Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, protocol, and practice guidelines developed based on recommended practices of the Association of periOperative Registered Nurses and current peer-reviewed literature. An interdisciplinary project team of institutional stakeholders was used to insure context-relevant operationalization of the evidence in practice. The team was assembled, led in a review of relevant literature, and convened regularly until project products were finished. Three scholars with expertise in the content area were then identified by the project team and asked to validate the content of developed products. Products were revised according to expert feedback. Implementation and evaluation plans were developed by the project team to provide the institution with all necessary process details to carry out the practice change. The evaluation plan advises using a retrospective chart review to compare rates of infection between patients receiving chlorhexidine skin preparation with showers and preoperative chlorhexidine cloths alone. A positive outcome could contribute to positive social change by decreasing preventable infections.

The purpose of this project was to improve primary care provider knowledge, attitude and behaviors related to the current HIV-screening and PrEP implementation guidelines. Surveys were conducted among five primary care providers at a Midwest VA Healthcare System before and after an HIV and PrEP-related education. The surveys were anonymous, and participation was voluntary. Each participant received a survey by pen and paper to self-assess their HIV-screening and PrEP prescribing intention, comfort-level with HIV prevention practices, and knowledge before and after the presentation by using Likert scales, true/false, and correct answer recall questions. Of the eligible 11 providers in attendance of the presentation, six of the 11 (54.5%) participated in the surveys. One participant was excluded as he/she did not submit his/her completed presurvey, which rendered the survey incomplete for data analysis. The included participants (n=5) worked in General/Primary Care, were either a MD (2 of 5) or NP (3 of 5), who have practiced as their current clinical title for less than 5 years to greater than 25 years. Responses were measured based on the FREQ procedure as the sample size was small. Following the intervention, there was no overall increase in intent to follow the current CDC HIV screening guidelines however intention prior to the intervention was already high. Following education, the providers’ ability to identify those at risk for HIV increased by 60% (3 of 5), and comfort-level in identifying those at risk for HIV whom are PrEP eligible increased by 80% (4 of 5). Of these providers, there was an 80% (4 of 5) increase in provider self-rated comfort-level in discussing PrEP with high risk patients post-education. Each provider rated their intention to prescribe PrEP after the intervention on a Likert scale, as “Probably” or “Very Probable,” which was a 60% (3 of 5) provider improvement. Overall, responses indicated an improvement of provider knowledge, attitudes, and behavior after receiving HIV screening and PrEP education. Findings of this project are comparable with previous research, this project, however, did not evaluate actual provider change in practice following education.

No description available.

No description available.

Antiretroviral treatment pre-exposure prophylaxis (PrEP) is an effective daily prevention medicine to reduce risks of HIV infections in high-risk populations. The current study examined PrEP uptake among gay men using the integrative model of behavioral prediction (IMBP) as the theoretical framework. Briefly, the IMBP states that attitude, norms, and behavioral control predict intention, which then predicts behavior. The intention-behavior relationship is moderated by actual control variables: skills and environmental constraints. To examine how IMBP variables affect PrEP uptake among gay men, I first conducted formative elicitation interviews with gay men; then I used the results from the interviews to construct the main survey. Then, the project recruited 500 gay men to participate in the survey, half of whom were PrEP takers and half of whom were not. The results of path modeling showed that attitudes and norms predicted behavioral intention, and intention predicted PrEP uptake among gay men. Results of moderation analyses testing the influence of skills and environmental constraints showed that HIV knowledge, lack of access to a doctor(s), and lack of health care system knowledge were significant moderators between intention and PrEP uptake. The practical implications, theoretical contributions, and empirical advancements were discussed.

