Objective — To describe the vascular distribution pattern of contrast medium during intraosseous regional perfusion (IORP) of the distal portion of the forelimb in horses. Sample Population — 13 cadaver forelimbs from 12 horses without vascular or orthopedic disease of the distal forelimb. Procedure — Serial lateromedial radiographs were taken of 10 heparinized cadaver distal forelimbs at 0, 1, 2, 6, 15, and 30 minutes during IORP of the third metacarpal bone (MCIII) using iodinated contrast medium and a tourniquet placed over the proximal MCIII. Vascular regions of interest (ROI) were created for each radiograph. Reviewers identified presence or absence of contrast in each ROI. This information was summarized to identify vessel-filling patterns over time. Vessel identification was verified using computed tomography angiography and latex perfusion studies on separate cadaver distal forelimbs. Results — During IORP, contrast medium filled the medullary cavity of the MCIII, exited via trans-cortical vessels and diffused distally to the remaining arteries and veins of the limb, distal to the tourniquet. Maximum vessel and soft tissue opacification occurred in most specimens at 6 and 30 minutes, respectively. Serial radiography vessel patterns matched those of CT images and dissected specimens. Conclusions and Clinical Relevance — Intraosseous regional perfusion provides a repeatable pattern of vascular distribution in the distal portion of the equine forelimb. This is the first documentation of arterial perfusion using this technique. Previous reports indicate that IORP only delivers medications to the venous vessels of the perfused limb. Maximum soft tissue perfusion was observed at 30 minutes. / Master of Science

In six, healthy, adult horses, the origin of the left internal carotid artery was isolated via a modified hyovertebrotomy approach. Normograde blood flow was occluded by placement of a tourniquet on the artery near its origin. Lumenal access was gained through placement of a distally directed introducer sheath and retrograde blood flow from the cerebral arterial circle was confirmed. An 8.5 mm diameter detachable latex balloon loaded onto a carrier catheter and placed within a guiding catheter was introduced into the internal carotid artery through the introducer sheath and advanced to the target occlusion site (the proximal curve of the sigmoid flexure of the internal carotid artery). The balloon was inflated with 0.5 ml of a radiopaque solution. Correct placement and inflation of the balloon were confirmed by intraoperative radiography. The balloon was then released and the guiding and carrier catheters withdrawn. Immediate embolization of the distal internal carotid artery was determined by lack of retrograde blood flow through the introducer sheath. The introducer sheath was withdrawn from the vessel and the proximal tourniquet was replaced with two ligatures. Horses were euthanized on day 30 and detailed gross and histopathologic examinations were performed. The balloons were easily placed into the target site and produced immediate occlusion of retrograde flow from the cerebral arterial circle. All balloons remained inflated in their original position throughout the study period. Mature thrombus formation and absence of clinically significant inflammation were consistent findings in all occluded internal carotid arteries at gross necropsy and histologic examination. / Master of Science

