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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The global distribution of dissolved cadmium (Cd) in the world's oceans is generally well understood. However, information on seasonal variability of this and other trace metals in the open ocean is difficult to obtain and, therefore, our understanding is limited. Here, we present a 3-year time series of field measurements of dissolved and particulate Cd and phosphate (PO4) from a transect across the subtropical convergence, south-eastern New Zealand. In the final year of study, the bioactive trace metals (iron, Fe; zinc, Zn; cobalt, Co) and nutrients (nitrate, NO3; silicate, Si(OH)4) were also measured to identify their influence on Cd cycling in the region. Cadmium varied seasonally from 0.009 to 0.137 nM in the sub-Antarctic surface waters (SASW). Zinc in SASW varied between 0.03 and 0.011 nM, which is low enough to suggest Zn limitation year-round. The seasonal input of dissolved Fe may stimulate phytoplankton growth in summer where microplankton (especially diatoms) dominate the phytoplankton distribution. The Cd : PO4 ratio also varied strongly with season (0.015 × 10–3 to 0.05 × 10–3). This seasonal variation in the Cd : PO4 ratio is productivity driven as revealed in the characteristic trend in the Cd : PO4 ratio, particulate Cd and chlorophyll- a measurements. The high seasonal variability between Cd and PO4 complicates the application of the Cd proxy for the reconstruction of historical PO4 concentrations in SASW. The marine cycling of Cd is intriguing because it mimics the essential nutrient phosphorus (P), except at the subtropical convergence (STC). Here, we present a 3-year time series of field measurements of Cd and P concentration across the STC, New Zealand. Cadmium concentration exhibits extreme seasonality (50×), much larger than do other bio-utilised elements. The timing of the drawdown implies a biological role for Cd. [ABSTRACT FROM AUTHOR]

In situ effects of ocean acidification are increasingly studied at submarine CO2 vents. Here we present a preliminary investigation into the water chemistry and biology of cool temperate CO2 vents near Whakaari–White Island, New Zealand. Water samples were collected inside three vent shafts, within vents at a distance of 2 m from the shaft and at control sites. Vent samples contained both seawater pH on the total scale (pHT) and carbonate saturation states that were severely reduced, creating conditions as predicted for beyond the year 2100. Vent samples showed lower salinities, higher temperatures and greater nutrient concentrations. Sulfide levels were elevated and mercury levels were at concentrations considered toxic at all vent and control sites, but stable organic and inorganic ligands were present, as deduced from Cu speciation data, potentially mediating harmful effects on local organisms. The biological investigations focused on phytoplankton, zooplankton and macroalgae. Interestingly, we found lower abundances but higher diversity of phytoplankton and zooplankton at sites in the direct vicinity of Whakaari. Follow-up studies will need a combination of methods and approaches to attribute observations to specific drivers. The Whakaari vents represent a unique ecosystem with considerable biogeochemical complexity, which, like many other vent systems globally, require care in their use as a model of 'future oceans'. CO2 vents have been proposed as potential analogues to investigate the effects of ocean acidification on natural ecosystems. Here we present a preliminary evaluation of the suitability of the temperate CO2 vents at Whakaari–White Island (New Zealand) as natural study sites in the Southern Hemisphere. We conclude that these vents represent a unique ecosystem with considerable biogeochemical complexity and recommend care in their use as a model of the future ocean. [ABSTRACT FROM AUTHOR]

