Publications by authors named "Joanna Harris"

17 Publications

  • Page 1 of 1

A hitchhiker guide to manta rays: Patterns of association between Mobula alfredi, M. birostris, their symbionts, and other fishes in the Maldives.

PLoS One 2021 14;16(7):e0253704. Epub 2021 Jul 14.

The Manta Trust, Dorset, United Kingdom.

Despite being among the largest and most charismatic species in the marine environment, considerable gaps remain in our understanding of the behavioural ecology of manta rays (Mobula alfredi, M. birostris). Manta rays are often sighted in association with an array of smaller hitchhiker fish species, which utilise their hosts as a sanctuary for shelter, protection, and the sustenance they provide. Species interactions, rather than the species at the individual level, determine the ecological processes that drive community dynamics, support biodiversity and ecosystem health. Thus, understanding the associations within marine communities is critical to implementing effective conservation and management. However, the underlying patterns between manta rays, their symbionts, and other hitchhiker species remain elusive. Here, we explore the spatial and temporal variation in hitchhiker presence with M. alfredi and M. birostris throughout the Maldives and investigate the factors which may influence association using generalised linear mixed effects models (GLMM). For the first time, associations between M. alfredi and M. birostris with hitchhiker species other than those belonging to the family Echeneidae are described. A variation in the species of hitchhiker associated with M. alfredi and M. birostris was identified, with sharksucker remora (Echeneis naucrates) and giant remora (Remora remora) being the most common, respectively. Spatiotemporal variation in the presence of manta rays was identified as a driver for the occurrence of ephemeral hitchhiker associations. Near-term pregnant female M. alfredi, and M. alfredi at cleaning stations, had the highest likelihood of an association with adult E. naucrates. Juvenile E. naucrates were more likely to be associated with juvenile M. alfredi, and a seasonal trend in E. naucrates host association was identified. Remora were most likely to be present with female M. birostris, and a mean number of 1.5 ± 0.5 R. remora were observed per M. birostris. It is hoped these initial findings will serve as the basis for future work into the complex relationships between manta rays and their hitchhikers.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253704PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279400PMC
July 2021

Implementation of an antimicrobial stewardship programme and reduction in carbapenemase-producing Enterobacterales in an Australian local health district.

JAC Antimicrob Resist 2020 Sep 13;2(3):dlaa041. Epub 2020 Jul 13.

Department of Infectious Diseases, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Crown Street, Wollongong, New South Wales 2500, Australia.

Background: Carbapenemase-producing Enterobacterales (CPE) are increasingly seen in Australian hospitals. Antimicrobial stewardship (AMS) interventions have been shown to reduce rates of carbapenem-resistant organisms; data on their effect on CPE rates are limited.

Objectives: To explore the effect of a multi-site computer-supported AMS programme on the rates of CPE in an Australian local health district.

Methods: All laboratory CPE isolates between 2008 and 2018 were identified. Microbiological and demographic data, CPE risk factors and outcomes were collected. Monthly carbapenem use was expressed as DDD per 1000 occupied bed days (OBD). Hand hygiene compliance rates among healthcare workers were analysed. A computer-supported AMS programme was implemented district-wide in 2012. Bivariate relationships were examined using Pearson's and predictors of CPE isolates using time series linear regression.

Results: We identified 120 isolates from 110 patients. Numbers of CPE isolates and carbapenem use both showed a strong downward trend during the study period; the decreases were strongly correlated (0.80, 0.006). The positive relationship between carbapenem use and CPE isolation was maintained while adjusting for time (0.05, 0.001). Average yearly consumption of carbapenems fell by 20%, from 18.4 to 14.7 DDD/1000 OBD following implementation of the AMS programme. Hand hygiene compliance rates remained high throughout.

Conclusions: We demonstrated a reduction of CPE isolates in conjunction with reduced carbapenem use, longitudinally consolidated by a formal AMS programme. Prospective studies are needed to validate the effect of AMS on carbapenem resistance, especially in high-prevalence settings.
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http://dx.doi.org/10.1093/jacamr/dlaa041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210183PMC
September 2020

Environmental drivers of reef manta ray (Mobula alfredi) visitation patterns to key aggregation habitats in the Maldives.

PLoS One 2021 23;16(6):e0252470. Epub 2021 Jun 23.

The Manta Trust, Corscombe, Dorset, United Kingdom.