Les cancers viro-induits dont le chef de file est le cancer du col utérin lié aupapillomavirus humain (HPV) représentent une cause importante de mortalité dans la Caraïbe. Ilsont récemment été désignés comme objectif de santé publique par les registres des cancers antillais.Pour autant, les données virologiques disponibles sont rares et concernent principalement lesantilles anglophones. Des études de répartition génotypique menées à Tobago, en Jamaïque et à laBarbade montrent, en population générale, une forte prévalence des infections par les HPV à hautrisque oncogène (HRHPV) et une prédominance de génotypes différents de ceux qui prévalent dansles pays du nord (i.e.: HPV16, HPV18) notamment les génotypes HPV45 et HPV58. Ces donnéessoulèvent la question de l’existence d’un profil de distribution génotypique particulier dans laCaraïbe et la nécessité, le cas échéant, d’adapter la stratégie de prévention vaccinale des infectionspar les HPV à haut risque oncogène car les vaccins actuels ne ciblent que les génotypes 16 et 18 .Objectifs : L’objectif principal du travail était de décrire la distribution génotypique (estimation dela prévalence des différents génotypes) des HPV oncogènes impliqués dans les infections de lasphère ano-génitale des femmes, en Guadeloupe. L’objectif secondaire était de préciser les facteursdémographiques, sociaux et cliniques associés à la présence d’une infection ano-génitale à HPVoncogène.Patients et méthodes : Trois études ont été envisagées : i) une étude rétrospective, en populationgénérale, à partir des données cytologiques et virologiques du cabinet de pathologie de Guadeloupedont l’activité est la plus intense dans le domaine ciblé, ii) deux études prospectives conduites chezdes femmes immunodéprimées, soit par une transplantation rénale, soit par une maladie systémiqueauto-immune. Cette population de femmes a été choisie car elle est caractérisée par une prévalenceélevée d’infections ano-génitales à HPV oncogènes et une fréquence importante de complicationscarcinologiques HPV-induites, documentée dans la littérature.8prévalence des HPV à haut risque oncogène de type ni 16 ni 18 comme en atteste la distributiongénotypique observée en population générale et en population immunodéprimée (i.e. prévalenceforte du type HPV52 et à moindre degré des types HPV39 et HPV51 chez les patientestransplantées et des types HPV31, HPV58, HPV39, HPV45 chez les patientes présentant unemaladie systémique auto-immune). Ces résultats confortent les données des études précédemmentconduites dans l’arc antillais et constituent un argument pour élargir la protection vaccinale anti-HPV aux types non 16 non 18, dans le but d’ optimiser la prévention primaire du cancer du colutérin, aux Antilles.Le vaccin anti-HPV nonavalent, de commercialisation récente, semble représenter une optionintéressante. En effet, les 5 types supplémentaires de HRHPV qu’il cible par rapport aux vaccins de1ère génération (i.e.: HPV31, HPV33, HPV45, HPV52, HPV58) correspondent aux types despapillomavirus humains à haut risque oncogène ni 16 ni 18 qui circulent activement dans laCaraïbe, y compris deux types impliqués dans les cancers invasifs du col utérin aux antillesfrançaises: HPV33 et HPV45.Les facteurs de risque d’infection par les HPV oncogènes identifiés dans notre travailcorrespondent aux facteurs largement documentés dans la littérature comme le début précoce desrapports sexuels ou le statut de célibataire. Une étude de plus grande envergure est nécessaire pourinvestiguer l’association avec la sclérodermie systémique. / Of the virus-related cancers, cervical cancer linked to the human papillomavirus(HPV), is one of the leading causes of mortality in the Caribbean. These cancers have recently beenidentified as an important public health problem by Caribbean cancer registries. However,virological data available are limited and related primarily to the English-speaking Caribbean.Genotypic distribution studies in Tobago, Jamaica and Barbados show a high HPV prevalence ofhigh-risk HPV types (HR HPV) infections in the general population and a predominance ofgenotypes different from those of northern countries (i.e.: HPV16 and HPV18) in particular typesHPV45 and HPV58. These data raise the question of the existence of a specific genotypicdistribution profile in the Caribbean and the need, if required, to adapt vaccine prevention strategyagainst HRHPV infections because current vaccines only target