A national observing network has been operating over the past 4 years to inform the scientific and economic challenges of ocean acidification (OA) facing New Zealand. The New Zealand Ocean Acidification Observing Network (NZOA-ON) consists of 12 sites across varied coastal ecosystems. These ecosystems range from oligotrophic ocean-dominated systems to eutrophic river-dominated systems, with sites that are pristine or affected by agriculture and urbanisation. Fortnightly measurements of total alkalinity and dissolved inorganic carbon provide the baseline of carbonate chemistry in these varied ecosystems and will facilitate detection of future changes, as well as providing a present-day baseline. The National Institute of Water and Atmospheric Research and the University of Otago have developed a 'grass-roots' sampling program, providing training and equipment that enable sampling partners to collect field samples for analyses at a central laboratory. NZOA-ON leverages existing infrastructure and partnerships to maximise data captured for understanding the drivers of chemical changes associated with OA and ecological responses. NZOA-ON coordinates with and contributes to global initiatives to understand and mitigate the broader impacts of OA. A description of NZOA-ON is presented with preliminary analyses and comparison of data from different sites after the first 4 years of the network. The New Zealand Ocean Acidification Observing Network (NZOA-ON) has been developed to inform the scientific and economic challenges that New Zealand is facing in response to more acidic ocean waters. Remote field sites are distributed across New Zealand coastal waters to better understand how ocean chemistry is changing in response to increasing atmospheric carbon dioxide and how ecosystems will be affected. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In this paper an efficient methodology adopting Fuzzy ART neural network is presented to solve the comprehensive part-machine grouping (PMG) problem in cellular manufacturing (CM). Our Fuzzy ART/RRR-RSS (Fuzzy ART/ReaRRangement-ReaSSignment) algorithm can effectively handle the real-world manufacturing factors such as the operation sequences with multiple visits to the same machine, production volumes of parts, and multiple copies of machines. Our approach is based on the non-binary production data-based part-machine incidence matrix (PMIM) where the operation sequences with multiple visits to the same machine, production volumes of parts, and multiple identical machines are incorporated simultaneously. A new measure to evaluate the goodness of the non-binary block diagonal solution is proposed and compared with conventional performance measures. The comparison result shows that our performance measure has more powerful discriminating capability than conventional ones. The Fuzzy ART/RRR-RSS algorithm adopts two phase approach to find the proper block diagonal solution in which all the parts and machines are assigned to their most preferred part families and machine cells for minimisation of inter-cell part moves and maximisation of within-cell machine utilisation. Phase 1 (clustering phase) attempts to find part families and machines cells quickly with Fuzzy ART neural network algorithm which is implemented with an ancillary procedure to enhance the block diagonal solution by rearranging the order of input presentation. Phase 2 (reassignment phase) seeks to find the best proper block diagonal solution by reassigning exceptional parts and machines and duplicating multiple identical machines to cells with the purpose of minimising inter-cell part moves and maximising within-cell machine utilisation. To show the robustness and recoverability of the Fuzzy ART/RRR-RSS algorithm to large-size data sets, a modified procedure of replicated clustering which starts with the near-best solution and rigorous qualifications on the number of cells and duplicated machines has been developed. Experimental results from the modified replicated clustering show that the proposed Fuzzy ART/RRR-RSS algorithm has robustness and recoverability to large-size ill-structured data sets by producing highly independent block diagonal solution close to the near-best one. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The objective of this research was to use analytical and experimental approaches to investigate the effects of cutting tool geometry with a negative side cutting edge angle (SCEA) on machining parameters. The first task of this research was to conduct experimental tests for different SCEAs, cutting speeds, feed rates and depths of cut. The second task was to develop a mathematical model to predict cutting forces for the three-dimensional oblique cutting operation. These tasks were accomplished as follows. One set of the experimental results was used as feedback to develop new empirical formulae required to predict cutting forces. A second set of experimental tests was conducted in this study to ensure the validity of the empirical relationships associated with the mathematical model. A comparison of cutting forces and other machining parameters was made between the output of the mathematical model and the experimentally-measured values. New cutting tools are proposed by using the results of the expanded mathematical model. The benefits of this research are as follows: a model for an oblique cutting operation as a function of SCEAs, cutting speeds, feed rates and depths of cut was developed; the effect of negative SCEAs on machining parameters in an oblique cutting process was investigated; and a new direction for designing cutting tool geometry with negative SCEAs, which improves the quality of surface finish and productivity of cutting tool life in turning operations was developed. [ABSTRACT FROM AUTHOR]

