and that the effects of viscosity and surface tension are negligible. The problems considered are physically important, since they can be used to model the flow of water near the bow or stern of a wide, blunt ship. Alternatively, the solutions can be interpreted as describing the flow into, or out of, a horizontal slot. In the past, all research conducted on this topic has been dedicated to the situation where the flow is irrotational. The results from such studies are extended here, by allowing the fluid to have constant vorticity throughout the flow domain. In addition, new results for irrotational flow are also presented. When studying the flow of a fluid past a surface-piercing body, it is important to stipulate in advance the nature of the free surface as it intersects the body. Three different possibilities are considered in this thesis. In the first of these possibilities, it is assumed that the free surface rises up and meets the body at a stagnation point. For this configuration, the nonlinear problem is solved numerically with the use of a boundary integral method in the physical plane. Here the semi-infinite body is assumed to be rectangular in shape, with a rounded corner. Supercritical solutions which satisfy the radiation condition are found for various values of the Froude number and the dimensionless vorticity. Subcritical solutions are also found; however these solutions violate the radiation condition and are characterised by a train of waves upstream. In the limit that the height of the body above the horizontal bottom vanishes, the flow approaches that due to a submerged line sink in a $90^\circ$ corner. This limiting problem is also examined as a special case. The second configuration considered in this thesis involves the free surface attaching smoothly to the front face of the rectangular shaped body. For this configuration, nonlinear solutions are computed using a similar numerical scheme to that used in the stagnant attachment case. It is found that these solution exist for all supercritical Froude numbers. The related problem of the cusp-like flow due to a submerged sink in a corner is also considered. Finally, the flow of a fluid emerging from beneath a semi-infinite flat plate is examined. Here the free surface is assumed to detach from the trailing edge of the plate horizontally. A linear problem is formulated under the assumption that the elevation of the plate is close to the undisturbed free surface level. This problem is solved exactly using the Wiener-Hopf technique, and subcritical solutions are found which are characterised by a train of sinusoidal waves in the far field. The nonlinear problem is also considered. Exact relations between certain parameters for supercritical flow are derived using conservation of mass and momentum arguments, and these are confirmed numerically. Nonlinear subcritical solutions are computed, and the results are compared to those predicted by the linear theory.

Exploring the Potential to Educate “Good Citizens” through the Australian Civics and Citizenship Curriculum.

This chapter examines the ways in which notions of ‘a good citizen’ and ‘civic virtue’ have been conceptualized in the new Civics and Citizenship Curriculum for students in Years 3 – 10 in Australia. It argues that whilst Civics and Citizenship Education (CCE) has, over time and in various ways, been recognized as a significant aspect of Australian education, only recently has attention been given to the relational and multidimensional conceptions of citizenship. Considerations of ‘morality’, ‘a good citizen’ and ‘civic virtue’ offer possibilities to engage with multidimensional notions of citizenship, which acknowledge that citizenship perspectives can be affected by personal, social, spatial and temporary situations (Cogan & Derricott, 2000). In the current statement on national goals for schooling in Australia, which informed the development of CCE, the Melbourne Declaration (MCEETYA, 2008) called for young Australians to be educated to “act with moral and ethical integrity” and be “committed to national values of democracy, equity and justice, and participate in Australia’s civic life” (MCEETYA, 2008, pp. 8–9). The chapter claims that this maximal emphasis (McLaughlin, 1992), based on active, values based and interpretive approaches to democratic citizenship which encourage debate and participation in civil society, was evident in the new Civics and Citizenship Curriculum. However, it contends that the recommendations of the recent Review of the Australian Curriculum: Final report (Australian Government, 2014a & b), will now limit CCE’s potential to deliver the sort of active and informed citizenship heralded by the Melbourne Declaration. This is because the Review advocates for a content-focused minimal (McLaughlin, 1992) emphasis on civic knowledge, with diminished attention to citizenship participation and processes. In doing so, the Review foregrounds conceptions of the ‘good citizen’ in more limited terms of responsibility, obligations and compliance with the status quo.