genotypes 16 and 18.Objectives: The main objective of this study was to describe the distribution of carcinogenic HPVtypes involved in anogenital infections of women in Guadeloupe. The second objective was toidentify the demographic, social and clinical factors associated with the presence of oncogenic HPVinfection of the anogenital area.Patients and methods: Three studies were conducted: (i) a retrospective study concerning thegeneral population based on cytological and virological data from the Guadeloupe pathologylaboratory whose activity is the most intense in the targeted field; (ii) two prospective studies inwomen immunocompromised (i.e.: kidney transplant recipients, autoimmune systemic disease).This population of women was chosen because it is characterized by a high prevalence of HPVanogenital infections with frequent HPV-induced mucosal cancer complications reported in theliterature.Our 3 studies show a high prevalence of anogenital infections with carcinogenic HPVin women on the island of Guadeloupe. This high prevalence appears to be directly linked to theprevalence of high-risk, oncogenic HPVs of type non 16 and non 18, as evidenced by the genotypicdistribution observed in the general population and the immunocompromised population (i.e. HPV52 , HPV39, HPV51 in kidney transplant recipients and HPV31, HPV58, HPV39, HPV45 inpatients with autoimmune systemic disease). These results are in accordance with data from studiespreviously carried-out in Caribbean. They constitute an argument for extending the protectionagainst non-16 and non-18 HPV types infections with the aim of optimizing the basic prevention ofcervical cancer in the caribbean countries. The nonavalent new HPV vaccine seems to constitute aninteresting option. The 5 additional types of HR HPV that it targets compared to first generationvaccines (i.e.: HPV31, HPV33, HPV45, HPV52, HPV58) correspond to high risk HPV types nor16nor18 that are actively marketed in the Caribbean, including two types involved in invasive cervical11cancer in the French West Indies: HPV33 and HPV45.Risk factors for HPV infection identified in our study correspond to factors widely documented inthe literature such as early onset of sexual intercourse or unmarried status. A larger study is neededto investigate the association with systemic sclerosis.

by Leung Chi-man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 106-117). / Abstracts in English and Chinese. / ABSTRACT (English) --- p.i-ii / ABSTRACT (Chinese) --- p.iii / ACKNOWLEDGMENT --- p.iv / LIST OF CONTENTS --- p.v-viii / LIST OF TABLES --- p.ix-x / LIST OF FIGURES --- p.xi / ABBREVIATIONS --- p.xii / TERMS --- p.xiii-xiv / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- History and taxonomic background of Acinetobacter --- p.1 -3 / Chapter 1.2 --- "Microbiology, ecology and habitats of Acinetobacter species" --- p.4 / Chapter 1.2.1 --- Isolation of Acinetobacter --- p.4 / Chapter 1.2.2 --- Clinical importance of Acinetobacter species --- p.5 / Chapter 1.2.3 --- Acinetobacter 226}0ؤ An endemic nosocomial pathogens of particular importance in Hong Kong --- p.6-7 / Chapter 1.2.4 --- Lack of knowledge of Acinetobacter genomic DNA groups --- p.7 / Chapter 1.2.5 --- Human carriage of Acinetobacter species --- p.8-9 / Chapter 1.2.6 --- Species from environment --- p.9-10 / Chapter 1.3 --- Identification of Acinetobacter --- p.10-11 / Chapter 1.3.1 --- DNA-DNA hybridization --- p.11 / Chapter 1.3.2 --- Phenotypic identification by conventional tests --- p.11 / Chapter 1.3.3 --- Genotypic identification by Amplified Ribosomal DNA Restriction Analysis (ARDRA) --- p.12-13 / Chapter 1.3.4 --- Other PCR methods --- p.13 / Chapter 1.3.5 --- Genotypic identification by tDNA fingerprinting --- p.14 / Chapter 1.4 --- Biotyping --- p.14-15 / Chapter 1.5 --- Background of this research project --- p.15 / Chapter 1.5.1 --- Distribution of different species of Acinetobacter --- p.15-16 / Chapter 