A marked reconfiguration of the Mertz Polynya following the 2010 calving of the Mertz Glacier Tongue has been associated with a decrease in the size and activity of the polynya. We report observations of the oceanic carbonate (CO2) system in late-summer 2013, the third post-calving summer season. Estimates of seasonal net community production (NCP) based on inorganic carbon deficits and the oxygen-argon ratio indicate that the waters on the shelf to the east of Commonwealth Bay (adjacent to the Mertz Glacier) remain productive compared to pre-calving conditions. The input of residual or excess alkalinity from melting sea ice is found to contribute to the seasonal enhancement of carbonate saturation state and pH in shelf waters. Mean rates of NCP in 2012-2013 are more than twice as large as those observed in the pre-calving summers of 2001 and 2008 and suggest that the new (post-calving) configuration of the polynya favors enhanced net community production and a stronger surface ocean sink for atmospheric CO2 due at least in part to the redistribution of sea ice and associated changes in summer surface stratification. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Norovirus outbreaks cause significant patient distress and adversely affect healthcare service delivery. Measures to manage outbreaks include controlling patient/staff movement and advising visitors of the risks of infection; temporary suspension of visiting (TSV) is advocated by some. Factors influencing the use of TSV have not previously been reported.Aim: To describe current practice in Scotland regarding TSV during norovirus outbreaks.Methods: Cross-sectional survey of Scottish Health Boards [National Health Service (NHS)] Infection Prevention Leads (N = 22) and independent care home (ICH) managers (N = 107).Findings: TSV practice is inconsistent across care settings. NHS findings: although 86.4% reported a recent norovirus outbreak, only 36.4% reported having criteria in place to guide TSV decisions and only 57.9% of those who had an outbreak implemented TSV. Conversely, 77.6% ICH respondents do have TSV criteria in place; 70.1% who had previously experienced an outbreak all reported that they would normally close to visitors. The majority of both NHS (81.8%) and ICH (84.2%) respondents reported making exceptions to TSV for individual cases. Despite variation in practice, 75% NHS and 81.8% ICH respondents agreed that TSV was helpful in controlling outbreaks. Factors influencing TSV implementation decisions included use of judgement in individual cases, perceived lack of evidence for the role of visitors in transmission, and belief in patients' rights to have visitors.Conclusion: Implementation of TSV in Scotland is inconsistent, with variation in the use of criteria, personal beliefs, and professional judgements. Further research on the role of visitors in transmission and service-user acceptability of TSV is required for policy development. [ABSTRACT FROM AUTHOR]

Infection prevention is an under-resourced research and development topic, with limited evidence for practice in the most basic of measures. A survey of IPS R&D members indicated that what might appear to be simple interactions and interventions in healthcare, such as hand shaking and hand hygiene, should be considered complex interventions taking account of behaviour at the individual and social level as well as contextual factors. Future studies need to be designed utilising comprehensive approaches, for example, the Medical Research Council complex interventions framework, tailored to the country and more local cultural context, if we are to be serious about evidence for infection prevention and control practice. [ABSTRACT FROM AUTHOR]

Objective As prostate-specific antigen (PSA) makes prostate cancer (PCA) screening more accessible, more men are being identified with conditions that indicate high risk for developing PCA, such as elevated PSA and high-grade intraepithelial neoplasia (HGPIN). In the present study, we assessed psychological well-being and risk perception in individuals with those high-risk conditions. Methods A questionnaire consisting of a psychological symptom survey, a trait risk-aversion survey, and a cancer-specific risk perception survey was administered to 168 patients with early-stage localized PCA and 69 patients at high risk for PCA (n = 16 HGPIN, n = 53 PSA > 4 ng/mL). Analysis of variance was used to examine differences in psychological well-being and appraisal of risk between the groups. Results Compared with the PCA group, the high-risk group perceived their risk of dying from something other than PCA to be significantly lower (p = 0.007). However, PCA patients reported significantly more clinically important psychological symptoms. Conclusions The identification of prostate conditions that predict progression to cancer might not result in the psychological symptoms commonly experienced by PCA patients, but does appear to be related to a distorted perception of the disease's mortal risk. Patients with PCA experience reduced psychological well-being, but better understand the risks of PCA recurrence and death. Education on the risks and outcomes of PCA can help at-risk men to view health assessments with reduced worry. [ABSTRACT FROM AUTHOR]

Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. * Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan. * Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics. * Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. [ABSTRACT FROM AUTHOR]

This article describes a potentiometric ocean acidification simulation system which automatically regulates pH through the injection of 100% CO2 gas into temperature-controlled seawater. The system is ideally suited to long-term experimental studies of the effect of acidification on biological processes involving small-bodied (10-20mm) calcifying or non-calcifying organisms. Using hobbyist-grade equipment, the system was constructed for approximately USD 1200 per treatment unit (tank, pH regulation apparatus, chiller, pump/filter unit). An overall tolerance of ±0.05 pHT units (SD) was achieved over 90 days in two acidified treatments (7.60 and 7.40) at 12 °C using glass electrodes calibrated with synthetic seawater buffers, thereby preventing liquid junction error. The performance of the system was validated through the independent calculation of pHT (12 °C) using dissolved inorganic carbon and total alkalinity data taken from discrete acidified seawater samples. The system was used to compare the shell growth of the marine gastropod Zeacumantus subcarinatus infected with the trematode parasite Maritrema novaezealandensis with that of uninfected snails at pH levels of 7.4, 7.6, and 8.1. [ABSTRACT FROM AUTHOR]

Study design:Within-subject repeated measures.Objectives:To determine the intra- and inter-tester reliability of aortic pulse wave velocity (aPWV) measurements collected using applanation tonometry in individuals with spinal cord injury (SCI).Setting:Inpatient Rehabilitation Centre and outpatient Clinic in Vancouver, BC, Canada.Methods:Fifteen men and three women with traumatic SCI (age: 46±16 years; C3-L1; American Spinal Injury Association Impairment Scale A-D; 2-284 months post injury) participated in two testing sessions separated by an average of 2 days. During each testing session, aPWV measurements were collected in the supine position following 10 min of rest. Arterial blood pressure waveforms were collected simultaneously by two trained raters at the carotid and femoral arterial sites using applanation tonometry. Heart rate was continuously measured using a single-lead electrocardiogram, whereas brachial blood pressures were measured at 5-min intervals using an automated device.Results:Intra- and inter-tester aPWV measurements demonstrated almost perfect reliability with intraclass correlation coefficients of 0.91 and 0.98 (P<0.001), and coefficients of variation of 5.9% and 3.4%, respectively. The smallest detectable differences (SDDs) for intra- and inter-tester measurements were 0.9 m s−1 and 0.6 m s−1, respectively. There were no significant differences in heart rate or blood pressure between intra- and inter-testing sessions.Conclusion:Applanation tonometry measurements of aPWV are reliable in individuals with SCI. In addition, the SDDs were smaller than a clinically relevant value, suggesting that this measurement is suitable for repeated measures study designs in SCI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite limited evidence of meticillin-resistant Staphylococcus aureus (MRSA) decolonization efficacy, the practice of decolonization for both pre-admission and on-admission patients is growing. Recent research within National Health Service (NHS) Scotland revealed low rates of treatment and consequent low efficacy in home-based decolonization. As no national guidelines on home-based decolonization currently exist, practices within NHS Scotland may be variable. AIM: To establish current pre-admission MRSA home-based decolonization protocols and patient advice within NHS Scotland. Similarities and differences were identified to determine possible sources of variability. METHODS: Cross-sectional survey distributed electronically to MRSA Screening Project Managers within each NHS geographical region in Scotland (N = 15). FINDINGS: Thirteen out of 15 NHS regions responded; one region reported no standard protocol. From the remaining 12 regions, 100% recommended use of mupirocin and antiseptic bodywash daily for five days; this was the only consistent aspect of practice across responding regions. Variation was noted in advice regarding method of mupirocin application, bodywash product and volume of bodywash recommended. Six regions (50%) specified bodywash skin contact time, yet these times varied across regions. Mouth care was advocated by three regions (25%). Daily change of facecloths and clothes was endorsed by five regions (41.7%); four regions (33.3%) promoted daily towel changes. Only one region (8.3%) suggested daily bedroom cleaning; three regions (25%) advised changing bed linen daily. CONCLUSIONS: Variation in protocols and patient advice may influence efficacy of home-based decolonization and further research may inform the development of evidence-based clinical guidelines.Copyright © 2012 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Grounded theory methods can help to generate a theoretical explanation of social processes in specific contexts. This paper discusses theoretical sampling to guide interview participant selection and reflects on the practical application of this procedure to outline the value and limitations of using survey data in this way. [ABSTRACT FROM AUTHOR]

