Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention

ABSTRACT: BACKGROUND: Careful hand hygiene (HH) is the single most important factor in preventing the transmission of infections to patients, but compliance is difficult to achieve and maintain. A lack of understanding of the processes involved in changing staff behaviour may contribute to the failure to achieve success. The purpose of this study was to identify nurses' and administrators' perceived barriers and facilitators to current HH practices and the implementation of a new electronic monitoring technology for HH. METHODS: Ten key informant interviews (three administrators and seven nurses) were conducted to explore barriers and facilitators related to HH and the impact of the new technology on outcomes. The semi structured interviews were based on the Theoretical Domains Framework by Michie et al. and conducted prior to intervention implementation. Data were explored using an inductive qualitative analysis approach. Data between administrators and nurses were compared. RESULTS: In 9 of the 12 domains, nurses and administrators differed in their responses. Administrators believed that nurses have insufficient knowledge and skills to perform HH, whereas the nurses were confident they had the required knowledge and skills. Nurses focused on immediate consequences, whereas administrators highlighted long-term outcomes of the system. Nurses concentrated foremost on their personal safety and their families' safety as a source of motivation to perform HH, whereas administrators identified professional commitment, incentives, and goal setting. Administrators stated that the staff do not have the decision processes in place to judge whether HH is necessary or not. They also highlighted the positive aspects of teams as a social influence, whereas nurses were not interested in group conformity or being compared to others. Nurses described the importance of individual feedback and self-monitoring in order to increase their performance, whereas administrators reported different views. CONCLUSIONS: This study highlights the benefits of using a structured approach based on psychological theory to inform an implementation plan for a behavior change intervention. This work is an essential step towards systematically identifying factors affecting nurses' behaviour associated with HH.     

Chlortetracycline and demeclocycline inhibit calpains and protect mouse neurons against glutamate toxicity and cerebral ischemia

Minocycline is a potent neuroprotective tetracycline in animal models of cerebral ischemia. We examined the protective properties of chlortetracycline (CTC) and demeclocycline (DMC) and showed that these two tetracyclines were also potent neuroprotective against glutamate-induced neuronal death in vitro and cerebral ischemia in vivo. However, CTC and DMC appeared to confer neuroprotection through a unique mechanism compared with minocycline. Rather than inhibiting microglial activation and caspase, CTC and DMC suppressed calpain activities. In addition, CTC and DMC only weakly antagonized N-methyl-D-aspartate (NMDA) receptor activities causing 16 and 14%, respectively, inhibition of NMDA-induced whole cell currents and partially blocked NMDA-induced Ca2+ influx, commonly regarded as the major trigger of neuronal death. In vitro and in vivo experiments demonstrated that the two compounds selectively inhibited the activities of calpain I and II activated following glutamate treatment and cerebral ischemia. In contrast, minocycline did not significantly inhibit calpain activity. Taken together, these results suggested that CTC and DMC provide neuroprotection through suppression of a rise in intracellular Ca2+ and inhibition of calpains.     

PRC2/EED-EZH2 Complex Is Up-Regulated in Breast Cancer Lymph Node Metastasis Compared to Primary Tumor and Correlates with Tumor Proliferation In Situ

Background

Lymph node metastasis is a key event in the progression of breast cancer. Therefore it is important to understand the underlying mechanisms which facilitate regional lymph node metastatic progression.

Methodology/Principal Findings

We performed gene expression profiling of purified tumor cells from human breast tumor and lymph node metastasis. By microarray network analysis, we found an increased expression of polycomb repression complex 2 (PRC2) core subunits EED and EZH2 in lymph node metastatic tumor cells over primary tumor cells which were validated through real-time PCR. Additionally, immunohistochemical (IHC) staining and quantitative image analysis of whole tissue sections showed a significant increase of EZH2 expressing tumor cells in lymph nodes over paired primary breast tumors, which strongly correlated with tumor cell proliferation in situ. We further explored the mechanisms of PRC2 gene up-regulation in metastatic tumor cells and found up-regulation of E2F genes, MYC targets and down-regulation of tumor suppressor gene E-cadherin targets in lymph node metastasis through GSEA analyses. Using IHC, the expression of potential EZH2 target, E-cadherin was examined in paired primary/lymph node samples and was found to be significantly decreased in lymph node metastases over paired primary tumors.

Conclusions/Significance

This study identified an over expression of the epigenetic silencing complex PRC2/EED-EZH2 in breast cancer lymph node metastasis as compared to primary tumor and its positive association with tumor cell proliferation in situ. Concurrently, PRC2 target protein E-cadherin was significant decreased in lymph node metastases, suggesting PRC2 promotes epithelial mesenchymal transition (EMT) in lymph node metastatic process through repression of E-cadherin. These results indicate that epigenetic regulation mediated by PRC2 proteins may provide additional advantage for the outgrowth of metastatic tumor cells in lymph nodes. This opens up epigenetic drug development possibilities for the treatment and prevention of lymph node metastasis in breast cancer.     