In der vorliegenden Studie wurden 32 Patienten (19 Frauen, 13 Männer, medianes Alter 50 Jahren, Spanne: 26-83 Jahre) mit einem klinisch akralen neuropathischen Schmerzsyndrom unterschiedlicher Genese mittels QST, PREP und Hautbiopsie untersucht. Unser Patientenkollektiv bestand aus drei Subgruppen: sechsen Patienten erfüllten die Kriterien einer SFN, acht Patienten hatten eine Neuropathie der großkalibrigen Nervenfasern mit zusätzlicher Beeinträchtigung der kleinkalibrigen Nervenfasern und weitere acht Patienten hatten ein akrales Schmerzsyndrom mit neuropathischen Charakteristika, ohne vorbekannte Diagnose einer Neuropathie der groß- oder kleinkalibrigen Nervenfasern. Die Patienten wurden mittels klinischer neurologischer Untersuchung, elektrophysiologischer Tests, QST, PREP und Hautbiopsie untersucht. Die Patientendaten wurden jeweils mit Daten großer Kontrollgruppen verglichen, die wir in unserer Klinik unter Angehörigen und Freunden unserer Patienten mit deren Einwilligung rekrutiert hatten. QST und die Hautbiopsie waren bei Patienten mit SFN und PNP jeweils auffällig, bei akralem Schmerzsyndrom unklarer Ätiologie hingegen unauffällig. Nach elektrischer kutaner Stimulation aller drei Körperregionen zeigte sich eine Amplitudenminderung der PREP-Reizantwort in allen Patientensubgruppen (7,5 µV in der SFN-Gruppe, 3,8 µV in der PNP-Gruppe, und 11,3 µV bei den Patienten mit akralem Schmerzsyndrom). Somit konnten wir zeigen, dass eine Kleinfaserpathologie in der Studienpopulation von Patienten mit neuropathischem Schmerzsyndrom besteht. Nur die Amplitudenminderung der PREP bildet diese Pathologie ab. Diese Daten erlauben uns die eingangs aufgestellte Hypothese, dass PREP zur Diagnostik bei Frage nach Kleinfaserbeteiligung geeignet ist, positiv zu belegen. PREP ist eine nicht-invasive Methode für die Evaluation der Funktion v.a. der Aδ-Faser mit standardisiertem Ablaufprotokoll zur Erhebung von reproduzierbaren Daten. Sie kann bei Patienten mit der Anamnese eines akralen neuropathischen Schmerzsyndroms einen objektiven Hinweis auf eine Dysfunktion der kleinkalibrigen Nervenfasern, auch wenn bereits etablierte Methoden (QST und Hautbiopsie) unauffällig bleiben, erbringen. Entsprechend können die PREP eine wertvolle Ergänzung der klinischen Untersuchungsbatterie für die Evaluation der Funktion der kleinkalibrigen Nervenfasern sein. / 32 adult patients (19 female, 13 male, median age 50 years, range 26-83) suffering from acral neuropathic pain were examined with QST, PREP and skin punch biopsy. Applying current diagnostic criteria and the results of the neurophysiological studies, 16/32 (50%) patients were classified as having idiopathic SFN (Devigili et al., 2008), 8/32 (25%) patients had a mixed fiber neuropathy (MFN, i.e. large and small fiber neuropathy), and 8/32 (25%) patients had neuropathic pain without signs of a large fiber neuropathy or SFN. Patients with SFN and mixed fiber neuropathy were having pathological findings in the skin punch biopsy (reduction of the intraepidermal nerve fiber density-IENFD), while normal findings were seen in patients with acral neuropathic pain Pain related evoked potentials after electrical skin stimulation at three body regions (face, hand, foot) revealed reduction of the peak-to-peak amplitude (PPA) in all patient-groups. Therefore, PREP was the only test providing findings of a small fiber impairment in patients with acral neuropathic pain even when QST and skin punch biopsy remained normal. PREP, as non-invasive method for the evaluation of the Aδ-pathways can be proposed as a valuable additional test for the evaluation of small fiber dysfunction in patients with neuropathic pain syndromes.