The promotion of stakeholder partnerships features within practice development work and is intuitively appealing, but in reality meaningful partnerships can be problematic. We report the findings of four parallel Nominal group Technique Interviews undertaken with groups of professional (nurses from practice and academia) and lay stakeholder representatives during a seminar event. The group work sought to explore the mechanisms, which could facilitate meaningful practice development partnerships between nurses, academic nurses and people. The most highly ranked suggestions included creating a culture where practice development is seen as everyone's business and establishing a unified collaborative infrastructure. A range of enabling and inhibiting conditions were explored and the complexity of achieving consensus decision-making processes that would allow realization of the policy rhetoric was exposed. [ABSTRACT FROM AUTHOR]

The Late Ordovician--Early Silurian Brunswick subduction complex in northern New Brunswick preserves a nearly intact southeast-facing forearc terrane with clear links among Silurian subduction, underplating, exhumation, and forearc sedimentation. The forearc terrane grew over time due to successive accretion and underplating of seamounts and isolated ribbons made up of continental and transitional crust concomitant with foreland migration of the trench. A sliver of strongly deformed epidote-blueschists derived from an accreted seamount was stacked together with slightly lower-pressure winchite-bearing tectonites and medium- to high-pressure greenschists of the Fournier, California Lake, and Tetagouche blocks into a series of D1 metamorphic nappes during Salinic closure of the Tetagouche-Exploits backarc basin. The blueschists (~375 °C, 7.2 kbar) locally preserve mineralogical (zoning from actinolite or barroisite core to a rim of glaucophane) and microstructural evidence for a counterclockwise pressure-temperature (P-T) path ascribed to underthrusting beneath the young oceanic lithosphere of the Fournier block shortly after the inception of subduction at ca. 450 Ma. The next phase of accretion is represented by underplating of the California Lake block at ca. 442 Ma. This may have caused emplacement of the blueschists above the slightly lower metamorphic grade Canoe Landing Lake winchite-bearing nappe (350 °C, 6.5 kbar). Underplating of the Tetagouche block at ca. 435 Ma extruded the blueschist sliver and underlying nappes of the California Lake block immediately above greenschistfacies nappes (~5.8 kbar) and beneath lower-pressure (4-5 kbar) greenschist-facies basalt and gabbro of the ophiolitic Fournier block, which was deformed and imbricated earlier, probably during accretion of the California Lake block. Shear sense indicators confirm that the hanging-wall shear zone of the blueschist sliver accommodated Early Silurian normal motion. D1 is generally time-transgressive due to down-stepping of the underplating-related deformation. Metamorphic relicts, as well as zoning in amphibole and epidote, indicate that the Canoe Landing Lake and other nappes underwent clockwise P-T paths related to subduction of the cool oceanic lithosphere and/or accretion of the California Lake and Tetagouche blocks. [ABSTRACT FROM AUTHOR]