Processing of vibratory and acoustic signals by ventral cord neurones in the cricket Gryllus campestris

The responses of single vibratory receptors and ascending ventral cord interneurones were studied extracellularly in Gryllus campestris L. The physiology of the vibration receptors resembled those found in tettigoniids and locusts. The frequency responses of the subgenual receptors provide two possible cues for central frequency discrimination: differences in mean tuning between groups of receptors in the different leg pairs and a range of receptors tuned to different frequencies within one subgenual organ.Most of the ascending vibratory interneurones were highly sensitive in either the low or high frequency range. Broadbanded neurones were less sensitive. The characteristic sensitivity peaks of these units are due mainly to receptor inputs from a particular leg pair, although most central neurones receive inputs from all 6 legs. Only one neurone type, TN1 received excitatory inputs from both auditory and vibratory receptors; its responses were greatly enhanced by the simultaneous presentation of both stimulus modes. The responses to sound stimuli of AN2, on the other hand, were inhibited by vibration. No other auditory interneurones investigated were influenced by inputs from vibration receptors. Central processing of vibratory information in the cricket is compared with that of tettigoniids and locusts.     

Structural variability of collagen fibers in the calcareous axial rod of a sea pen

Previous studies revealed that the organic matrix of the skeletal rod of the sea pen, Veretillum cynomorium, contained about 50% collagenous protein. The present ultrastructural study, based upon conventional staining methods, shows the existence of an abundant, longitudinally arranged nonbanded and fibrillar material separated by a reticular matrix. After incubation with ³H-proline, labeling is specifically localized on the fibrillar material. Some fibers occasionally display a transverse striation with a period of 11 to 14 nm which can be associated with a chevron striation. Infrequently, some other fibers display a more distinct banding of 55 to 70 nm or even yield a checkerboard pattern. However, a majority of fibers remain without a regular structure comparable to the periodic striations observed in the collagen of other animals. After treatment with 1% PTA in 70% ethanol, all the fibers show a clear banding of 14 nm and some of them possess two types of striations. The same result is obtained on fibers mechanically dissociated and negatively stained. As these methods show a periodic banding pattern on all the fibers, it is likely that all the fibers (striated or not) observed after routine electron microscopy correspond to collagen material. This collagen appears to be both polymorphic and completely new in comparison to that which is characteristic of the mesoglea. The polymorphic aspect is compared to that obtained from vertebrate collagens.     

Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology - an update for the surgical oncologist

Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesophageal junction (GOJ) pose several specific challenges. Numerous difficulties arise when the existing TNM staging systems for gastric and oesophageal cancers are applied to GOJ tumours. The issues facing the current TNM staging and GOJ tumour classification systems are reviewed in this article. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases, have implications for specimen reporting. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy is carefully documented pathologically. In addition, several controversial and novel areas such as endoscopic mucosal resection, lymph node micrometastases and the sentinel node concept are being studied. We aim to review these aspects, with special relevance to oesophageal and gastro-oesophageal cancer specimen reporting, to update the surgical oncologist with an interest in upper gastrointestinal cancer.     

Binocular interactions of motion detection fibers in the optic lobes of flies

Zusammenfassung Nervenfasern, die die optischen Ganglien beider Kopfseiten von Musca und Phaenicia verbinden und die selektiv auf Musterbewegungen antworten, zeigen binoculare Wechselwirkungen. Details dieser Wechselwirkungen und der Ort an dem sie in den optischen Ganglien stattfinden wurden ermittelt. Die Bedeutung dieser Einheiten für die direkte Steuerung von Wendereaktionen beim Flug wurde ebenfalls untersucht.

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This research was supported by the National Institutes Health, United States Public Health Service Grant NB 03627.     

The Flora of the Perivaginal Area: The Normal Flora and the Effect of a Deodorant Spray

S ummary . The microbial flora of the thigh adjacent to the vaginal labia and of the mucosal surface of the labia has been examined quantitatively and qualitatively in students from Colleges of Education and a University, and in persons attending a Consultant Gynaecologist for non-suppurative conditions. In the 2 student populations, members of the Micrococcaceae and diphtheroids were the most common organisms but all populations yielded many organisms of gut origin. Differences between the populations may relate to social and hygienic conditions and should make us wary of direct comparisons with other, different populations. The effect of intimate hygiene deodorants containing 0.01% or 0.02% of chlorhexidine was compared with a base spray containing no antibacterial agent. No significant effect of these sprays on the microbial flora could be demonstrated.