1.5.2 --- Consideration of taxonomical problems --- p.16 / Chapter 1.5.3 --- Characterization of Acinetobacter isolates --- p.17 / Chapter 1.6 --- Research objectives --- p.18 / Chapter CHAPTER 2 --- MATERIALS AND METHODS / Chapter 2.1 --- Materials --- p.19 / Chapter 2.1.1 --- Reference strains --- p.19-20 / Chapter 2.1.2 --- Antimicrobial agents and chemicals --- p.20-21 / Chapter 2.1.3 --- "Carbohydrates, enzymes and other materials" --- p.22 / Chapter 2.1.4 --- Commercial media and media prepared manually --- p.23-26 / Chapter 2.1.5 --- Reagents --- p.27 / Chapter 2.1.6 --- Instruments and Software used in this study --- p.28 / Chapter 2.2 --- Methods --- p.28 / Chapter 2.2.1 --- Routine laboratory collection --- p.28 / Chapter 2.2.2 --- Blood culture collection --- p.29 / Chapter 2.2.3 --- Human carriage site collection --- p.29-31 / Chapter 2.2.4 --- Surveillance screening of clinical specimens --- p.31-32 / Chapter 2.2.5 --- Environmental samples 226}0´ؤؤ vegetable --- p.32 / Chapter 2.2.6 --- Environmental samples 一 soil --- p.32-34 / Chapter 2.3 --- General bacteriological techniques for genus identification --- p.34-37 / Chapter 2.4 --- Molecular techniques used for the delineation of genomic DNA groups --- p.37 / Chapter 2.4.1 --- Amplified ribosomal restriction DNA analysis (ARDRA) --- p.37-39 / Chapter 2.4.2 --- Characterization of acinetobacters by tRNA spacer (tDNA) fingerprinting analysis --- p.40-42 / Chapter 2.5 --- Biotyping of Acinetobacter spp --- p.42 / Chapter 2.6 --- Minimum Inhibitory Concentration (MIC) --- p.43-44 / Chapter CHAPTER 3 --- DISTRIBUTION OF ACINETOBACTER SPECIES / Chapter 3.1 --- Results --- p.45 / Chapter 3.1.1 --- Isolation of acinetobacters from surveillance screening of clinical specimens --- p.45-49 / Chapter 3.1.2 --- Isolation of acinetobacters from routine laboratory specimens --- p.49-50 / Chapter 3.1.3 --- Distribution of acinetobacter genomic DNA groups in all clinical specimens --- p.50-51 / Chapter 3.1.4 --- Isolation of acinetobacters from blood culture --- p.51 -52 / Chapter 3.1.5 --- Isolation of acinetobacters from human carriage sites --- p.53-55 / Chapter 3.1.6 --- Isolation of acinetobacters from environmental samples --- p.56-59 / Chapter 3.2 --- Discussion --- p.60 / Chapter 3.2.1 --- Prevalence of Acinetobacter species in clinical specimens --- p.60-61 / Chapter 3.2.2 --- Distribution of acinetobacter genomic DNA groups in clinical specimens --- p.61 -63 / Chapter 3.2.3 --- Distribution of different genomic DNA groups of Acinetobacter on carriage sites --- p.63-65 / Chapter 3.2.4 --- Distribution of different genomic DNA groups of Acinetobacter in environmental samples --- p.65-66 / Chapter CHAPTER 4 --- AN ASSESSMENT OF TDNA FINGERPRINTING IN THE IDENTIFICATION OF ACINETOBACTER SPECIES / Chapter 4.1 --- Results --- p.67 / Chapter 4.1.1 --- Complexity of tDNA fingerprint patterns --- p.67 / Chapter 4.1.2 --- Assessment of tDNA fingerprinting --- p.67-69 / Chapter 4.1.3 --- Construction of fingerprints database with the reference Acinetobacter strains --- p.70 / Chapter 4.1.4 --- Delineation of different genomic DNA groups in the fingerprints database --- p.71 / Chapter 4.1.5 --- Cluster analysis of tDNA fingerprints of Acinetobacter isolates classified by ARDRA --- p.71-73 / Chapter 4.2 --- Discussion --- p.74-75 / Chapter 4.3 --- Conclusion --- p.75-76 / Chapter CHAPTER 5 --- "BIOTYPING OF ISOLATES FROM CLINICAL SPECIMENS, CARRIAGE SITES AND ENVIRONMENTAL SAMPLES" / Chapter 5.1 --- Results --- p.77 / Chapter 5.1.1 --- Biotypes of A. baumannii --- p.77 / Chapter 5.1.2 --- Biotypes of genomic DNA group --- p.3 78 / Chapter 5.1.3 --- Biotypes of genomic DNA group 13TU --- p.78-79 / Chapter 5.2 --- Discussion --- p.79-80 / Chapter CHAPTER 6 --- ANTIMICROBIAL SUSCEPTIBILITIES OF ACINETOBACTER SPECIES / Chapter 6.1 --- Results --- p.81 / Chapter 6.1.1 --- Bacterial strains --- p.81 / Chapter 6.1.2 --- Susceptibilities of Acinetobacter