Det finns relativt omfattande internationell (främst amerikansk) litteratur som visat att militär internationell insats påverkar den anställde och dennes familj/nätverk, men få svenska studier. Syftet med denna studie var att fördjupa kunskapen om psykologiska belastningsfaktorer och stödbehov i samband med militär insats i utlandet med fokus på familjesituationen. Aktuella frågeställningar var: Hur upplevde veteranen/partnern ökad belastning, stressreaktioner eller annan påverkan på måendet? Hur upplevde veteranen/partnern/paret behov av stöd? Hur upplevde veteranen/partnern att PREP, ett pedagogiskt förebyggande program för par, varit till hjälp vid insats? Undersökningsgruppen bestod av fyra par som genomgått PREP där en i paret deltagit i en militär internationell insats i Afghanistan. Inför intervjuerna gjordes en intervjuguide på basis av inläst material. Det insamlade intervjumaterialet bearbetades utifrån tematisk analys. Resultat som framkom var ökad belastning på hemmavarande, (övergående) påverkan på måendet hos paret, betydelsen av mentala och praktiska förberedelse och en fungerande kommunikation liksom svårigheter att ta varandras perspektiv. Positiva effekter framkom som yrkesmässig utveckling, kamratskap under missionen och att paret klarat utmaningen. Specifika förutsättningar för anhörig till civilrekryterad personal beskrevs. Behov av stöd i olika former framkom liksom att PREP varit till hjälp. Slutsatser som drogs var betydelsen av delaktighet, vikten av att följa upp mental hälsa, att ett ”nätverkstänk” bör genomsyra hela (utbildnings)insatsen samt att bygga upp ”förstärkt PREP” eller andra anpassade former för par i behov av professionell behandling.

No description available.

This study investigates the effect of offering Pre-Exposure Prophylaxis (PrEP) against HIV, as a public policy, on the spread of syphilis through behavioral changes on the willingness to engage on riskier sex behavior (i.e. condomless sex). To explore such phenomena, a Difference in Differences method is applied to groups of municipalities in the southeastern region of Brazil. No significant effect was found after restricting the sample to approximate the underlying characteristics of the groups. The results do not support the findings of the previous studies, performed on smaller target groups, nor contradict them. The inconclusiveness of the results is likely due to, amongst other factors, the small number of individuals both taking PrEP or diagnosed with syphilis, compared to the general population of the municipalities.

AtPreP (Arabidopsis thaliana Presequence Protease) is a zink metallooligopeptidase that is dually targeted to both mitochondria and chloroplasts. In these organelles it functions as a peptidasome that degrades the N-terminal targeting peptides that are cleaved off from the mature protein after protein import, as well as other unstructured peptides. In A. thaliana there are two isoforms of PreP, AtPreP1 and AtPreP2.  We have performed characterization studies of single and double prep knockout plants. Immunoblot analysis revealed that both PreP isoforms are expressed in all tissues with highest expression levels in flowers and siliques. Furthermore, AtPreP1 was shown to be the most abundant isoform of the two. When comparing phenotype, the atprep2 mutant was similar to wild type, whereas the atprep1 mutant had a slight pale-green phenotype in the early developmental stages. The atprep1 atprep2 double knockout plants showed a chlorotic phenotype in true leaves, especially prominent during the early developmental stages. When analysing the first true leaves of double knockout plants, we found a significant decrease in chlorophyll a and b content. Mitochondrial respiratory rates measurements showed partially uncoupled mitochondria. Ultrastructure analysis using electron microscopy on double knockout plants showed aberrant chloroplasts with altered grana stacking and clearly fewer starch granules. Older plants showed less altered  phenotype, although there was a significant decrease in the accumulated biomass of about 40% compared to wild type. Peptidolytic activity studies showed no sign of compensatory mechanisms in the absence of AtPreP in mitochondria; in contrast we found a peptidolytic activity in the chloroplast membranes not related to AtPreP. In addition to zinc located in the catalytic site, crystallographic data revealed two Mg-binding sites in the AtPreP structure. To further investigate the role of these Mg-binding sites, we have made AtPreP variants that are unable to bind metal ions. Our data shows that one of these sites located close to the catalytic site is important for the activity of AtPreP. We also measured proteolytic activity of four human PreP-SNP variants and observed that the activity of all the hPreP-SNPs variants was lower; especially the hPreP-SNP (A525D) variant that displayed only 20-30 % of wild type activity. Interestingly, the activity was fully restored for all SNP-variants by addition of Mg2+.