Search

There is a scarcity of qualitative research focusing on the implementation of infection prevention and control (IPC) guidance in low-income countries. This study aimed to address this gap by exploring the perspectives of healthcare workers (HCWs) regarding the implementation of IPC guidance at the healthcare facility level in Uganda. The study also sought to generate a theoretical understanding of the processes involved in implementing IPC guidance in these settings. This robust qualitative research employed a design based on constructivist grounded theory methodology, conducting individual interviews with 13 frontline health workers such as doctors, nurses, nurse interns, and laboratory staff. The key findings of the study revealed that HCWs undergo a process of 'striving for improved practice' in their efforts to implement IPC guidance. This process involved four phases: recognising the importance of IPC, playing a role, encountering challenges, and overcoming challenges. However, achieving full implementation proved difficult due to various individual and organisational barriers presented by the low-income setting. HCWs employed improvisation as a means to overcome these obstacles. Additionally, the study identified enabling factors that facilitated the implementation of IPC guidance within these settings. This study is significant as it applies robust qualitative research methods to provide valuable evidence of HCWs' perspectives on an important topic in an under-researched context, with findings transferable to similar settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Dozens of new antiviral systems have been recently characterized in bacteria. Some of these systems are present in eukaryotes and appear to have originated in prokaryotes, but little is known about these defense mechanisms in archaea. Here, we explore the diversity and distribution of defense systems in archaea and identify 2610 complete systems in Asgardarchaeota, a group of archaea related to eukaryotes. The Asgard defense systems comprise 89 unique systems, including argonaute, NLR, Mokosh, viperin, Lassamu, and CBASS. Asgard viperin and argonaute proteins have structural homology to eukaryotic proteins, and phylogenetic analyses suggest that eukaryotic viperin proteins were derived from Asgard viperins. We show that Asgard viperins display anti-phage activity when heterologously expressed in bacteria. Eukaryotic and bacterial argonaute proteins appear to have originated in Asgardarchaeota, and Asgard argonaute proteins have argonaute-PIWI domains, key components of eukaryotic RNA interference systems. Our results support that Asgardarchaeota played important roles in the origin of antiviral defense systems in eukaryotes., (© 2024. The Author(s).)

Despite significant efforts in the development of noninvasive blood glucose (BG) monitoring solutions, delivering an accurate, real-time BG measurement remains challenging. We sought to address this by using a novel radiofrequency (RF) glucose sensor to noninvasively classify glycemic status. The study included 31 participants aged 18-65 with prediabetes or type 2 diabetes and no other significant medical history. During control sessions and oral glucose tolerance test sessions, data were collected from both a RF sensor that rapidly scans thousands of frequencies and concurrently from a venous blood draw measured with an US Food and Drug Administration (FDA)-cleared glucose hospital meter system to create paired observations. We trained a time series forest machine learning model on 80% of the paired observations and reported results from applying the model to the remaining 20%. Our findings show that the model correctly classified glycemic status 93.37% of the time as high, normal, or low.

Background: Effective infection prevention and control (IPC) practices among healthcare workers are crucial to prevent the spread of COVID-19 and other infections in healthcare settings., Aim: To synthesise evidence on behaviour change theories, models, or frameworks applied to understand healthcare workers' IPC practices during the COVID-19 pandemic., Methods: PubMed, EBSCOhost interface, ProQuest interface, MEDLINE (Ovid), and grey literature were searched for primary studies published between December 2019 and May 2023. The Mixed Method Appraisal Tool evaluated the methodological quality of the studies. Two reviewers independently completed study selection, data extraction, and quality assessment., Results: The search yielded 2110 studies, of which 19 were included. Seven behaviour change theories, models, and frameworks were identified, with the Health Belief Model and Theoretical Domains Framework being the most employed. Based on these theories, models, and frameworks, the included studies identified cognitive, environmental, and social factors influencing healthcare workers' compliance with COVID-19 IPC practices., Discussion: This review offers insights into the critical role of behavioural change theories, models, or frameworks in understanding the factors influencing healthcare workers' compliance with IPC practices during COVID-19. It also highlights the potential of these theories in guiding the development of evidence-based interventions to improve healthcare workers' compliance with IPC practices., Competing Interests: The author(s) declare that no potential conflict of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: This study illustrates image rejection rates of the lateral wrist x-ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image-repeat decision-making skills existing between radiologists, experienced radiographers and junior radiographers., Methods: A retrospective review was conducted of all rejected lateral wrist x-ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study., Results: The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers., Conclusions: This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision-making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs., (© 2023 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Background: The alarming growth of antimicrobial resistance organisms (AMRs) and the threat caused by health care-associated infections require hospitalized individuals who are infected or colonized with AMRs to be cared for in isolation, predominantly in single rooms. None of the existing reviews focus on or specifically address the patient's experience of being cared for in contact isolation when affected by AMRs exploring this specific context., Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for the conduct of systematic reviews was applied. Five databases were searched from inception to April 2019, with keywords related to adult patient experiences, AMR, and contact isolation. The evidence was certified by 2 reviewers. Principles of thematic analysis were used to produce a narrative synthesis of the findings., Results: Eighteen eligible studies were identified. Narrative synthesis resulted in 3 overarching categories reflecting the patient experience: privacy versus loneliness; emotional responses to isolation; quality of care, recovery, and safety in isolation., Conclusions: This review synthesizes existing evidence reflecting the patient experience of contact isolation. Study findings were often contradictory and may not reflect contemporary health care, such as shorter hospital stays, or societal preferences for greater privacy. Further research focusing on contemporary health care contexts is recommended., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS., Setting: Rural areas of New South Wales classified as Modified Monash Categories 3-7., Participants: Semistructured interviews were conducted with seven purposively sampled participants who self-identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW., Design: Data collection and analysis were guided by hermeneutic phenomenology., Findings: We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control., Discussion: The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

The COVID-19 pandemic has caused significant medical and psychological challenges worldwide, and not only exceeded the capacity of hospitals and intensive care units but also an individuals' ability to cope with life. Health-care workers have continued to provide care for patients despite exhaustion, fear of transmission to themselves and their family, illness or death of friends and colleagues, and losing many patients. They have also faced additional stress and anxiety due to long shifts combined with unprecedented population restrictions, including personal isolation. In this study, we study the effect of an app-based Yoga of Immortals (YOI) intervention on mental health of healthcare workers. In this study, the health care workers were digitally recruited, and their psychological parameters were measured using validated questionaries. The participants were randomly grouped into control and test groups. The validated psychological measures were the Patient Health Questionnaire-8 (PHQ-8), Insomnia Severity Index (ISI) and generalized anxiety disorder (GAD-7) scales. The digital YOI intervention significantly reduced the anxiety, depression symptoms, and insomnia in healthcare workers of all age groups. In contrast, there was no improvement in the control group. This study details the effectiveness of an app-based YOI intervention in healthcare workers., Competing Interests: IS was employed by SYC infinite. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Currie, Gupta, Shivanand, Desai, Bhatt, Tunuguntla and Verma.)

