Managing the risk of iatrogenic transmission of Creutzfeldt-Jakob disease in the UK.

BACKGROUND: With the emergence of bovine spongiform encephalopathy (BSE) and variant Creutzfeldt-Jakob disease (CJD) in the UK, there is concern about iatrogenic transmission, and the approach to managing this risk is unique. AIM: To describe and review CJD incident management and the notification of individuals 'at increased risk' as a strategy for reducing iatrogenic transmission. METHODS: A description of iatrogenic CJD transmission, the CJD Incidents Panel's role, the number and nature of CJD incidents reported and the individuals considered 'at increased risk' by mid-2012. FINDINGS: Seventy-seven UK cases of CJD are likely to have resulted from iatrogenic transmission, among recipients of human-derived growth hormone (64 cases), dura mater grafts (eight cases), blood transfusions (four cases) and plasma products (one case). To limit transmission, the Panel reviewed 490 incidents and advised on look-backs, recalls of blood and plasma products, and quarantining and disposing of surgical instruments. Additionally, on Panel advice, around 6000 asymptomatic individuals have been informed they are at increased risk of CJD and have been asked to follow public health precautions. CONCLUSION: The strategy to reduce iatrogenic transmission of CJD has been developed in a context of scientific uncertainty. The rarity of transmission events could indicate that incident-related exposures present negligible transmission risks, or--given the prolonged incubation and subclinical phenotypes of CJD--infections could be yet to occur or have been undetected. Scientific developments, including better estimates of infection prevalence, a screening test, or improvements in decontaminating surgical instruments, may change future risk management

Going beyond defining: Preschool educators\u27 use of knowledge in their pedagogical reasoning about vocabulary instruction

Previous research investigating both the knowledge of early childhood educators and the support for vocabulary development present in early childhood settings has indicated that both educator knowledge and enacted practice are less than optimal, which has grave implications for children\u27s early vocabulary learning and later reading achievement. Further, the nature of the relationship between educators\u27 knowledge and practice is unclear, making it difficult to discern the best path towards improved knowledge, practice, and children\u27s vocabulary outcomes. The purpose of the present study was to add to the existing literature by using stimulated recall interviews and a grounded approach to examine how 10 preschool educators used their knowledge to made decisions about their moment-to-moment instruction in support of children\u27s vocabulary development. Results indicate that educators were thinking in highly context-specific ways about their goals and strategies for supporting vocabulary learning, taking into account important knowledge of their instructional history with children and of the children themselves to inform their decision making in the moment. In addition, they reported thinking about research-based goals and strategies for supporting vocabulary learning that went beyond simply defining words for children. Implications for research and professional development are discussed

EPUAP classification system for pressure ulcers: European reliability study

‘The definitive version is available at www3.interscience.wiley.com .' Copyright Blackwell PublishingPeer reviewe

Assessment of a self-reported Drinks Diary for the estimation of drinks intake by care home residents: Fluid Intake Study in the Elderly (FISE)

Objectives: We evaluated the accuracy of a newly developed self-completed Drinks Diary in care home residents and compared it with direct observation and fluid intake charts. Design: Observational study. Setting: Residential care homes in Norfolk, UK. Participants: 22 elderly people (18 women, mean age 86.6 years SD 8.6, 12 with MMSE scores <27). Measurements: Participants recorded their own drinks intake over 24 hours using the Drinks Diary while care staff used the homes’ usual fluid intake chart to record drinks intake. These records were compared with drinks intake assessed by researcher direct observation (reference method), during waking hours (6am to 10pm), while drinks taken from 10pm to 6am were self-reported and checked with staff. Results: Drinks intake assessed by the Drinks Diary was highly correlated with researcher direct observation (Pearson correlation coefficient r=0.93, p<0.001, mean difference -163ml/day) while few staff-completed fluid charts were returned and correlation was low (r=0.122, p=0.818, mean difference 702ml/day). The Drinks Diary classified 19 of 22 participants correctly as drinking enough or not using both the European Food Safety Authority and US recommendations. Conclusion: The Drinks Diary estimate of drinks intake was comparable with direct observation and more accurate (and reliably completed) than staff records. The Drinks Diary can provide a reliable estimate of drinks intake in elderly care home residents physically and cognitively able to complete it. It may be useful for researchers, care staff and practitioners needing to monitor drinks intake of elderly people, to help them avoid dehydration

Environmental Impacts of Productivity-Enhancing Crop Research: A Critical Review

Study by Drs. Mywish Maredia and Prabhu Pingali reviewing evidence of the possible negative impacts of productivity-enhancing technologies on the environment. Identifying "negative land savings" as a suitable measure of negative impact, the authors find salinity problems associated with irrigation as the most complete available index of land savings lost, and together with less precise measures of the impacts of intensification and monocultures, estimate global land savings lost to be on the order of 90-100 million hectares. This is several hundreds of millions of hectares less than the positive land savings attributable to CGIAR research on eight mandated crops (see "Environmental Impacts of the CGIAR: An Assessment.")A treatment of efforts by the CGIAR and NARS to mitigate negative impacts on the environment follows, focusing on the development of pest-resistant varieties and integrated pest management practices which reduce the need for pesticides. While this was identified clearly as an area of significant advances, farmers' adoption of these varieties and practices was not matched by a concomitant reduction in pesticide use - which represented a major failure in disseminating the implications of the new technologies for pesticide requirements. The study ends by pointing to the complexities of relating environmental impacts to agricultural research, given the many factors other than research that contribute to these impacts. Adding to this difficulty of attributing the causes of environmental impacts to research, the authors describe a common tendency of literature to conflate the green revolution with the larger phenomenon of agricultural intensification

Overcoming the risk of inaction from emissions uncertainty in smallholder agriculture

The potential for improving productivity and increasing the resilience of smallholder agriculture, while also contributing to climate change mitigation, has recently received considerable political attention (Beddington et al 2012). Financial support for improving smallholder agriculture could come from performance-based funding including sale of carbon credits or certified commodities, payments for ecosystem services, and nationally appropriate mitigation action (NAMA) budgets, as well as more traditional sources of development and environment finance. Monitoring the greenhouse gas fluxes associated with changes to agricultural practice is needed for performance-based mitigation funding, and efforts are underway to develop tools to quantify mitigation achieved and assess trade-offs and synergies between mitigation and other livelihood and environmental priorities (Olander 2012)

Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

Contrasting fast precipitation responses to tropospheric and stratospheric ozone forcing

The precipitation response to radiative forcing (RF) can be decomposed into a fast precipitation response (FPR), which depends on the atmospheric component of RF, and a slow response, which depends on surface temperature change. We present the first detailed climate model study of the FPR due to tropospheric and stratospheric ozone changes. The FPR depends strongly on the altitude of ozone change. Increases below about 3 km cause a positive FPR; increases above cause a negative FPR. The FPR due to stratospheric ozone change is, per unit RF, about 3 times larger than that due to tropospheric ozone. As historical ozone trends in the troposphere and stratosphere are opposite in sign, so too are the FPRs. Simple climate model calculations of the time-dependent total (fast and slow) precipitation change, indicate that ozone's contribution to precipitation change in 2011, compared to 1765, could exceed 50% of that due to CO2 change