Diarrheagenic Escherichia coli (E. coli) and Neisseria sp. are Gram-negative pathogens that cause high disease burden, especially in low-income countries.Enterohemorrhagic E. coli (EHEC) and enteropathogenic E. coli (EPEC) are a subset of E. coli that can cause disease. The sequence of E. coli genomes revealed the presence of at least 16 putative pili operons, it is still unknown if they encode functional pili. Several adhesins have been described in EPEC; however it is still an enigma if EHEC produces pili. In this dissertation the identification and characterization of a new pilus in EHEC is described. The main pilin subunit is encoded in the yagZ gene (renamed ecpA) and is present in all E. coli. We demonstrate ECP production in 137 (70%) of a total of 197 ecpA+ strains representing different categories of E. coli. Isogenic ecpA mutants of EHEC O157:H7 and fecal commensal E. coli showed significant reduction in adherence to cultured epithelial cells. Adherence levels were not hampered after single mutation of ecpA in EPEC. Only after the removal of the known EPEC adhesins such as BFP and intimin we were able to see significant reduction in adherence levels. In sum, ECP is the first pilus of EHEC O157:H7 with a potential role in host epithelial cell colonization. However, EPEC-ECP plays a secondary role in adherence.Since 2007 the CDC recommends only third generation cephalosporins as the elected treatment for Neisseria gonorrhoeae infections. There is an urgent need to search for new drug targets and to development new drugs. Regions rich in guanine in the DNA are able to form secondary structures known as G-quadruplexes. It has been shown that G-quadruplexes are involved in control of transcription, translation and telomere elongation in mammalian cells. G-quadruplex interactive compounds are being developed for cancer therapy. G-quadruplex motifs are also present in bacteria. The fact that G-quadruplex interactive compounds can impair cancer development leads us to hypothesize that these drugs can be used as antimicrobials. This work presents evidence for the potential of G-quadruplex interactive compounds as broad-spectrum antimicrobials.

AN EXPLORATORY MODEL OF MEDICATION REFILL ADHERENCE BEHAVIOR by Gayle Holmes Payne Coronary heart disease (CHD) is the leading cause of death in the United States with over 15.8 million Americans suffering from the chronic disease (U.S. Department of Health and Human Services, 2007). Adherence to medication regimens has been identified as a key mediator between medical practice and patient outcomes (Kravitz & Melnikow, 2004). In this study, participants (N = 355) with CHD completed a questionnaire measuring their background characteristics, cognitive status, health literacy skills, self-efficacy levels, their perceived concerns and necessity beliefs about medication use, and enablers and barriers to their medication-taking behavior. Information regarding each participant’s number of medications and presence of disease was obtained from medical charts. Data regarding the dependent variable, cardiovascular medication refill adherence, were collected from pharmacy records. The data were used to see how the various variables work together in a model that explains cardiovascular medication refill adherence behavior. The study aimed to contribute to the body of adherence research by jointly examining all variables found to have an association with medication adherence through a path analysis to explain the determinants of medication refill adherence behavior. Analyses indicated that the hypothesized model did not fit the data. Additional analysis was conducted using a condensed revised model (age, self-efficacy, perceived concerns and necessity) and a self-reported measure of medication adherence (Adherence to Refills and Medication Scale) as the dependent variable. The revised model fit the data, X2(5, N = 355) = 6.71, p = .24. The revised model did not explain a statistically significant amount of the variance in medication adherence, suggesting that there may be other additional factors that may mediate the relationship between independent variables and medication refill adherence. Additional research is needed to reveal all the determinants of medication refill adherence behavior and to identify the most effective measure of adherence behavior. Given the number of people who suffer from CHD, and the often low rates of medication adherence, research that continues to explore and improve medication refill adherence will have a significant impact on morbidity and mortality rates.

Cross infection is a global health problem. The cost for cross infection increases every year. Florence Nightingale focused her attention on preventing cross infections by using good hygiene and as a nurse that is one of your more important tasks. Nurses have guidelines for how hygiene should be implemented in practice. The aim of this study is to investigate factors that influence nurses´ compliance to guidelines regarding hygiene. A literature review was used to analyze scientific articles related to the topic. The result showed that education increases nurses´ compliance to follow guidelines. Furthermore compliance to hand hygiene was higher after contact with the patient then before. The result also showed that the nurses were more worried about attracting an infection from the patient then giving an infection to the patient. The studies revealed that nurses want more education about guidelines and the latest research on the subject. The authors think that nurses need more education about hygiene in order to understand the importance of following guidelines. Nurses also need time for both reading updated information infection control and implementing the hygiene guidelines more frequently in practice.