(1) Background: The wide range of preparedness, physical fitness, and capabilities of older athletes makes it challenging to recommend general training programs for this cohort ranging from ages 35 to 80 and older. Weightlifting has enjoyed an unprecedented growth in recent years, especially among women. The objectives of this study are to describe age and sex differences in self-reported training regimens and concurrent training for Masters weightlifters and investigate regional differences. (2) Methods: A total of 1051 Masters weightlifters from Australia, Canada, Europe, and the USA completed an online survey that included questions on sport history and training practices. (3) Results: A training session typically lasted 1.5 to 2 h for both sexes across all ages. Weightlifters engaged in concurrent training (66.9%), especially in endurance training (24.9%) and CrossFit (36.4%), but the proportions differed across geographic regions. Older females maintained training 4 days per week, while older males reduced this to 3 days per week. (4) Conclusions: Weightlifting training practice of Masters athletes was remarkably consistent across ages, but concurrent training differed between males and females and across regions. This study provides helpful information for athletes, coaches, and sport organizations about the variation in weightlifting training practices and concurrent training of older athletes.

Background: The link between inappropriate antibiotic prescribing and the global threat of antimicrobial resistance is well documented. International strategies recommend antimicrobial stewardship (AMS) programmes, with improvement interventions to safeguard antibiotics., Aim: This study sought to systematically evaluate the impact of multi-professional Antimicrobial Management Team (AMT) staff resource availability on stewardship activities., Methods: We conducted an on-line, cross-sectional survey of AMTs in each regional Health Board and the national specialist hospital in Scotland (N = 15). Responses were analysed descriptively, exploring observed relationships between variables to identify patterns., Findings: Results highlighted apparent variation in the levels of AMT resource availability across Scotland, not directly influenced by Health Board size, with some larger Health Boards having proportionately poorer AMT resource allocation. However, the range and frequency of activities to support AMS was not directly linked to either Health Board size or staff resource allocation, indicating a more complex inter-relationship between factors., Conclusions: There is apparent inequity in staff resource available for AMTs across Scotland, with significantly lower resource allocation in comparison with recommendations from other international studies. However, considering these survey findings with our earlier qualitative research indicates that leadership style and team member enthusiasm may be as, if not more, influential than resource availability on the scope of AMT activities. These findings have international relevance for hospital service managers considering the recruitment, training and ongoing support of AMTs, in order to maximize impact from a limited resource., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background: The number of nurse prescribers is increasing, yet little evidence exists about their antibiotic prescribing behaviour., Aim: To measure nurse independent prescribers' (NIPs) intention to manage patients, presenting with an upper respiratory tract infection (URTI) for the first time, without prescribing an antibiotic and to examine the determinants of this behaviour., Methods: This was a mixed-method study using the Reasoned Action Approach (RAA). Content analysis of data from 27 telephone interviews with NIPs informed the development of a questionnaire which was tested for validity and reliability and used in a national survey of NIPs across Scotland. Descriptive and inferential statistical analysis was carried out to determine intention to manage patients without prescribing an antibiotic and the significant influences on this intention., Findings: From 184 participants it was found that NIPs intended to manage patients, presenting with a URTI for the first time, without prescribing an antibiotic. Key determinants were perceived norm, perceived behavioural control, and moral norm. Significant beliefs were positive social influence from other non-medical prescribers (P = 0.007) and nurse prescribers (P = 0.045), the enablers of prescriber experience and confidence (P ≤ 0.001), and the barrier of pressure from patients/carers (P = 0.010)., Conclusion: The findings provide reassurance that NIPs intend to prescribe appropriately. The identification of nurse-specific barriers and enablers to this intention should be acknowledged and targeted in future interventions to manage this behaviour., (Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Microbial rhodopsins are simple light-harvesting complexes that, unlike chlorophyll photosystems, have no iron requirements for their synthesis and phototrophic functions. Here, we report the environmental concentrations of rhodopsin along the Subtropical Frontal Zone off New Zealand, where Subtropical waters encounter the iron-limited Subantarctic High Nutrient Low Chlorophyll (HNLC) region. Rhodopsin concentrations were highest in HNLC waters where chlorophyll-a concentrations were lowest. Furthermore, while the ratio of rhodopsin to chlorophyll-a photosystems was on average 20 along the transect, this ratio increased to over 60 in HNLC waters. We further show that microbial rhodopsins are abundant in both picoplankton (0.2-3 μm) and in the larger (>3 μm) size fractions of the microbial community containing eukaryotic plankton and/or particle-attached prokaryotes. These findings suggest that rhodopsin phototrophy could be critical for microbial plankton to adapt to resource-limiting environments where photosynthesis and possibly cellular respiration are impaired., (© 2021 Society for Applied Microbiology and John Wiley & Sons Ltd.)

Introduction: The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach., Main Recommendations: We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions., Changes in Management as a Result of the Guidelines: A GRADE approach is used. Targeted recommendations for both high and low risk children. New tympanostomy tube otorrhoea section. New Priority 5 for health services: annual and catch-up ear health checks for at-risk children. Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children. Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration. Concurrent audiology and surgical referrals are recommended where delays are likely. Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis. The use of autoinflation devices is recommended for some children with persistent otitis media with effusion. Definitions for mild (21-30 dB) and moderate (> 30 dB) hearing impairment have been updated. New "OMapp" enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families., (© 2021 Commonwealth of Australia and The Menzies School of Health Research. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

The aim of this article is to explore the positive and negative impacts of working therapeutically in complex psychological trauma (CPT), particularly the field of gender-based violence (GBV) and childhood sexual abuse (CSA), from the clinicians' perspective. The focus was on the prospect of positive gains and growth for therapists. Twenty-one clinicians ( n = 21; counselors/psychotherapists and psychologists) from National Health Service (NHS) specialist trauma services, a community mental health team, and specialist sexual assault counseling organization participated. Interpretative phenomenological analysis (IPA) was utilized to conduct single one-off interviews and analysis. Six themes were identified: Called to the work; Connection, Separation, and Oneness; Into and out of the darkness; Chaos into meaning; Reparation not repetition; and Expansion and growth. The first "Therapist Led Framework of Growth in Trauma Work" is presented. Vicarious posttraumatic growth (VPTG) was a key finding, with CPT therapists experiencing a "challenge/benefit/change" growth process. Adoption of actively relational strategies to enhance clinicians' growth process through trauma work is being proposed. The benefits of conceptualizing both the positive and negative impacts of such work for supervision, training, shaping the formal curricula, service management, and continuing professional development (CPD) are being discussed. The need for good practice guidelines on self-care internationally is highlighted.

Background/objectives: Although several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown., Design: Pragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad., Setting: Four clinical trial sites (CTSs) based in academic and clinical health systems., Participants: A total of 2,150 English- or Spanish-speaking PWD who are not receiving hospice or residing in a nursing home and their caregivers., Interventions: Eighteen months of (1) HSDC provided by a nurse practitioner or physician's assistant dementia care specialist who works within the health system, or (2) CBDC provided by a social worker or nurse care consultant who works at a community-based organization, or (3) UC with as needed referral to the Alzheimer's Association Helpline., Measurements: Primary outcomes: PWD behavioral symptoms and caregiver distress as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity and Modified Caregiver Strain Index scales., Secondary Outcomes: NPI-Q Distress, caregiver unmet needs and confidence, and caregiver depressive symptoms. Tertiary outcomes: PWD long-term nursing home placement rates, caregiver-reported PWD functional status, cognition, goal attainment, "time spent at home," Dementia Burden Scale-Caregiver, a composite measure of clinical benefit, Quality of Life of persons with dementia, Positive Aspects of Caregiving, and cost effectiveness using intervention costs and Medicare claims., Results: The results will be reported in the spring of 2024., Conclusion: D-CARE will address whether emphasis on clinical support and tighter integration with other medical services has greater benefit than emphasis on social support that is tied more closely to community resources. It will also assess the effectiveness of both interventions compared with UC and will evaluate the cost effectiveness of each intervention., (© 2020 The American Geriatrics Society.)