Molecular recognition of 2,4,6-trinitrotoluene by 6-aminohexanethiol and surface-enhanced Raman scattering sensor

2,4,6-trinitrotoluene (TNT) is one of the most commonly used nitro aromatic explosives in landmine, military and mining industry. This article demonstrates rapid and selective identification of TNT by surface-enhanced Raman spectroscopy (SERS) using 6-aminohexanethiol (AHT) as a new recognition molecule. First, Meisenheimer complex formation between AHT and TNT is confirmed by the development of pink colour and appearance of new band around 500 nm in UV-visible spectrum. Solution Raman spectroscopy study also supported the AHT:TNT complex formation by demonstrating changes in the vibrational stretching of AHT molecule between 2800-3000 cm−1. For surface enhanced Raman spectroscopy analysis, a self-assembled monolayer (SAM) of AHT is formed over the gold nanostructure (AuNS) SERS substrate in order to selectively capture TNT onto the surface. Electrochemical desorption and X-ray photoelectron studies are performed over AHT SAM modified surface to examine the presence of free amine groups with appropriate orientation for complex formation. Further, AHT and butanethiol (BT) mixed monolayer system is explored to improve the AHT:TNT complex formation efficiency. Using a 9:1 AHT:BT mixed monolayer, a very low detection limit (LOD) of 100 fM TNT was realized. The new method delivers high selectivity towards TNT over 2,4 DNT and picric acid. Finally, real sample analysis is demonstrated by the extraction and SERS detection of 302 pM of TNT from spiked.

Structural optimization approach for specially shaped composite tank in spacecrafts

This study proposes an optimized approach of designing in which a model specially shaped composite tank for spacecrafts is built by applying finite element analysis. The composite layers are preliminarily designed by combining quasi-network design method with numerical simulation, which determines the ratio between the angle and the thickness of layers as the initial value of the optimized design. By adopting an adaptive simulated annealing algorithm, the angles and the numbers of layers at each angle are optimized to minimize the weight of structure. Based on this, the stacking sequence of composite layers is formulated according to the number of layers in the optimized structure by applying the enumeration method and combining the general design parameters. Numerical simulation is finally adopted to calculate the buckling limit of tanks in different designing methods. This study takes a composite tank with a cone-shaped cylinder body as example, in which ellipsoid head section and outer wall plate are selected as the object to validate this method. The result shows that the quasi-network design method can improve the design quality of composite material layer in tanks with complex preliminarily loading conditions. The adaptive simulated annealing algorithm can reduce the initial design weight by 30%, which effectively probes the global optimal solution and optimizes the weight of structure. It can be therefore proved that, this optimization method is capable of designing and optimizing specially shaped composite tanks with complex loading conditions.

Prevalence of alcohol-impaired driving and riding in northern Ghana

Objective The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists’ perception on their own alcohol use and knowledge of legal Blood Alcohol Concentration (BAC) limit of Ghana. Method With the assistance of police, the systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and a follow-up breath tests conducted to measure the actual breath alcohol levels among positive participants. Results In all, 9.7% of the 789 participants had detectable alcohol among whom 6% exceeded the legal (BAC) limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath tested) followed by truck drivers 9% and motorcyclists (7% of all motorcyclists breath tested). The occurrence of a positive BAC among cyclists was about 8 times higher, (OR=7.73; p<0.001) and 2 times higher, among motorcyclists (OR=2.30; p=0.039) compared with private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than females (OR=1.67; p=0.354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than weekdays (OR=2.62; p=0.001). Conclusion Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instil the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.

Adolescent self-reported physical activity and autonomy: A case for constrained and structured environments?

The provision of autonomy supportive environments that promote physical activity engagement have become popular in contemporary youth settings. However, questions remain about whether adolescent perceptions of their autonomy have implications for physical activity. The purpose of this investigation was to examine the association between adolescents’ self-reported physical activity and their perceived autonomy. Participants (n = 384 adolescents) aged between 12 and 15 years were recruited from six secondary schools in metropolitan Brisbane, Australia. Self-reported measures of physical activity and autonomy were obtained. Logistic regression with inverse probability weights were used to examine the association between autonomy and the odds of meeting youth physical activity guidelines. Autonomy (OR 0.61, 95% CI 0.49-0.76) and gender (OR 0.62, 95% CI 0.46-0.83) were negatively associated with meeting physical activity guidelines. However, the model explained only a small amount of the variation in whether youth in this sample met physical activity guidelines (R2 = 0.023). For every 1 unit decrease in autonomy (on an index from 1 to 5), participants were 1.64 times more likely to meet physical activity guidelines. The findings, which are at odds with several previous studies, suggest that interventions designed to facilitate youth physical activity should limit opportunities for youth to make independent decisions about their engagement. However, the small amount of variation explained by the predictors in the model is a caveat, and should be considered prior to applying such suggestions in practical settings. Future research should continue to examine a larger age range, longitudinal observational or intervention studies to examine assertions of causality, as well as objective measurement of physical activity.