genomic DNA groups --- p.82-86 / Chapter 6.1.3 --- Distribution of resistance patterns in Acinetobacter species --- p.87-90 / Chapter 6.2 --- Discussion --- p.91 / Chapter 6.2.1 --- Antimicrobial susceptibilities of different genomic DNA groups of Acinetobacter from different sources --- p.91-92 / Chapter 6.2.2 --- Emergence of P-Lactam resistance --- p.92 / Chapter 6.2.3 --- Activity of sulbactam --- p.93 / Chapter 6.2.4 --- Susceptibility of carbapenem --- p.93 / Chapter 6.2.5 --- Quinolones resistance --- p.94 / Chapter 6.2.6 --- Aminoglycoside resistance --- p.94-95 / Chapter 6.3 --- Conclusion --- p.95 / Chapter CHAPTER 7 --- GENERAL DISCUSSION / Chapter 7.1 --- Significance of delineation of genomic DNA groups of Acinetobacter --- p.96-98 / Chapter 7.2 --- Epidemiology and clinical implication of Acinetobacter species in Hong Kong --- p.99-104 / Chapter 7.3 --- Characterization of Acinetobacter --- p.104 / Chapter 7.4 --- Future work --- p.104-105 / REFERENCES --- p.106-117 / APPENDIX --- p.118-126

Francisella tularensis est une bactérie intracellulaire à Gram négatif et l'un des agents les plus infectieux connu à l'heure actuelle, en particulier par voie respiratoire. L'inhalation d'une dizaine de bactéries suffit à provoquer une maladie mortelle : la tularémie pulmonaire. Sa facilité de dissémination par aérosols, ainsi que le caractère létal de cette pathologie, ont contribué à considérer F. tularensis comme une arme biologique potentielle. La tularémie pulmonaire est une infection aigue qui s'accompagne d'une réponse immunitaire inadaptée. F. tularensis infecte en premier lieu les cellules phagocytaires, notamment les macrophages. Alors que ces derniers sont des acteurs majeurs de la défense contre les agents infectieux, de nombreux mécanismes d'échappement permettent à F. tularensis d'éviter ou de résister aux réponses de l'hôte et ainsi de se multiplier et de disséminer dans l'organisme. Ainsi, après un retard initial dans la mise en place de la réponse immunitaire, la présence d'un grand nombre de bactéries et de signaux de danger libérés par les cellules infectées, conduisent au déclenchement d'une réponse inflammatoire excessive. Celle-ci se caractérise par une tempête cytokinique provoquant un recrutement massif de cellules immunitaires, en particulier de neutrophiles, dans les tissus infectés. Les dommages tissulaires associés à cette réponse inflammatoire sont en grande partie responsable de la mortalité associée aux infections pulmonaires par F. tularensis. La tularémie est actuellement traitée par antibiothérapie. Malheureusement, l'absence de symptômes spécifiques de cette maladie rend le diagnostic difficile et, par conséquent, retarde la prescription du traitement adapté. Or, l'efficacité des antibiotiques est considérablement réduite par cette administration tardive. De nouvelles stratégies thérapeutiques sont donc nécessaires pour remplacer ou compléter l'antibiothérapie. Dans ce contexte, nous avons cherché à déterminer si la modulation de la réponse inflammatoire excessive induite par F. tularensis pouvait être bénéfique pour l'hôte infecté et ainsi être utilisée comme thérapie accessoire. L'objectif de mon travail de thèse était d'évaluer les propriétés anti-inflammatoires et le potentiel bénéfice thérapeutique du mannodendrimère 3T (M3T), un composé synthétisé par l'équipe de J. Nigou, dans un modèle murin d'infection pulmonaire par F. tularensis. Le M3T, conçu pour mimer les propriétés anti-inflammatoires d'un glycolipide de la paroi de Mycobacterium tuberculosis, a précédemment montré un effet inhibiteur sur la production de cytokines pro-inflammatoires et le recrutement de neutrophiles dans un modèle murin d'inflammation pulmonaire aigue induite par le LPS. La souche F. novicida, provoquant chez la souris une pathologie similaire à une infection pulmonaire par F. tularensis, a été utilisée comme souche de substitution dans ces travaux. In vitro, nous avons