Objectives: To synthesize current evidence for the effectiveness of interventions to ensure the timely review of antibiotics in acute care hospitals., Methods: Five databases were searched from 1 January 2015 to 8 March 2019 for studies in English, focused on the timely review of antibiotics in acute care hospitals. Randomized controlled trials, non-randomized studies, case-control and cohort study designs were eligible. Intervention strategies were categorized according to the Cochrane Effective Practice and Organisation of Care taxonomy of health interventions, then mapped to the intervention functions of the behaviour change wheel., Results: Fourteen studies were included. Most studies (11 out of 14) were conducted in single sites. Nine out of 14 reported intervention delivery by more than one healthcare professional. Physicians were the main targets of interventions in all studies. Thirteen out of 14 studies tested interventions comprising more than one strategy. The three most commonly utilized strategies within interventions were clinical practice guidelines, audit and feedback, and educational materials. Only one study employed theory in intervention evaluation. Reported interventions led to timely review and switch of IV antibiotic therapy, and shortened durations of overall antibiotic therapy., Conclusions: Interventions to improve the review of antibiotics were found to be effective in the short to medium term, with limited evidence of long-term sustainability in multiple sites. Future research may benefit from the application of theory to intervention design and detailed specifications of interventions to aid their easy replication and implementation in different contexts., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)

Background: Antimicrobial stewardship (AMS) describes activities concerned with safe-guarding antibiotics for the future, reducing drivers for the major global public health threat of antimicrobial resistance (AMR), whereby antibiotics are less effective in preventing and treating infections. Appropriate antibiotic prescribing is central to AMS. Whilst previous studies have explored the effectiveness of specific AMS interventions, largely from uni-professional perspectives, our literature search could not find any existing evidence evaluating the processes of implementing an integrated national AMS programme from multi-professional perspectives., Methods: This study sought to explain mechanisms affecting the implementation of a national antimicrobial stewardship programme, from multi-professional perspectives. Data collection involved in-depth qualitative telephone interviews with 27 implementation lead clinicians from 14/15 Scottish Health Boards and 15 focus groups with doctors, nurses and clinical pharmacists (n = 72) from five Health Boards, purposively selected for reported prescribing variation. Data was first thematically analysed, barriers and enablers were then categorised, and Normalisation Process Theory (NPT) was used as an interpretive lens to explain mechanisms affecting the implementation process. Analysis addressed the NPT questions 'which group of actors have which problems, in which domains, and what sort of problems impact on the normalisation of AMS into everyday hospital practice'., Results: Results indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training. Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners., Conclusions: This study provides original evidence of barriers and enablers to the implementation of a national AMS programme, from multi-professional, multi-organisational perspectives. The use of a robust theoretical framework (NPT) added methodological rigour to the findings. Our results are of international significance to healthcare policy makers and practitioners seeking to strengthen the sustainable implementation of hospital AMS programmes in comparable contexts.

An estimated 25,000 people of Black, Asian and other Minority Ethnic (BAME) origins live with dementia in UK - a number which is expected to increase sevenfold by 2051. People from many BAME communities experience dementia in a markedly different way to their white British counterparts. For instance diagnosis is more likely to occur at an advanced stage of the illness, while there is a lower take-up of mainstream dementia services. This research study focused on the experiences of caregivers for family and friends living with dementia from South Asian, African Caribbean and Chinese communities in Bristol. Data were collected through interviews with 27 participants and 8 focus groups attended by 76 participants. Additionally, interviews were carried out with 16 paid staff and volunteers working for Voluntary and Community Sector Organisations (VCSOs) that provided services for older people from these three communities. As concepts emerged during data analysis, so these were checked with each community. The grounded theory, 'fear of diminishment' was present across all communities: participants both needed and wanted support, but they were reluctant to accept this if it came at the cost of being diminished as a person. To resolve this dilemma, informants turned to BAME-led VCSOs, which provided ongoing support and advocated on behalf of their members. However, the services provided by these VCSOs varied and reflected differences in the ways in which communities enacted the theory. Given the increasing importance of cultural diversity within dementia care, this study has important implications for communities across the UK and elsewhere, and points towards the need for sustainable and equitable resourcing of dementia care within BAME-led VCSOs.

Objective: Understanding craniofacial growth and development is important for accurate diagnosis, treatment planning and post-treatment evaluation of orthodontic cases. Paramount to this is knowledge of the cranial base growth and development, since it is the foundation upon which the remaining facial structures develop. The purpose of this study was to analyse different anatomical structures in the posterior cranial base and determine its changes during the adolescent years (13-15 year of age) using CBCT., Materials and Methods: Sixty CBCT images of the adolescent population that received orthodontic treatment at two time-points (mean age T1: 13.1 years/T2: 14.6years) were used to assess growth related dimensional changes using 33 selected landmarks. Inter-rater, intra-rater and accuracy of 33 selected landmarks in the posterior cranial base and surrounding area were then evaluated via three-dimensional (3D) cone-beam computed tomography (CBCT). Linear differences were then calculated among the different landmarks to determine the changes present in the sample., Results: The selected landmarks in the posterior cranial base and surrounding area were found to be reliably and accurately located in 3D. Over the growth period studied (17.5months), minor statistically significant changes occurred, but they were deemed clinically irrelevant., Conclusions: The studied landmarks in the posterior cranial base and surrounding area showed minor clinically insignificant changes over the study period. The observed changes could be attributed to measurement error. The posterior cranial base is deemed to be stable in all three dimensions of study during the adolescent growth period studied., (Copyright © 2020 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Efforts to address the complex global problem of antimicrobial resistance (AMR) highlight the need for imagination and innovation. However, nursing has not yet leveraged its potential to innovate to prevent AMR advancing., Aims: This paper focuses on the initial phase of an ongoing research and development study that seeks to foster nursing imagination and innovation by enhancing the meaningfulness of AMR for practising nurses and by facilitating their creative ideas., Methods: This aim is addressed through application of arts and humanities approaches, in particular the use of visualisation, co-design and historical methods, underpinned by the Design Council Double Diamond process model. The first phase with 20 UK participants explored how hospital and community-based nurses understand and respond to the priorities and consequences of AMR within their everyday working lives., Results: Nurses varied in their conceptualisations of AMR and in their depictions and explanations of its meaning and priority within everyday practices. Some saw infection prevention and control as bound up with AMR, whereas others differentiated in the context of specific work activities. Insights into related reasoning and practice tactics were also generated., Conclusions: The initial project phase provides a basis for fostering nursing innovation in this important field., (© The Author(s) 2020.)

Purpose: To estimate the absolute number of adult survivors of childhood cancer in the U.S. population who carry a pathogenic or likely pathogenic variant in a cancer predisposition gene., Methods: Using the Surveillance, Epidemiology, and End Results (SEER) Program, we estimated the number of childhood cancer survivors on December 31, 2016 for each childhood cancer diagnosis, multiplied this by the proportion of carriers of pathogenic/likely pathogenic variants in the St. Jude Lifetime Cohort (SJLIFE) study, and projected the resulting number onto the U.S., Results: Based on genome sequence data, 11.8% of 2450 SJLIFE participants carry a pathogenic/likely pathogenic variant in one of 156 cancer predisposition genes. Given this information, we estimate that 21 800 adult survivors of childhood cancer in the United States carry a pathogenic/likely pathogenic variant in one of these genes. The highest estimated absolute number of variant carriers are among survivors of central nervous system tumors (n = 4300), particularly astrocytoma (n = 1800) and other gliomas (n = 1700), acute lymphoblastic leukemia (n = 4300), and retinoblastoma (n = 3500). The most frequently mutated genes are RB1 (n = 3000), NF1 (n = 2300), and BRCA2 (n = 800)., Conclusion: Given the increasing number of childhood cancer survivors in the United States, clinicians should counsel survivors regarding their potential genetic risk, consider referral for genetic counseling and testing, and, as appropriate, implement syndrome-specific cancer surveillance or risk-reducing measures., (© 2019 Wiley Periodicals, Inc.)

