HIV positive patient with GBS-like syndrome

Introduction. Guillain–Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. Conclusion. This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive

Comparative genomics of Shiga toxin encoding bacteriophages

Background Stx bacteriophages are responsible for driving the dissemination of Stx toxin genes (stx) across their bacterial host range. Lysogens carrying Stx phages can cause severe, lifethreatening disease and Stx toxin is an integral virulence factor. The Stx-bacteriophage vB_EcoP-24B, commonly referred to as 24B, is capable of multiply infecting a single bacterial host cell at a high frequency, with secondary infection increasing the rate at which subsequent bacteriophage infections can occur. This is biologically unusual, therefore determining the genomic content and context of 24B compared to other lambdoid Stx phages is important to understanding the factors controlling this phenomenon and determining whether they occur in other Stx phages. Results The genome of the Stx2 encoding phage, 24B was sequenced and annotated. The genomic organisation and general features are similar to other sequenced Stx bacteriophages induced from Enterohaemorrhagic Escherichia coli (EHEC), however 24B possesses significant regions of heterogeneity, with implications for phage biology and behaviour. The 24B genome was compared to other sequenced Stx phages and the archetypal lambdoid phage, lambda, using the Circos genome comparison tool and a PCR-based multi-loci comparison system. Conclusions The data support the hypothesis that Stx phages are mosaic, and recombination events between the host, phages and their remnants within the same infected bacterial cell will continue to drive the evolution of Stx phage variants and the subsequent dissemination of shigatoxigenic potentia

The Care Certificate Evaluation: an overview

BACKGROUND: Front line care workers play a key role in health and social care provision for older people and this has been reflected in training innovations aiming to improve the care provided by these workers. One recent training initiative has been the Care Certificate, which was fully launched in England in April 2015 and which aims to provide a consistent and transferable approach to this training. However, little is currently known about the patterns of implementation adopted by care organisations or about the perceptions of the Care Certificate held by care providers and by those in receipt of this care. AIMS: In order to address these issues and to optimise its impact, the implementation of the Care Certificate is being evaluated through an 18 month national study funded by the Department of Health Policy Research Programme. Project Reference Number PR-R14-0915-12004. METHODS: This study includes a telephone survey of care organisations in England as well as qualitative explorations of the views and experiences of the Care Certificate held by care providers and care receivers. This poster provides an overview of this national evaluation, highlighting why it is needed, how it is being carried out as well as summarising some of its preliminary findings

Factors Influencing the quality of emergency department nurse shift handover

Session presented on Friday, September 26, 2014: Background: Nurse-to-nurse shift handover is defined as defined as bidirectional communication that results in the transfer of information and responsibility for a patient (Friesen et al., 2008; McFetridge et al., 2007; Tregunno, 2009). Nurse-to-nurse shift handover is an integral part of safe nursing care as incoming nurses depend on handover information to inform decision making, establish priorities, and to plan and provide patient care. The Emergency Department (ED) is a clinical area where nurse-to-nurse handover communication is particularly vulnerable as a result of the unpredictable, often chaotic nature of the environment. Although a large amount of handover literature is aimed at examining handover on inpatient units, there is little literature exploring nurse-to-nurse shift handover in the ED. Moreover, the majority of existing handover literature is focused on identifying handover interventions rather than identifying the factors that influence handover. It is only through understanding the factors that influence handover quality that effective interventions can be developed. Objective: The aim of this research is to identify factors that influence the quality of nurse-to-nurse shift handover in the ED, as perceived by the incoming nurse. Subject Population: A random sample of 650 Registered Nurses (RN) employed in Ontario Emergency Departments (ED) were invited to complete a mailed survey asking about factors influencing the last shift handover that was received. Research Design: Data were collected using pencil and paper surveys mailed to participants homes. Surveys were mailed using a modified version of Dillmans Tailored Design Method (Dillman et al., 2009). Survey items were based on literature review findings used to develop a hypothesized theoretical model of factors influencing handover communication. The hypothesized model included 18 factors hypothesized to directly influence the quality of handover, in addition to four interaction effects. The 83 item survey was comprised of instruments examining nurse related factors (e.g., education, experience), organizational factors (e.g., safety climate, staffing), and handover processes (e.g., use of technology, checklists). The majority of questions were scored using Likert scales, with response options ranging from strongly disagree to strongly agree. Results: The overall survey response rate was 40.1%. The mean rating for handover quality was 3.42 (SD = 0.92) out of five, indicating that nurses reported handover as being slightly better than good. Using survey data, the hypothesized theoretical model was analyzed using stepwise multiple linear regression to identify variables that influence quality of nurse-to-nurse handover communication. Conclusions: Using the factors identified in this model, it is possible to develop evidence-based interventions to improve the quality of handover communication. Understanding factors that influence ED nurse-to-nurse handover communication and developing evidence-based interventions is integral to improving patient safety, continuity of care, and staff and organizational outcomes