montré que le M3T inhibe la production de cytokines pro-inflammatoires induite par F. novicida dans des macrophages et cellules dendritiques humaines. D'un point de vue mécanistique, l'ensemble des données suggère que le M3T inhibe la réponse inflammatoire induite par F. novicida via le récepteur TLR2, en activant une voie de signalisation dépendante du récepteur DC-SIGN. In vivo, le M3T a été administré par injection intraveineuse 6 h post-infection, puis quotidiennement pendant 3 jours, en combinaison avec un traitement antibiotique sous-optimal. / Francisella tularensis is an intracellular Gram negative bacterium and the causative agent of tularemia. It is one of the most infectious agents known to date. Infection by the respiratory route leads to the deadly pulmonary form of tularemia. For these reasons, F. tularensis has been considered for years as a potential biological weapon. Pulmonary tularemia is characterized by an acute infection and a defect in immune responses. Particularly, the innate immune system plays a central role in F. tularensis infection and pathology. Macrophages, key cells of the innate immune system, are the main target for F. tularensis. This bacterium has evolved many strategies to escape host defenses that allow it to replicate within the cells and then disseminate into the whole organism. At this systemic stage, bacteria, along with alarm signals from infected cells, are recognized by innate immune receptors, triggering an inappropriate inflammatory response. The latter is characterized by a cytokine storm leading to a massive recruitment of immune cells, particularly neutrophils, in infected tissue. Tissue damages caused by this inflammation are a major cause of mortality associated with F. tularensis infections. Today, the treatment of tularemia is based on antibiotherapy. However, no specific symptoms can be assigned to pulmonary tularemia making its diagnosis difficult. This delays the administration of an appropriate antibiotiotherapy whose efficacy is therefore decreased. Thus, new therapeutic strategies are needed to replace or complement antibiotics. In this context, we investigated whether reducing the excessive inflammation induced by F. tularensis could be beneficial for the host and be considered as an adjunctive host- directed therapy. The aim of my work was to evaluate the anti-inflammatory properties and the therapeutic potential of mannodendrimer 3T (M3T), a synthetic coumpond designed in the team, in a mouse model of pulmonary infection by F. tularensis. M3T was previously designed to mimic the anti-inflammatory traits of a specific glycolipid from Mycobacterium tuberculosis. It was previously shown to inhibit the production of pro-inflammatory cytokines and neutrophils recruitment in a mouse model of LPS-induced pulmonary inflammation. Here, we used F. novicida as a surrogate for F. tularensis since it induces an identical inflammatory pathology. In vitro, M3T was found to inhibit the production of pro-inflammatory cytokines in human macrophages and dendritic cells infected by F. novicida. M3T modulates inflammatory response triggered by F. novicida via TLR2 most likely by the activation of a DC-SIGN-dependant pathway. In vivo, M3T was administered 6 h post-infection and then, daily for 3 days, by intraveinous injection and combined with a suboptimal antibiotic. This combination increases the survival rate of mice infected with F. novicida as compared to mice treated with antibiotic alone. M3T treatment has no impact on bacterial burden but seems to reduce tissue damages as observed by histological analyses of lungs, liver and spleen of infected mice. Altogether, our data demonstrate that M3T administration provides a therapeutic benefit in a mouse model of pulmonary infection by F. novicida. On a more general perspective our results suggest that targeting inflammation can be considered as an adjunctive treatment in acute pulmonary infections.

Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States (U.S.). The largest increases of incidence for HCV infection are reported in the Appalachian region. This study aimed to 1) examine the prevalence and trends of HCV infection in the U.S. from 1999 to 2012; 2) investigate barriers to HCV infection treatment in Northeast Tennessee and the U.S.; and 3) study characteristics and risk factors for HIV-infection and HCV-infection in Northeast Tennessee. In the U.S., data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 to study the prevalence of HCV infection and barriers to treatment. In Northeast Tennessee, hepatitis C and HIV/AIDS data were obtained from National Electronic Disease Surveillance System (NEDSS) and enhanced HIV/AIDS Reporting System (eHARS). Descriptive statistics and multiple logistic regression models were used for analysis. Odds ratios (OR) and 95% confidence intervals (CI) were reported. There was an estimated 3.8 million people having HCV antibody in the U.S. in 2012. No significant change was found in the prevalence of HCV infection during 1999 – 2012. The leading barrier to the treatment was cost issues in the U.S. (50.0%) and Northeast Tennessee (25.0%), respectively. HCV patients without symptoms in Northeast Tennessee were more likely to be untreated (OR: 3.08, 95% CI: 1.10-8.60) and patients without health insurance in the U.S. were more likely to be untreated than their counterparts (OR: 3.38, 95% CI: 1.14-10.05). The incidence of acute hepatitis C peaked in 2012-2013 in Northeast Tennessee, while the incidence of HIV/AIDS increased by 100% from 2013 to 2015. More injection drug users (IDUs) and less men who have sex with men (MSM) were observed in patients with HCV infection than in those with HIV infection (IDUs: 50.63% vs.16.38% p

In response to improving quality patient care, combined with the growing rates of surgical site infections (SSIs) in vascular patients, the need to explore current practice trends with current evidence has been identified. SSIs affect quality patient care and compromise patient safety. Empirical evidence has recommended the use of a chlorhexidine wash preoperatively to reduce SSIs. Despite this recommended practice, vascular patients were not receiving it in their routine plan of care within a hospital organization in southern Ontario. Guided by Lewin's theory of planned change, this project explored how the planning of a chlorhexidine preoperative surgical skin preparation protocol impacted progress toward improved care of vascular patients. The project was designed as a quality improvement project examining approximately 110 vascular surgical procedures over a 1-month period and staff surveys that were provided to staff in the preoperative (n = 88), same day surgery (n = 68), and inpatient (n = 47) units. These data were analyzed and demonstrated a reduction in vascular SSIs from 4.9% pre-implementation to 2.8% 1-month post-implementation. Major themes generated from the staff surveys demonstrated the nursing staff had a good understanding of the content that was presented in the in-service provided. These findings have implications for social change by highlighting the benefits of incorporating evidence in to practice and further informing the preoperative practice in other surgical specialties.