Ca2+ is the most ubiquitous second messenger found in all cells. Alterations in [Ca2+]i contribute to a wide variety of cellular responses including neurotransmitter release, muscle contraction, synaptogenesis and gene expression. Voltage-dependent Ca2+ channels, found in all excitable cells ( Hille 1992 ), mediate the entry of Ca2+ into cells following depolarization. Ca2+ channels are composed of a large pore-forming subunit, called the α1 subunit, and several accessory subunits. Ten different α1 subunit genes have been identified and classified into three families, Cav1-3 ( Dunlap et al. 1995 , Catterall 2000 ). Each α1 gene produces a unique Ca2+ channel. Although chromaffin cells express several different types of Ca2+ channels, this review will focus on the Cav2.1 and Cav2.2 channels, also known as P/Q- and N-type respectively ( Nowycky et al. 1985 , Llinas et al. 1989b , Wheeler et al. 1994 ). These channels exhibit physiological and pharmacological properties similar to their neuronal counterparts. N-, P/Q and to a lesser extent R-type Ca2+ channels are known to regulate neurotransmitter release ( Hirning et al. 1988 , Horne & Kemp 1991 , Uchitel et al. 1992 , Luebke et al. 1993 , Takahashi & Momiyama 1993 , Turner et al. 1993 , Regehr & Mintz 1994 , Wheeler et al. 1994 , Wu & Saggau 1994 , Waterman 1996 , Wright & Angus 1996 , Reid et al. 1997 ). N- and P/Q-type Ca2+ channels are abundant in nerve terminals where they colocalize with synaptic vesicles. Similarly, these channels play a role in neurotransmitter release in chromaffin cells ( Garcia et al. 2006 ). N- and P/Q-type channels are subject to many forms of regulation ( Ikeda & Dunlap 1999 ). This review pays particular attention to the regulation of N- and P/Q-type channels by heterotrimeric G-proteins, interaction with SNARE proteins, and channel inactivation in the context of stimulus-secretion coupling in adrenal chromaffin cells. [ABSTRACT FROM AUTHOR]

Background. Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit. However, empirical evidence of the effectiveness of clinical audit in changing practice is limited. Few studies have attempted to evaluate practice development or clinical outcomes within the conceptual framework of change theory. Several published studies have used passive feedback in an attempt to promote a change in practice. Sending information to health care workers on their performance is one of the simplest ways of attempting to change performance. Aims. To evaluate the impact on infection rates of the passive feedback of surgical wound infection rate data to nurses and surgeons within an empirical rational approach to change, and the active feedback of data within a normative re-educative approach to change. Methods. A prospective cohort study over a 3-year period of all surgical patients undergoing clean elective surgery (n = 2241). Patients were monitored whilst an inpatient and up to 30 days postoperatively by an independent observer to determine surgical wound infection rates. The method employed was 'gold standard' surveillance, whereby patients were followed up into the community setting. Interventions. Interventions of feedback and withdrawal of feedback of infection rate data and introduction of guidelines for evidence-based surgical practice within a change theory framework were monitored by the incidence of infection during the periods of the particular intervention. Results. Although the feedback of infection rate data impacted on the subsequent infection rates, the reduction was not statistically significant. However, a significant reduction in the infection rates was achieved following the introduction of guidelines for best surgical practice (P < 0.05). Conclusions. The findings indicate that if change in practice is to be achieved by the feedback of performance data, then the process of feedback should be active and within a normative re-educative approach to change. [ABSTRACT FROM AUTHOR]

The article reviews several motion pictures, including "Tango," directed by Luis Moglia Barth, "Cuesta Abajo," directed by Carlos Gardel, and "Loco Lindo," directed by Arturo Mom.