Background: Determination of human papillomavirus (HPV) status has become clinically relevant for patient stratification under UICC TNM8 staging. Within the United Kingdom, a combination of p16 IHC and HPV DNA-ISH is recommended for classifying HPV status. This study will assess a series of clinically applicable second-line molecular tests to run in combination with p16 IHC to optimally determine HPV status., Methods: The ability of HPV RNA-ISH, HPV DNA-ISH, and HPV DNA-PCR to identify p16-positive/HPV-positive patients was investigated in a population-based oropharyngeal squamous cell carcinoma (OPSCC) cohort of patients diagnosed in Northern Ireland from 2000 to 2011., Results: Only 41% of the Northern Irish OPSCC patient population was associated with HPV-driven carcinogenesis. Both ISH assays were more specific than the DNA-PCR assay (100% and 95% vs. 67%) and were less likely to be affected by preanalytic factors such as increasing block age. A pooled HPV genotype probe for RNA-ISH was found to be the most accurate molecular assay assessed (95% accuracy) when compared with p16 positivity., Conclusions: Our study demonstrates the advantage of tissue-based molecular assays when determining HPV status in retrospective samples. Specifically, we demonstrate the enhanced sensitivity and specificity of ISH techniques compared with PCR-based methodology when working with formalin-fixed paraffin-embedded tissue, and found HPV RNA-ISH to be the most effective assay for determining HPV status., Impact: As p16 IHC is a relatively inexpensive, accessible, and sensitive test for stratifying patients by HPV status, this study finds that more patients would benefit from first-line p16 IHC followed by specific HPV testing using HPV RNA-ISH to confirm HPV status., (©2019 American Association for Cancer Research.)

Aim: To report the surgical and audiological outcomes of myringoplasty (Type I tympanoplasty) in Indigenous Australian children living in remote and regional communities in northern Australia., Method: An observational cohort study, with prospective recording of the details of surgery. Audiological outcomes were collected independently, and these data were integrated in the present study. Children aged 5-18 year underwent myringoplasty in the Northern Territory during a program initiated by the Australian Government. Surgery was performed by surgeons drawn from across Australia., Results: 412 primary myringoplasties were performed. The mean age at surgery was 11 years. The tympanic membrane was closed in 64.2% of cases. Fascial grafting was associated with greater surgical success than cartilage. Dryness of the ear at surgery did not affect drum closure. Post-operative aural discharge was half that reported in historical literature. Surgical success was independent of the patient's age at surgery. Post-operative audiograms were available on 216 cases. At last review, hearing had improved even when the operation was not a surgical success, with hearing aid candidacy falling from 84 to 34%. Hearing was similar irrespective of the size of the perforation at surgery or the graft used and did not change with the time between surgery and review. The best hearing was associated with drum closure and Types A or C tympanograms. A conductive hearing loss persisted after surgery that was greater when there was an immobile drum., Conclusions: Indigenous children benefited from myringoplasty, even when the operation was not a "surgical success" as deemed by drum closure. There lower incidence of post-operative discharge from persistent perforations suggests an improvement in the ear health of the population. A persistent conductive loss persists, likely a consequence of the underlying disease but possibly from the surgery., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: To explore patients' accounts of screening and being managed for colonisation with the antimicrobial resistant organism, carbapenemase-producing Enterobacteriaceae (CPE), when in hospital., Background: Antimicrobial resistance (AMR) has been identified as one of the biggest global health challenges of the 21st Century. As the threat from AMR grows, screening to identify patients who are colonised with resistant organisms such as CPE is becoming an increasingly important aspect of nursing practice, in order to reduce risk of transmission of infection within hospitals. There is currently little research evidence on the patient experience of hospital management of CPE colonisation., Methods: Qualitative semi-structured telephone interviews were undertaken, using a topic guide. Nine patients participated in the study. The data were analysed thematically, and rigour was maintained through peer review. The COREQ checklist was used., Results: Two main themes were identified: "I can't make sense of CPE," illustrating limitations in patients' understandings of CPE; and, "I feel as if they are saying it is my fault," indicating the feelings of responsibility and blame which patients experienced., Conclusions: This paper contributes original evidence to the limited literature on patients' experiences of being colonised with CPE. The findings suggest that support and information provided for patients by healthcare professionals needs to be based on current evidence-based guidance on the nature of CPE and its implications for patient care, as well as being responsive to patients' emotional needs., Relevance to Clinical Practice: This study has international relevance for nursing practice. As the global threat of AMR grows, the demands on healthcare providers to manage resistant organisms and their implications for patient care within healthcare settings are increasing. Enabling healthcare professionals to engage sensitively with patients being managed for colonisation with CPE is paramount to providing patient-centred care., (© 2019 John Wiley & Sons Ltd.)

Background: Chronic suppurative otitis media (CSOM) is a significant health issue affecting Aboriginal Australians. Long-term hearing loss can cause communication problems, educational disadvantage, and social isolation. Current standard treatment for CSOM in our region is twice daily dry mopping of the pus from the ear canal followed by instillation of ciprofloxacin antibiotic ear drops for up to 16 weeks, or until the discharge resolves for a period of 3 days. The treatment is long, laborious and fails to resolve ear discharge in 70% of cases in remote communities. Bacterial pathogens also persist. Povidone-iodine ear wash is the preferred method of clearing ear discharge in Western Australia. However, evidence of its effectiveness is lacking. In systematic reviews, topical antibiotics (ciprofloxacin) have been shown to be more effective than oral antibiotics or topical antiseptics. Currently, it is unclear whether there are any benefits of combining these treatments., Methods: This protocol describes a 2 × 2 factorial randomised controlled trial of two different interventions (povidone-iodine ear wash and oral cotrimoxazole), given as adjunctive therapy to standard treatment for CSOM. 280 children, between 2 months and 17 years of age, Indigenous or non-Indigenous, living in participating Northern Territory (NT) communities are randomised to standard treatment (dry mopping and ciprofloxacin drops) plus one of two topical treatments (dilute povidone-iodine ear wash or no wash) and one of two oral medication treatments (16 weeks of cotrimoxazole or placebo)., Discussion: Current treatment of CSOM in our region shows that eradication of bacterial pathogens from the middle ear space and dry ears is often not achieved. This trial will evaluate the efficacy of adjunctive treatments of antiseptic ear washes and oral antibiotics. Clinical, microbiological and hearing outcomes will be reported., Trial Registration: This trial (ACTRN12614000234617) was registered with ANZCTR on 05 April 2014.