Brachylaima spp. (Digenea: Brachylaimidae) are terrestrial trematodes of mammals and birds and have land snails as their first and second intermediate hosts. This thesis describes a new species of Brachylaima and investigates infection in both snail intermediate hosts and definitive host animals. A laboratory life-cycle was established using brachylaimid eggs recovered from the faeces of an infected human. Five species of introduced European helicid and hygromiid snails, Theba pisana, Cernuella virgata, Cochlicella acuta, Cochlicella barbara and Microxeromagna armillata were susceptible first intermediate hosts. These same snails and introduced Helix aspersa as well as the native snails Succinea australis and Strangesta gawleri were suitable second intermediate hosts. Field and laboratory studies revealed that in addition to humans and mice, various species of birds and reptiles were also definitive hosts. On the basis of its unique morphological and lifecycle features, a new species, Brachylaima cribbi was described. The scanning electron microscopical appearances of the various life-cycle stages were detailed. Studies of Swiss albino outbred mice and 8 strains of inbred mice revealed that C57BL/6J mice were most susceptible to B. cribbi infection. The peak infection occurred 4 weeks after inoculation with metacercariae following which worms were expelled over the next few weeks. Exposure to a second infection in C57BL/6J mice did not result in accelerated expulsion of adult worms but did significantly inhibit their fecundity. In contrast, when immunodeficient NOD SCID mice were infected with B. cribbi metacercariae the adult worms persisted for the life span of the host mice. 6,432 land snails were collected over a distance of 3,000 km across southern Australia. Sporocyst-infected snails were found in all districts of South Australia and Victoria with the percentages of infected T. pisana, C. virgata, C. acuta and C. barbara ranging from 1.7 to 4.7%. These 4 species together with M. armillata, S. australis and S. gawleri were infected with metacercariae being found in 18-63% of snails and the mean number of metacercariae per infected snail ranged from 2.1 to 6.1. Laboratory studies revealed that eggs may remain viable for almost 12 months in mouse faeces. The prepatent period for a sporocyst infection is 7-10 weeks after egg ingestion. Metacercariae 7 weeks of age are capable of developing into adult worms. Detailed studies of seasonal variations in sporocyst and metacercarial infection rates were studied at 4 ecologically diverse sites on the Yorke Peninsula of South Australia. The clinical features and epidemiological circumstances of B. cribbi infections of 12 humans are detailed, as is their satisfactory response to treatment with praziquantel. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2003.

<p>Syftet med denna litteraturstudie var att beskriva varför följsamheten gällande handhygien ofta är låg bland vårdpersonal, samt hur man kan öka följsamheten för handhygien bland vårdpersonal. Metoden som använts var en litteraturstudie. Datainsamling skedde via databaserna Medline (PubMed), Cinahl (EBSCO host) och Academic Search Elite. Sökorden som använts: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. Totalt användes 15 vetenskapliga artiklar. Resultatet delades in i två huvudrubriker: Orsaker till att följsamheten ofta är låg bland vårdpersonal och faktorer som kan öka följsamheten gällande handhygien bland vårdpersonal. De två huvudrubrikerna delades in i sex underrubriker: tidsbrist, hudbekymmer, kunskapsbrist, utbildning, affisch/posters och tillgänglighet. Resultatet visade att det finns många anledningar till att följsamheten för handhygien är låg. Studien visar att tidsbrist, hudbekymmer samt kunskapsbrist gällande hand hygien är de vanligaste orsakerna. Utbildning tillsammans med affischer/posters samt ökad tillgänglighet vad gäller material har visat sig vara det mest effektiva sättet att öka följsamheten av handhygien.</p><p><strong><p>Nyckelord</p><p>.</p>: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. </strong></p>

Syftet med denna litteraturstudie var att beskriva varför följsamheten gällande handhygien ofta är låg bland vårdpersonal, samt hur man kan öka följsamheten för handhygien bland vårdpersonal. Metoden som använts var en litteraturstudie. Datainsamling skedde via databaserna Medline (PubMed), Cinahl (EBSCO host) och Academic Search Elite. Sökorden som använts: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. Totalt användes 15 vetenskapliga artiklar. Resultatet delades in i två huvudrubriker: Orsaker till att följsamheten ofta är låg bland vårdpersonal och faktorer som kan öka följsamheten gällande handhygien bland vårdpersonal. De två huvudrubrikerna delades in i sex underrubriker: tidsbrist, hudbekymmer, kunskapsbrist, utbildning, affisch/posters och tillgänglighet. Resultatet visade att det finns många anledningar till att följsamheten för handhygien är låg. Studien visar att tidsbrist, hudbekymmer samt kunskapsbrist gällande hand hygien är de vanligaste orsakerna. Utbildning tillsammans med affischer/posters samt ökad tillgänglighet vad gäller material har visat sig vara det mest effektiva sättet att öka följsamheten av handhygien. Nyckelord . : prevention, hand disinfection, hand washing, infection control, nosocomial infection och education.