A burn is a type of injury to the skin caused by fire, heat, electricity, chemicals, radiation or friction. It occurs in all age groups. Burn wound infection remains the leading cause of skin graft failure and one of the leading causes of burn injury related mortality. Dressings impregnated with silver compounds are the mainstay of treatment for burn wounds to prevent or combat the infection. However, most commercially available silver based wound dressings cause trauma upon removal because of adhesion to the wound bed. A recent study has shown that burn dressing related pain is linked to more severe depressive and posttraumatic stress symptoms. Furthermore, emerging resistance associated with silver based wound dressings is a growing concern. Organic N-chloramines have been in clinical use for over 180 years thanks to their effectiveness toward a broad spectrum of microorganisms, and no resistance has been yet reported. This study aimed to develop an “ideal” wound dressing with both antibacterial and atraumatic properties. Poly(ethylene terephthalate) (PET) fabrics are among the most representative base materials in burn wound dressings and thus were chosen as the substrate. Specifically, a very thin layer of polyacrylamide (PAm) hydrogel was deposited onto the surface of PET fabric via plasma activation and photopolymerization. The treated PET fabric (termed as “PET-PAm”) was characterized with attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy and water contact angle measurement. We adapted an in vitro wet-gelatin adherence model to evaluate the effect of hydrogel deposition on reducing the adherence of PET. The deposited hydrogel layer was found to lower the adherence of PET fabrics. The peeling energy of PET decreased drastically from 2231.5 J/m2 to nearly 250 J/m2 after the deposition of hydrogel. On the other hand, we have also synthesized a series of new “composite” biocides with both N-chloramine and quaternary ammonium (QA) moieties. Those “composite” biocides exert boosted killing efficiency against methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant (MDR) Pseudomonas aeruginosa. The deposited hydrogel layer can also serve as the reservoir for the loading of the novel N-chloramine based “composite” biocides, to achieve a both non-adherent and antibacterial wound dressing.

No description available.

The objective of this study was to explore the link between school climate and bullying behaviour through a case study of two high schools. Grade 10 students received the two day Cross-Cultural Conflict Resolution (XCCR) Module initiated by YOUCAN. Phase I of this study involved the development of an XCCR Logic Model, which aimed to clarify the objectives and key elements of the XCCR Module. Phase II involved the in depth analysis of the XCCR Module through an 84-item survey and qualitative semi-structured interviews with school and program staff. Data from this study did not indicate any changes in bullying behaviour or school climate between pre-and post-implementation. This study highlights a need to incorporate measures for program adherence and program fidelity in future studies. The results of this study provided two practical contributions, an XCCR Logic Model and information about bullying and school climate for the participating schools.

Background & Objectives: Participation in cognitive, social and physical activity (PA) may play a role in prevention of cognitive decline in older adults. Literature supporting the benefits of healthy lifestyle behaviours, especially PA, on cognition continues to accumulate. Moreover, a strong association between gait and cognitive health is increasingly being recognized. Yet, a firm understanding of the individual differences and between-person effects of PA on cognition and gait of older adults is lacking. Thus, the primary objective of the main study was to distinguish the within- and between-person sources of variation in PA on cognition in a group of inactive older adults. Study 2 examined the within- and between-person effects of a) PA on gait and b) gait on cognition. Study 3 examined the social cognitive predictors of walking. Methods: The between- and within-person of PA on cognition were examined in a single-group longitudinal design. Participants (n=159) were enrolled in a four-month supervised walking program and provided with materials and coaching to promote the adoption of behaviours to enhance and maintain their cognitive health. Group participants walked at least 3 times per week at a brisk intensity and were encouraged to get 150 minutes of moderate-to-vigorous PA per week. At baseline, participants completed measures of social cognitive predictors of walking. Assessments of cognition, diet, fitness, gait, PA and other health behaviours occurred at baseline, and at 6, 9, 12, and 16 weeks follow-up. Results and Discussion: Multilevel models revealed significant: 1) within-person effects of PA on select measures of executive functioning and 2) consistent between-group effects of cognitive activity, but not other lifestyle behaviours, on cognition. Study 2 revealed consistent significant 1) within-person effects of PA on gait velocity and stride time variability during dual task walking, 2) between-person effects of PA on gait velocity during both dual task and normal walking, and 3) between-person effects of gait velocity and stride time variability on cognition during both normal and dual task walking. Significant within-person effects of gait on cognition were limited. In study 3, self-monitoring emerged as a significant predictor of change in walking. Conclusion: Distinct patterns of within- and between-person effects on the PA, cognition and gait were observed. Further work will need to continue to clearly elucidate the within- and between-person sources of variation in relations between PA, gait and cognition using well-designed longitudinal and experimental designs. / Graduate / 0633 / 0623 / kkowalsk@uvic.ca