Objective: Adolescents are at risk of developing detrimental health behaviours that will affect their adult health. The aim was to estimate prevalence of health risk behaviours (HRB), comparing young people (12-18 years old) in Wiltshire (UK) who are vulnerable (looked after children, special education needs and disabilities, young carers and military dependents) to those who are not vulnerable and assess whether these behaviours are associated with protective factors (e.g. friendship groups)., Study Design: Secondary analysis of cross-sectional survey data (n = 4129)., Methods: In total, 900 vulnerable young people were compared with 3229 non-vulnerable young people. Differences between the two groups were assessed using Chi-squared tests, and associations with possible protective factors were assessed using logistic regression (adjusting for confounding factors)., Results: Vulnerable young people have a higher prevalence of smoking tobacco (15% vs 9%, P < 0.001), using cannabis (7% vs 5%, P = 0.03) and self-harming (16% vs 9%, P < 0.001) monthly or more compared with the rest of the Wiltshire adolescent population. Whilst vulnerable young people have many shared protective factors with non-vulnerable young people, there are also differences between the two groups., Conclusions: There are shared protective factors across HRB that can build on the resilience of a young person, impacting their current and future health. Therefore, we should focus our attention on developing protective factors that promote health and well-being, not solely delivering specialist interventions targeted at specific risks. Further consideration should be given to identifying and promoting protective factors specifically for vulnerable people as they have higher levels of HRB and experience protective factors differently., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: TNM8 staging for oropharyngeal squamous cell carcinomas (OPSCC) surrogates p16 immunohistochemistry for HPV testing. Patients with p16+ OPSCC may lack HPV aetiology. Here, we evaluate the suitability of TNM8 staging for guiding prognosis in such patients., Methods: HPV status was ascertained using p16 immunohistochemistry and high-risk HPV RNA and DNA in situ hybridisation. Survival by stage in a cohort of OPSCC patients was evaluated using TNM7/TNM8 staging. Survival of p16+/HPV- patients was compared to p16 status., Results: TNM8 staging was found to improve on TNM7 (log rank p = 0·0190 for TNM8 compared with p = 0·0530 for TNM7) in p16+ patients. Patients who tested p16+ but were HPV- (n = 20) had significantly reduced five-year survival (33%) compared to p16+ patients (77%) but not p16- patients (35%). Cancer stage was reduced in 95% of p16+/HPV- patients despite having a mortality rate twice (HR 2.66 [95% CI: 1.37-5.15]) that of p16+/HPV+ patients under new TNM8 staging criteria., Conclusion: Given the significantly poorer survival of p16+/HPV- OPSCCs, these data provide compelling evidence for use of an HPV-specific test for staging classification. This has particular relevance in light of potential treatment de-escalation that could expose these patients to inappropriately reduced treatment intensity as treatment algorithms evolve.

Objectives: Conventional two-dimensional (2D) cephalometric radiography is an integral part of orthodontic patient diagnosis and treatment planning. One must be mindful of its limitations as it indeed is a 2D representation of a vaster three-dimensional (3D) object. Issues with projection errors, landmark identification, and measurement inaccuracies impose significant limitations, which may now be overcome with the advent of cone-beam computed tomography (CBCT). A systematic review of the reliability of different 3D cephalometric landmarks in CBCT imaging was conducted., Materials and Methods: Electronic database searches were administered until October 2017 using PubMed, MEDLINE via OvidSP, EBMR and EMBASE via OvidSP, Scopus, and Web of Science. Google Scholar was used as an adjunctive search tool., Results: Thirteen articles considering CBCT scans of human subjects from preexisting data sets were selected and reviewed. Most of the studies had methodological limitations and were of moderate quality. Because of their heterogeneity, key data from each could not be combined and were reported qualitatively. Overall, in 3D, midsagittal plane landmarks demonstrated greater reliability compared with bilateral landmarks. A minimum number of dental landmarks were reported, although most were recommended for use., Conclusions: Further research is required to evaluate the reliability of 3D cephalometric landmarks when evaluating 3D craniofacial complexes.

Background: The Saskatchewan Medication Assessment Program (SMAP) is a publicly funded community pharmacy-based medication assessment service with limited previous evaluation. The purpose of this study was to explore community pharmacists' experiences with the SMAP., Methods: Online, self-administered questionnaire that consisted of a combination of 53 Likert scale and free-text questions. All licensed pharmacists who were practising in a community pharmacy setting in Saskatchewan were eligible to participate., Results: Response rate was 20.3% ( n = 228/1124). Most respondents agreed that the SMAP is achieving all of its intended purposes. For example, 89.7% agreed that the SMAP improved medication safety for patients who receive the service. Most pharmacists enjoyed performing the assessments (84.6%) and were confident in their ability to identify drug-related problems (88.3%). Pharmacists reported lack of time, patients having difficulty coming to the pharmacy and restrictive eligibility criteria as the top barriers to the SMAP. Good teamwork, employer support and personal professional commitment were the top recognized facilitators. Respondents made several suggestions to improve the SMAP in the free-text areas of the questionnaire., Conclusions: Community pharmacists in Saskatchewan were positive and confident about performing medication assessments, and most agreed that the SMAP is achieving all of the intended purposes. Respondents also identified several barriers to providing SMAP services, which have resulted in specific recommendations that should be addressed to improve the program., Competing Interests: Statement of Conflicting Interests:The authors have no conflicts of interest to report.

Objectives: Drivers of antimicrobial resistance (AMR) are diffuse and complex including a range of interspecies behaviours between pet owners and their animals. We employed interpretative phenomenological analysis (IPA) to explore the relationship between pet owners and their companion animals in relation to AMR. Design: Cross sectional, qualitative study. Methods: Semi-structured interviews were conducted with twenty-three British pet owners, transcribed verbatim and subjected to Interpretative Phenomenological Analysis (IPA). Results: Three, inter-related Superordinate themes are presented 1) 'They're my fur babies': unconditional love and anthropomorphism; 2) 'They share everything with you': affection and transmission behaviours; and 3) 'We would err on the side of caution': decision making and antibiotic use'. Conclusions: Affectionate behaviours between companion animals and their owners pose a risk for AMR transmission but they are so deeply treasured that they are unlikely to be amenable to change. In contrast, the promotion of appropriate antibiotic stewardship for pet owners and vets may offer a viable pathway for intervention development, benefitting from synergies with other interventions that target prescribers., Competing Interests: No potential conflict of interest was reported by the authors., (© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: To reduce the risk of transmission of meticillin-resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonization. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours., Aim: To identify factors which influence staff compliance with hospital MRSA screening policies., Methods: A sequential two-stage mixed-methods design applied constructs from normalization process theory and the theoretical domains framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (N = 450). Multiple regression modelling identified which barriers and enablers best predict staff compliance., Findings: Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which 'make doing the right thing easy' influence compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)prioritization of MRSA screening are important., Conclusion: To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance., (Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: The most prevalent intervention for localized prostate cancer (pca) is radical prostatectomy (rp), which has a 10-year relative survival rate of more than 90%. The improved survival rate has led to a focus on reducing the burden of treatment-related morbidity and improving the patient and partner survivorship experience. Post-rp sexual dysfunction (sdf) has received significant attention, given its substantial effect on patient and partner health-related quality of life. Accordingly, there is a need for sdf treatment to be a fundamental component of pca survivorship programming., Methods: Most research about the treatment of post-rp sdf involves biomedical interventions for erectile dysfunction (ed). Although findings support the effectiveness of pro-erectile agents and devices, most patients discontinue use of such aids within 1 year after their rp. Because side effects of pro-erectile treatment have proved to be inadequate in explaining the gap between efficacy and ongoing use, current research focuses on a biopsychosocial perspective of ed. Unfortunately, there is a dearth of literature describing the components of a biopsychosocial program designed for the post-rp population and their partners., Results: In this paper, we detail the development of the Prostate Cancer Rehabilitation Clinic (pcrc), which emphasizes multidisciplinary intervention teams, active participation by the partner, and a broad-spectrum medical, psychological, and interpersonal approach., Conclusions: The goal of the pcrc is to help patients and their partners achieve optimal sexual health and couple intimacy after rp, and to help design cost-effective and beneficial rehabilitation programs., Competing Interests: CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