Automated ventricular mapping with multi-atlas fluid image alignment reveals genetic effects in Alzheimer's disease

We developed and validated a new method to create automated 3D parametric surface models of the lateral ventricles in brain MRI scans, providing an efficient approach to monitor degenerative disease in clinical studies and drug trials. First, we used a set of parameterized surfaces to represent the ventricles in four subjects' manually labeled brain MRI scans (atlases). We fluidly registered each atlas and mesh model to MRIs from 17 Alzheimer's disease (AD) patients and 13 age- and gender-matched healthy elderly control subjects, and 18 asymptomatic ApoE4-carriers and 18 age- and gender-matched non-carriers. We examined genotyped healthy subjects with the goal of detecting subtle effects of a gene that confers heightened risk for Alzheimer's disease. We averaged the meshes extracted for each 3D MR data set, and combined the automated segmentations with a radial mapping approach to localize ventricular shape differences in patients. Validation experiments comparing automated and expert manual segmentations showed that (1) the Hausdorff labeling error rapidly decreased, and (2) the power to detect disease- and gene-related alterations improved, as the number of atlases, N, was increased from 1 to 9. In surface-based statistical maps, we detected more widespread and intense anatomical deficits as we increased the number of atlases. We formulated a statistical stopping criterion to determine the optimal number of atlases to use. Healthy ApoE4-carriers and those with AD showed local ventricular abnormalities. This high-throughput method for morphometric studies further motivates the combination of genetic and neuroimaging strategies in predicting AD progression and treatment response. © 2007 Elsevier Inc. All rights reserved.

Automated 3D mapping & shape analysis of the lateral ventricles via fluid registration of multiple surface-based atlases

We developed and validated a new method to create automated 3D parametric surface models of the lateral ventricles, designed for monitoring degenerative disease effects in clinical neuroscience studies and drug trials. First we used a set of parameterized surfaces to represent the ventricles in a manually labeled set of 9 subjects' MRIs (atlases). We fluidly registered each of these atlases and mesh models to a set of MRIs from 12 Alzheimer's disease (AD) patients and 14 matched healthy elderly subjects, and we averaged the resulting meshes for each of these images. Validation experiments on expert segmentations showed that (1) the Hausdorff labeling error rapidly decreased, and (2) the power to detect disease-related alterations monotonically improved as the number of atlases, N, was increased from 1 to 9. We then combined the segmentations with a radial mapping approach to localize ventricular shape differences in patients. In surface-based statistical maps, we detected more widespread and intense anatomical deficits as we increased the number of atlases, and we formulated a statistical stopping criterion to determine the optimal value of N. Anterior horn anomalies in Alzheimer's patients were only detected with the multi-atlas segmentation, which clearly outperformed the standard single-atlas approach.

Eye-safe UV stand-off Raman spectroscopy for the ranged detection of explosives in the field

Increasing worldwide terrorist attacks involving explosives presents a growing need for a rapid and ranged explosive detection method that can safely be deployed in the field. Stand-off Raman spectroscopy shows great promise; however, the radiant exposures of lasers required for adequate signal generation are often much greater than what is safe for the eye or the skin, restricting use of the technique to un-populated areas. Here, by determining the safe exposure levels for lasers typically used in Raman spectroscopy, optimal parameter values are identified, which produce the largest possible detection range using power densities that do not exceed the eye-safe limit. It is shown that safe ultraviolet pulse energies can be more than three orders of magnitude greater than equivalent safe visible pulse energies. Coupling this to the 16-fold increase in Raman signal obtained in the ultraviolet at 266 nm over that at 532 nm results in a 131 times larger detection range for the eye-safe 266-nm system over an equivalent eye-safe 532-nm laser system. For the Raman system described here, this translates to a maximum range of 42 m for detecting Teflon with a 266-nm laser emitting a 100-mm diameter beam of 23.5-mJ nanosecond pulses.

Mapping teacher-faces

This paper uses Deleuze and Guattari's concept of faciality to analyse the teacher's face. According to Deleuze and Guattari, the teacher-face is a special type of face because it is an 'overcoded' face produced in specific landscapes. This paper suggests four limit-faces for teacher faciality that actualise different mixes of signifiance and subjectification in a classroom in which individualisation and massifications are affected. Understanding these limit-faces suggests new ways to conceive the affects actualised in the classroom that are subjected to increasing levels of surveillance from education policy makers. Through this ‘partial mapping’ new possibilities emerge to “escape the face”.