Secondhand smoke exposure in primary school children: A survey in Dhaka, Bangladesh

Introduction: We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh—a country with laws against smoking in public places.Methods: A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL.Results: Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21%(100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure.Conclusions: Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children.Implications: Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countriesare still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS

APCVD of dual layer transparent conductive oxides for photovoltaic applications

We report the atmospheric pressure chemical vapour deposition (APCVD) of a dual layer transparent conductive oxide (TCO). This combines a fluorine doped tin oxide (FTO) base layer with a fluorine doped zinc oxide (FZO) top layer, where we seek to utilise the respective advantages of each material and the differences in their associated industrial deposition process technologies. Deposition of a 250 nm thick FZO layer on FTO was enough to develop features seen with FZO only layers. The crystallographic orientation determined by the FZO dopant concentration. Changes to the deposition parameters of the underlying FTO layer effected stack roughness and carrier concentration, and hence optical scattering and absorption. Photovoltaic cells have been fabricated using this TCO structure showing promising performance, with efficiencies as high as 10.21% compared to reference FTO only values of 9.02%. The bulk of the coating was FTO, providing the majority of conductivity and the large surface features associated with this material, whilst keeping the overall cost low by utilising the very fast growth rates achievable. The FTO was capped with a thinner FZO layer to provide a top surface suitable for wet chemical or plasma etching, allowing the surface morphology to be tuned for specific applications

Towards an International Classification for Patient Safety: the conceptual framework

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpos

A Spectroscopic Survey of a Sample of Active M Dwarfs

A moderate resolution spectroscopic survey of Fleming's sample of 54 X-ray selected M dwarfs with photometric distances less than 25 pc is presented. Radial and rotation velocities have been measured by fits to the H-alpha profiles. Radial velocities have been measured by cross correlation. Artificial broadening of an observed spectrum has produced a relationship between H-alpha FWHM and rotation speed, which we use to infer rotation speeds for the entire sample by measurement of the H-alpha emission line. We find 3 ultra-fast rotators (UFRs, vsini > 100km/s), and 8 stars with 30 < vsini < 100 km/s. The UFRs have variable emission. Cross-correlation velocities measured for ultra-fast rotators (UFRs) are shown to depend on rotation speed and the filtering used. The radial velocity dispersion of the sample is 17 km/s. A new double emission line spectroscopic binary with a period of 3.55 days has been discovered, and another known one is in the sample. Three other objects are suspected spectroscopic binaries, and at least six are visual doubles. The only star in the sample observed to have significant lithium is a known TW Hya Association member, TWA 8A. These results show that there are a number of young (< 10^8 yr) and very young (< 10^7 yr) low mass stars in the immediate solar neighbourhood. The H-alpha activity strength does not depend on rotation speed. Our fast rotators are less luminous than similarly fast rotators in the Pleiades. They are either younger than the Pleiades, or gained angular momentum in a different way.Comment: 38 pages incl. 14 figures and 4 tables, plus 12 pages of table for electronic journal only; LaTeX, aastex.cls. Accepted 07/18/02 for publication in The Astronomical Journa

Macbeth by Shakespeare

This is a five-week unit that explores Shakespearean tragedy using Macbeth. The unit focuses on the literary elements of character motivation, foil, paradox, and the motifs of making decisions and good/moral vs. evil/immoral. The writing focus of the unit is creative and narrative, emphasizing the idea of motives, decision-making, and morality. Students will rewrite the ending of Macbeth by changing the decisions and path of one character. By the end of the unit, students will use their understandings from the unit to apply the lessons learned from the fictional characters to their own lives, and evaluate and recognize the importance of faith in moral decisions

Julius Caesar by Shakespeare

This unit takes a critical look at Shakespeare\u27s Julius Caesar as historical fiction, emphasizing that authors sometimes manipulate fact in their writing. It evaluates the power of persuasion and what makes a speech successfully persuasive. It also explores the concepts of honor and friendship, and how both are connected to morality