Background: Carbapenemase Producing Enterobacteriaceae (CPE) has spread rapidly and presents a growing challenge in antimicrobial resistance (AMR) management internationally. Screening for CPE may involve a rectal swab, there are limited treatment options for affected patients, and colonised patients are cared for in isolation to protect others. These measures are sound infection prevention precautions; however, the acceptability of CPE screening and its consequences are currently unknown.The aim of this study was ' To determine factors influencing acceptability of CPE screening from the perspectives of nursing staff and the general public.', Methods: National cross-sectional surveys of nursing staff ( n  = 450) and the general public ( n  = 261). The Theoretical Domains Framework (TDF) guided data collection and analysis. Regression modelling was used to identify factors that predicted acceptability of CPE screening., Results: For nursing staff, the following predictor variables were significant: intention to conduct CPE screening (OR 14.19, CI 5.14-39.22); belief in the severity of the consequences of CPE (OR 7.13, CI 3.26-15.60); knowledge of hospital policy for screening (OR 3.04, CI 1.45-6.34); preference to ask patients to take their own rectal swab (OR 2.89, CI 1.39-6.0); awareness that CPE is an organism of growing concern (OR 2.44, CI 1.22-4.88). The following predictor variables were significant for the general public: lack of knowledge of AMR (β - .11, p  = .01); social influences (β .14 , p  = .032); social norms (β .21 p  = .00); acceptability of being isolated if colonised (β .22, p  = .000), beliefs about the acceptability of rectal swabbing (β .15, p = .00), beliefs about the impact of careful explanation about CPE screening from a health professional (β .32, p = .00).Integrating results from staff and public perspectives points to the importance of knowledge of AMR, environmental resources, and social influences in shaping acceptability., Conclusions: This is the first study to systematically examine the acceptability of CPE screening across nursing staff and the public. The use of TDF enabled identification of the mechanisms of action, or theoretical constructs, likely to be important in understanding and changing CPE related behaviour amongst professionals and public alike., Competing Interests: The study was reviewed and approved by the School of Health and Life Sciences Ethics Committee at Glasgow Caledonian University (HLS/NCH/15/18). Access permission to NHS Nursing staff was granted by all 15 NHS Scotland Board Executive Leads for HAI. Return of completed questionnaires was taken as consent to participate.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Multi-drug resistant bacteria are an increasing concern in both human and veterinary medicine. Inappropriate prescribing and use of antibiotics within veterinary medicine may be a contributory factor to antimicrobial resistance (AMR). The 'One Health' Initiative aims to work across species and environments to reduce AMR, however; little is currently known about the factors which influence antibiotic prescribing among veterinary surgeons in companion animal practice. This paper reports on qualitative data analysis of interviews with veterinary surgeons whose practice partially or wholly focuses on companion animals (N = 16). The objective of the research was to explore the drivers of companion animal veterinary surgeons' antibiotic prescribing behaviours. The veterinary surgeons interviewed were all practising within the UK (England (n = 4), Scotland (n = 11), Northern Ireland (n = 1)). A behavioural thematic analysis of the data was undertaken, which identified barriers and facilitators to specific prescribing-related behaviours., Results: Five components of prescribing behaviours were identified: 1) confirming clinical need for antibiotics; 2) responding to clients; 3) confirming diagnosis; 4) determining dose, duration and type of antibiotic; and 5) preventing infection around surgery (with attendant appropriate and inappropriate antibiotic prescribing behaviours). Barriers to appropriate prescribing identified include: business, diagnostic, fear, habitual practice and pharmaceutical factors. Facilitators include: AMR awareness, infection prevention, professional learning and regulation and government factors., Conclusion: This paper uses a behavioural lens to examine drivers which are an influence on veterinary surgeons' prescribing behaviours. The paper contributes new understandings about factors which influence antibiotic prescribing behaviours among companion animal veterinary surgeons. This analysis provides evidence to inform future interventions, which are focused on changing prescribing behaviours, in order to address the pressing public health concern of AMR.

Background: The global burden of health care-associated infection (HAI) is well recognized; what is less well known is the impact HAI has on patients. To develop acceptable, effective interventions, greater understanding of patients' experience of HAI is needed. This qualitative systematic review sought to explore adult patients' experiences of common HAIs., Methods: Five databases were searched. Search terms were combined for qualitative research, HAI terms, and patient experience. Study selection was conducted by 2 researchers using prespecified criteria. Critical Appraisal Skills Programme quality appraisal tools were used. Internationally recognized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. The Noblit and Hare (1988) approach to meta-synthesis was adopted., Results: Seventeen studies (2001-2017) from 5 countries addressing 5 common types of HAI met the inclusion criteria. Four interrelated themes emerged: the continuum of physical and emotional responses, experiencing the response of health care professionals, adapting to life with an HAI, and the complex cultural context of HAI., Conclusions: The impact of different HAIs may vary; however, there are many similarities in the experience recounted by patients. The biosociocultural context of contagion was graphically expressed, with potential impact on social relationships and professional interactions highlighted. Further research to investigate contemporary patient experience in an era of antimicrobial resistance is warranted., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose Childhood cancer survivors are at increased risk of subsequent neoplasms (SNs), but the germline genetic contribution is largely unknown. We assessed the contribution of pathogenic/likely pathogenic (P/LP) mutations in cancer predisposition genes to their SN risk. Patients and Methods Whole-genome sequencing (30-fold) was performed on samples from childhood cancer survivors who were ≥ 5 years since initial cancer diagnosis and participants in the St Jude Lifetime Cohort Study, a retrospective hospital-based study with prospective clinical follow-up. Germline mutations in 60 genes known to be associated with autosomal dominant cancer predisposition syndromes with moderate to high penetrance were classified by their pathogenicity according to the American College of Medical Genetics and Genomics guidelines. Relative rates (RRs) and 95% CIs of SN occurrence by mutation status were estimated using multivariable piecewise exponential regression stratified by radiation exposure. Results Participants were 3,006 survivors (53% male; median age, 35.8 years [range, 7.1 to 69.8 years]; 56% received radiotherapy), 1,120 SNs were diagnosed among 439 survivors (14.6%), and 175 P/LP mutations were identified in 5.8% (95% CI, 5.0% to 6.7%) of survivors. Mutations were associated with significantly increased rates of breast cancer (RR, 13.9; 95% CI, 6.0 to 32.2) and sarcoma (RR, 10.6; 95% CI, 4.3 to 26.3) among irradiated survivors and with increased rates of developing any SN (RR, 4.7; 95% CI, 2.4 to 9.3), breast cancer (RR, 7.7; 95% CI, 2.4 to 24.4), nonmelanoma skin cancer (RR, 11.0; 95% CI, 2.9 to 41.4), and two or more histologically distinct SNs (RR, 18.6; 95% CI, 3.5 to 99.3) among nonirradiated survivors. Conclusion The findings support referral of all survivors for genetic counseling for potential clinical genetic testing, which should be prioritized for nonirradiated survivors with any SN and for those with breast cancer or sarcoma in the field of prior irradiation.