Magistro baigiamajame darbe analizuojama nepakankamai veiksmingo gydymo ambulatorinėmis sąlygomis ir su juo susijusio gydytojų nurodymų nesilaikymo problema. Darbo tikslas – nustatyti nedrausmingo gydymosi ambulatorinėmis sąlygomis proporcijas ir galimas priežastis tarp LSMUL Kauno klinikų Nefrologijos skyriuje stacionarizuotų pacientų, kuriems ambulatorininėmis sąlygomis taikytas gydymas nebuvo pakankamai veiksmingas. Tyrimo metu nustatyta, kad didžiajai daliai stacionarizuotų pacientų ambulatorinis gydymas nebuvo pakankamai veiksmingas. Įvertinta, kad daugiau negu du trečdaliai šių pacientų vaistus vartojo nedrausmingai. Nepakankamos žinios apie ligą, motyvacijos trūkumas, užmiršimas išgerti vaistus arba jų nutraukimas esant gerai savijautai – būdingi daugiau negu trečdaliui nedrausmingų pacientų. Tai rodo, jog, atsižvelgiant į aukštus nepakankamai veiksmingo ambulatorinio gydymo rodiklius, paciento apsilankymo pas sveikatos priežiūros specialistą metu, tikslinga atkreipti dėmesį į paciento vaistų vartojimo ypatumus. Užtikrintas ir aiškus pacientų informavimas apie nesigydymo riziką bei nedrausmingumo problemos akcentų diegimas socialinėje erdvėje galėtų prisidėti prie naujo požiūrio į paciento atsakomybę už savo sveikatos būklę formavimo, teigiamų gydymo rezultatų suvokimo, demotyvacinių mechanizmų vystymosi mažinimo. / The study analyzes the problem of insufficiently effective outpatient treatment and the related problem of medication non-adherence. The aim of the study is to investigate, among patients hospitalized in the nephrology sector, both the prevalence of non-adherence and the possible causes for which their ambulatory treatment was not sufficiently effective. It was found that majority of outpatient treatment cases were not sufficiently effective. It is estimated that more than two-thirds of these patients were non-adherent. The inadequate knowledge about the disease, lack of motivation, forgetfulness and discontinuation of drug use when feeling well were incident to over than one third of non-adherent patients. This suggests that, given the high rates of insufficiently effective outpatient treatment, it is appropriate to draw attention to the patient's medication-use peculiarities. Moreover, informing the patient about possible threats of non-adherence and a more social implementation of the treatment may help the patients to understand the positive results of the treatment and reduce the development of their demotivating mechanisms.

Thesis (Ph. D.)--University of Missouri-Columbia, 2009. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2009" Includes bibliographical references.

Bakgrund Följsamhet till hemträning hos patienter inom primärvården är ofta undermålig. För att en behandling ska få ett önskvärt resultat är det nödvändigt att patienten följer rekommendationerna från sin fysioterapeut. Syfte Syftet var att undersöka vilka erfarenheter fysioterapeuter, verksamma inom primärvården, har kring vilka faktorer i det kliniska arbetet som ökar patienters följsamhet till icke övervakad träning samt hur de utvärderar graden av följsamhet. Design och metod Studien har kvalitativ deskriptiv design med semistrukturerade intervjuer som datainsamlingsmetod. Databearbetning genomfördes enligt Graneheim och Lundmans modell för innehållsanalys. Resultat Totalt intervjuades sex fysioterapeuter. De huvudsakliga påverkande faktorerna var; användning av olika behandlingsstrategier, genomförande av uppföljning, patientens hälsostatus och förutsättningar, fysiologiska förklaringsmodeller, verksamhetens resurser, fysioterapeutens karaktäristika samt patienters ålder och kön. Utvärderingen av följsamhet skedde genom samtal och utvärdering vid återbesök med patienten. Konklusion En del av faktorerna kopplat till följsamhet kan vara svåra att påverka som fysioterapeut, exempelvis patientens hälsostatus, medan det går bättre att påverka andra faktorer i fysioterapeutens kliniska arbete, såsom att individanpassa träningen, använda sig utav förklaringsmodeller och ta hjälp av andra professioner. / Background Adherence to non-supervised training in primary care patients is often insufficient and there are no clear methods for improving and evaluating adherence. For a treatment to have a desirable result, it is necessary that the patient follows the recommendations from his physiotherapist. Aim The purpose of the study was to investigate what experiences physiotherapists who work in primary care have about what factors in their clinical work that increase patient adherence to non-supervised training and how they evaluate the degree of adherence. Design och methods The study has a qualitative and descriptive design with semi-structured interviews as data collection method. Data processing was carried out according to Graneheim and Lundman's content analysis model. Results A total of six physiotherapists were interviewed. The main impact factors were; use of different treatment strategies, follow-ups, patient’s health status and conditions, explanatory models, resources, physiotherapist's characteristics and age and gender of the patient. The evaluation of adherence is basically done through conversations and evaluation during patient follow up.  Conclusions Some of the factors linked to adherence may be difficult to influence as a physiotherapist, such as the patient's health status, while it is easier to influence other factors in the physiotherapist's clinical work, such as; personalizing the training, using explanatory models and utilizing other professionals.