Antimicrobial resistance (AMR) is a global challenge facing both human and animal healthcare professionals; an effective response to this threat requires a 'One-Health' approach to antimicrobial stewardship (AMS) to preserve important antibiotics for urgent clinical need. However, understanding of barriers and enablers to effective AMS behaviour in companion animal veterinary practice is currently limited. We conducted a Delphi study of 16 nationally recognised experts from UK-based veterinary policymakers, university academics and leaders of professional bodies. This Delphi study sought to identify veterinary behaviours which experts believe contribute to AMR and form vital aspects of AMS. Analysis of Delphi findings indicated a perceived hierarchy of behaviours, the most influential being antibiotic prescribing behaviours and interactions with clients. Other veterinary behaviours perceived as being important related to interactions with veterinary colleagues; infection control practices; and the use of diagnostic tests to confirm infection. Key barriers and enablers to AMS within each of these behavioural domains were identified. Specific interventions to address important barriers and enablers are recommended. To the authors' knowledge, this is the first study to establish expert consensus at a national level about which 'behaviours' (aspects of veterinarian practice) should be targeted in relation to AMR and AMS in companion animal veterinary practice., Competing Interests: Competing interests: None declared., (© British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017. 29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback. Evidence of effectiveness was found in all categories but the best quality evidence was on multimodal interventions and surveillance, monitoring, and feedback. We call for improvements in study design, reporting of research, and quality of evidence particularly from low-income countries, to strengthen the uptake and international relevance of IPC interventions., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Our study addresses how environmental variables, such as macronutrients concentrations, snow cover, carbonate chemistry and salinity affect the photophysiology and biomass of Antarctic sea-ice algae. We have measured vertical profiles of inorganic macronutrients (phosphate, nitrite + nitrate and silicic acid) in summer sea ice and photophysiology of ice algal assemblages in the poorly studied Amundsen and Ross Seas sectors of the Southern Ocean. Brine-scaled bacterial abundance, chl a and macronutrient concentrations were often high in the ice and positively correlated with each other. Analysis of photosystem II rapid light curves showed that microalgal cells in samples with high phosphate and nitrite + nitrate concentrations had reduced maximum relative electron transport rate and photosynthetic efficiency. We also observed strong couplings of PSII parameters to snow depth, ice thickness and brine salinity, which highlights a wide range of photoacclimation in Antarctic pack-ice algae. It is likely that the pack ice was in a post-bloom situation during the late sea-ice season, with low photosynthetic efficiency and a high degree of nutrient accumulation occurring in the ice. In order to predict how key biogeochemical processes are affected by future changes in sea ice cover, such as in situ photosynthesis and nutrient cycling, we need to understand how physicochemical properties of sea ice affect the microbial community. Our results support existing hypothesis about sea-ice algal photophysiology, and provide additional observations on high nutrient concentrations in sea ice that could influence the planktonic communities as the ice is retreating.

Background: Antimicrobial resistance (AMR) is a growing public health problem across the world. As the negative consequences of AMR become apparent at local, national and international levels, more attention is being focussed on the variety of mechanisms by which AMR is potentiated. We explore how interactions between pet owners and veterinarians represent a key arena in which AMR-related behaviours can be shaped., Methods: In depth semi-structured interviews were carried out with pet owners ( n  = 23) and vets ( n  = 16) across the UK in 2017. A thematic analysis approach was taken, with inductively gathered data analysed deductively using a behavioural framework to identified key behaviours emerging from participant accounts which were amenable to change., Results: Interactions between vets and pet owners were characterised by misunderstandings and misconceptions around antibiotics by pet owners, and a lack of clarity about the positions and intentions of the other party. Vets and pet owners had differing perceptions of where pressure to prescribe antibiotics inappropriately originated. Vets perceived it was mostly pet owners who pushed for inappropriate antibiotics, whereas pet owners reported they felt it was vets that overprescribed. Low levels of understanding of AMR in general were apparent amongst pet owners and understandings with regard to AMR in pets specifically were almost non-existent in the sample., Conclusions: Improved use of antibiotics could be assisted by educating the pet owning public and by guideline development for companion animal vets, concurrent development of mandatory legislation, increased consultation time to facilitate better communication, development of vet training on antimicrobial therapy and stewardship led interactions with pet owners, and increased levels of knowledge of pet-related AMR amongst pet owners., Competing Interests: Ethical approval for the study was granted from the ethics committee for Nursing and Community Health at Glasgow Caledonian University (Reference number: HLS/NCH/16/001).All data has been anonymised, participants all provided written consent for content of their interviews to be used in analysis, report and paper writing.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Ecotones are regarded as diversity hotspots in terrestrial systems, but it is unknown if this 'ecotone effect' occurs in the marine environment. Oceanic fronts are widespread mesoscale features, present in the boundary between different water masses, and are arguably the best potential examples of ecotones in the ocean. Here we performed the first seasonal study along an oceanic front, combining 16S rRNA gene sequencing coupled with a high spatial resolution analysis of the physical properties of the water masses. Using the Subtropical Frontal Zone off New Zealand we demonstrate that fronts delimit shifts in bacterioplankton community composition between water masses, but that the strength of this effect is seasonally dependent. While creating a transition zone where physicochemical parameters and bacterioplankton communities get mixed, this ecotone does not result in increased diversity. Thus unlike terrestrial ecotones, oceanic fronts are boundaries but not hotspots of bacterioplankton diversity in the ocean., (© 2018 Society for Applied Microbiology and John Wiley & Sons Ltd.)

While we now appreciate that autonomic dysfunction can impact wheelchair rugby performance, this is currently not being assessed during classification, largely due to lack of a standardized and evidence-based strategy to assess autonomic function. Our aim, therefore, was to establish the optimal autonomic testing protocol that best predicts cardiovascular capacity during competition by comprehensively examining autonomic function in elite wheelchair rugby athletes with cervical SCI and thereby enhance the standardized classification. Twenty-six individuals with cervical SCI (C4-C8; AIS A, B, C) participated in this study during the 2015 Parapan American Games in Toronto, Canada. Clinic autonomic testing included: sympathetic skin responses, baseline hemodynamics, orthostatic challenge test, and cold-pressor tests. Further, we completed standard motor/sensory assessments and obtained each participants' International Wheelchair Rugby Federation classification. These clinic metrics were correlated to in-competition heart rate monitoring obtained during competition. The current study provides novel evidence that the change in systolic blood pressure during an orthostatic challenge test predicts approximately 50% of the in-competition peak heart rate (P<.001). Conversely, International Wheelchair Rugby Federation classification was poorly associated with in-competition peak heart rate (R 2 =.204; P<.05). Autonomic testing provides deep insight regarding preserved autonomic control after SCI that is associated with performance in elite wheelchair rugby athletes. As such, incorporating assessments of cardiovascular capacity in classification will help to ensure a level playing field and may obviate the need for practices such as boosting to gain an advantage due to poor cardiovascular control., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To provide a synthesis of the published studies evaluating the natural growth and development of the human posterior cranial base (S-Ba)., Materials and Methods: The search was performed on MEDLINE, Embase, PubMed, and all EBM Reviews electronic databases. In addition, reference lists of the included studies were hand-searched. Articles were included if they analyzed posterior cranial-base growth in humans specifically. Study selection, data extraction, and risk of bias assessment were completed in duplicate. A meta-analysis was not justified., Results: Finally, 23 published studies were selected: 5 cross-sectional and 18 cohort studies. Articles were published between 1955 and 2015, and all were published in English. The sample sizes varied between 20 and 397 individuals and consisted of craniofacial measurements from either living or deceased human skulls. Validity of the measurements was not determined in any of the studies, while six papers reported some form of reliability assessment. All the articles included multiple time points within the same population or data from multiple age groups. Growth of S-Ba was generally agreed to be from spheno-occipital synchondrosis growth. Basion displaced downward and backward and sella turcica moved downward and backward during craniofacial growth. Timing of cessation of S-Ba growth was not conclusive due to limited identified evidence., Conclusions: Current evidence suggests that S-Ba is not totally stable, as its dimensions change throughout craniofacial growth and a minor dimensional change is observed even in late adulthood.

Background: Smartphone-based thermal imaging (SBTI) allows noninvasive temperature measurements. Its validity compared with a conventional infrared probe temperature scanner (IPTS) has not been studied. This study compares temperature measurements between the 2 technologies on human participants., Methods: Bilateral index finger temperature measurements were obtained on 30 healthy participants using IPTS and SBTI devices. Dominant versus nondominant sides (side-to-side difference) and individual side measurements between the 2 methods were compared for repeatability (precision) and agreement., Results: A total of 23 female and 7 male participants were tested. Based on nonoverlapping confidence intervals (CIs), intraclass correlation coefficient of repeatability was higher for SBTI than for IPTS measurements in side-to-side differences: 0.97 (95% CI, 0.96-0.99) versus 0.89 (95% CI, 0.82-0.95). The SBTI method recorded higher side-to-side difference and individual side measurements: 0.56°C (limits of agreement [LOA], -1.09°C to 2.20°C) and 2.64°C (LOA, 0.96°C-4.32°C), respectively., Conclusions: In addition to higher precision, SBTI offers added benefits of instantaneous acquisition of the temperature map of the entire hand, allowing quick comparisons of the uninjured and injured fingers. SBTI measurements consistently yielded higher temperature readings in the side-to-side difference as well as individual measurements. This suggested that both devices are not interchangeable for absolute temperature comparisons but are interchangeable in monitoring the changes in temperatures. This study suggests the potential for SBTI devices to be used in the clinical settings and may be of special benefit in telemedicine.

Study Design: Mixed-methods study using comprehensive survey and semi-structured interviews., Objectives: Compare the experiences of sexual education during rehabilitation for people with non-traumatic spinal cord dysfunction (SCDys) and traumatic spinal cord injury (SCI), determine preferences for the delivery of this information and provide recommendations for spinal rehabilitation professionals., Setting: Community, Australia., Methods: Adults completed survey (traumatic SCI n=115; SCDys=39) or were interviewed (SCDys: n=21). Survey included questions regarding sexual education during rehabilitation, participant satisfaction with this and preferred modes for receiving such information. These themes were also explored during interviews., Results: No difference between SCI and SCDys regarding satisfaction or preferred modes of presentation (all P>0.05). People with SCDys were less likely to report receiving sexuality education during rehabilitation (SCDys n=11, 30%; SCI n=61, 53%; P=0.03). Interviews suggested that this may be gendered, as only two women recalled receiving sexual education, whereas men often received this as part of continence management. Overall, only 18% were satisfied or very satisfied with sexual education and information received, and 36% were dissatisfied or very dissatisfied. Preferred modes for receiving sexuality information included sexuality counsellor (n=97), recommended internet sites (n=77), peer support workers (n=76), staff discussion (n=67), written information (n=67) and DVD (n=58). These preferences were confirmed during interviews, although women expressed a strong preference for written information sheets., Conclusion: There was very low satisfaction with sexuality education during rehabilitation. Our findings highlight the scope and directions for improving the sexual education and information given to people with both SCDys and SCI during rehabilitation.

Objective: To evaluate the accuracy and reliability of the diagnostic tools available for assessing maxillary transverse deficiencies., Methods: An electronic search of three databases was performed from their date of establishment to April 2015, with manual searching of reference lists of relevant articles. Articles were considered for inclusion if they reported the accuracy or reliability of a diagnostic method or evaluation technique for maxillary transverse dimensions in mixed or permanent dentitions. Risk of bias was assessed in the included articles, using the Quality Assessment of Diagnostic Accuracy Studies tool-2., Results: Nine articles were selected. The studies were heterogeneous, with moderate to low methodological quality, and all had a high risk of bias. Four suggested that the use of arch width prediction indices with dental cast measurements is unreliable for use in diagnosis. Frontal cephalograms derived from cone-beam computed tomography (CBCT) images were reportedly more reliable for assessing intermaxillary transverse discrepancies than posteroanterior cephalograms. Two studies proposed new three-dimensional transverse analyses with CBCT images that were reportedly reliable, but have not been validated for clinical sensitivity or specificity. No studies reported sensitivity, specificity, positive or negative predictive values or likelihood ratios, or ROC curves of the methods for the diagnosis of transverse deficiencies., Conclusions: Current evidence does not enable solid conclusions to be drawn, owing to a lack of reliable high quality diagnostic studies evaluating maxillary transverse deficiencies. CBCT images are reportedly more reliable for diagnosis, but further validation is required to confirm CBCT's accuracy and diagnostic superiority., Competing Interests: The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.

Study Design: Questionnaire development, validation and completion., Objectives: Develop comprehensive survey of sexuality issues including validated self-report versions of the International Spinal Cord Injury male sexual function and female sexual and reproductive function basic data sets (SR-iSCI-sexual function)., Setting: People with spinal cord damage (SCD) living in the community, Australia from August 2013 to June 2014., Methods: An iterative process involving rehabilitation medicine clinicians, a nurse specialising in sexuality issues in SCD and people with SCD who developed a comprehensive survey that included the SR-iSCI-sexual function. Participants recruitment through spinal rehabilitation review clinic and community organisations that support people with SCD., Results: Surveys completed by 154 people. Most were male (n=101, 65.6%). Respondents' median age was 50 years (interquartile range (IQR) 38-58), and they were a median of 10 years (IQR 4-20) after the onset of SCD. Sexual problems unrelated to SCD were reported by 12 (8%) respondents, and 114 (n=75.5%) reported sexual problems because of SCD. Orgasms were much less likely (χ(2)=13.1, P=0.006) to be normal in males (n=5, 5%) compared with females (n=11, 22%). Males had significantly worse (χ(2)=26.0, P=0.001) psychogenic genital functioning (normal n=9, 9%) than females (normal n=13, 26%) and worse (χ(2)=10.8, P=0.013) reflex genital functioning. Normal ejaculation was reported in only three (3%) men. Most (n=26, 52%) women reported reduced or absent menstruation pattern since SCD., Conclusion: The SR-iSCI-sexual function provides a useful tool for researchers and clinicians to collect information regarding patient-reported sexual functioning after SCD and to facilitate comparative studies.

Background: Noroviruses are a leading cause of outbreaks globally and the most common cause of service disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however, preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of this measure is not known., Aim: To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients, visitors and the wider public., Methods: Cross-sectional survey of patients (N = 153), visitors (N = 175) and the public (N = 224) in three diverse areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV during norovirus outbreaks, and to determine associations between these levels and various predictor variables., Findings: The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV 'is wrong as it ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational analysis demonstrated that overall acceptability was positively related to perceived severity (r = 0.65), identified benefits (r = 0.54) and implementing additional communication strategies (r = 0.60); acceptability was negatively related to potential barriers (r = -0.49)., Conclusions: There is greater service user and public support for the use of TSV than concerns around impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control measure that could be implemented consistently during norovirus outbreaks., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Objective: To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community., Methods: Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care., Results: 33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology., Conclusion: Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)