A detailed understanding of the dynamics of small-scale (10s km) habitat use by the reef manta ray (Mobula alfredi) in the Maldives Archipelago is required to develop an effective national conservation management plan for this wide-ranging species. Here, a combination of photo-ID sightings data and acoustic telemetry were used to investigate both long-term M. alfredi visitation trends and small-scale movement patterns to key habitats on the eastern side of Baa Atoll (Hanifaru Bay feeding area, Dhigu Thila multifunctional site, and Nelivaru Thila cleaning station). All tagged and most of the sighted M. alfredi exhibited high affinity to the eastern side of Baa Atoll, where 99% of detections occurred, and 69% of individuals were re-sighted in multiple years. Sightings data suggests that visitation patterns may be associated with differences in habitat use by sex and maturity status. Boosted regression trees indicated that tag detection probability at Hanifaru Bay increased with increased westerly wind speed (>5ms-1) during the day, close to a new and full moon just after high tide, and when the tidal range was low. Interaction effects between predictors suggest that wind-driven oceanographic processes, such as Langmuir Circulation, maybe working to increase zooplankton concentration at this location. Tag detection probability increased at Dhigu Thila under similar conditions. At Nelivaru Thila, it increased at lower wind speeds (<5ms-1), close to a full moon, three hours after high tide. These results suggest that M. alfredi may utilise cleaning stations during the day when environmental conditions are not suitable for feeding. There was a high level of connectivity between these three locations, which suggests they form part of a network of key habitats that provide essential services to M. alfredi locally. Future conservation efforts should focus on identifying all areas of key habitat use for this species within the Maldives; applying strict protective measures to these sites and any connecting migration corridors which link them.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252470PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221513PMC
June 2021

Fine-scale oceanographic drivers of reef manta ray () visitation patterns at a feeding aggregation site.

Ecol Evol 2021 May 24;11(9):4588-4604. Epub 2021 Mar 24.

The Manta Trust Dorset UK.

Globally, reef manta rays () are in decline and are particularly vulnerable to exploitation and disturbance at aggregation sites. Here, passive acoustic telemetry and a suite of advanced oceanographic technologies were used for the first time to investigate the fine-scale (5-min) influence of oceanographic drivers on the visitation patterns of 19 tagged to a feeding aggregation site at Egmont Atoll in the Chagos Archipelago. Boosted regression trees indicate that tag detection probability increased with the intrusion of cold-water bores propagating up the atoll slope through the narrow lagoon inlet during flood tide, potentially transporting zooplankton from the thermocline. Tag detection probability also increased with warmer near-surface temperature close to low tide, with near-surface currents flowing offshore, and with high levels of backscatter (a proxy of zooplankton biomass). These combinations of processes support the proposition that zooplankton carried from the thermocline into the lagoon during the flood may be pumped back out through the narrow inlet during an ebb tide. These conditions provide temporally limited feeding opportunities for , which are tied on the tides. Results also provide some evidence of the presence of Langmuir Circulation, which transports and concentrates zooplankton, and may partly explain why occasionally remained at the feeding location for longer than that two hours. Identification of these correlations provides unique insight into the dynamic synthesis of fine-scale oceanographic processes which are likely to influence the foraging ecology of at Egmont Atoll, and elsewhere throughout their range.
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http://dx.doi.org/10.1002/ece3.7357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093739PMC
May 2021

Association of Aβ deposition and regional synaptic density in early Alzheimer's disease: a PET imaging study with [C]UCB-J.

Alzheimers Res Ther 2021 01 5;13(1):11. Epub 2021 Jan 5.

Alzheimer's Disease Research Unit, Yale University School of Medicine, One Church Street, 8th Floor, New Haven, CT, 06510, USA.

Background: Attempts to associate amyloid-β (Aβ) pathogenesis with synaptic loss in Alzheimer's disease (AD) have thus far been limited to small numbers of postmortem studies. Aβ plaque burden is not well-correlated with indices of clinical severity or neurodegeneration-at least in the dementia stage-as deposition of Aβ reaches a ceiling. In this study, we examined in vivo the association between fibrillar Aβ deposition and synaptic density in early AD using positron emission tomography (PET). We hypothesized that global Aβ deposition would be more strongly inversely associated with hippocampal synaptic density in participants with amnestic mild cognitive impairment (aMCI; a stage of continued Aβ accumulation) compared to those with dementia (a stage of relative Aβ plateau).

Methods: We measured SV2A binding ([C]UCB-J) and Aβ deposition ([C]PiB) in 14 participants with aMCI due to AD and 24 participants with mild AD dementia. Distribution volume ratios (DVR) with a cerebellar reference region were calculated for both tracers to investigate the association between global Aβ deposition and SV2A binding in hippocampus. Exploratory analyses examined correlations between both global and regional Aβ deposition and SV2A binding across a broad range of brain regions using both ROI- and surface-based approaches.

Results: We observed a significant inverse association between global Aβ deposition and hippocampal SV2A binding in participants with aMCI (r = - 0.55, P = 0.04), but not mild dementia (r = 0.05, P = 0.82; difference statistically significant by Fisher z = - 1.80, P = 0.04). Exploratory analyses across other ROIs and whole brain analyses demonstrated no broad or consistent associations between global Aβ deposition and regional SV2A binding in either diagnostic group. ROI-based analyses of the association between regional Aβ deposition and SV2A binding also revealed no consistent pattern but suggested a "paradoxical" positive association between local Aβ deposition and SV2A binding in the hippocampus.

Conclusions: Our findings lend support to a model in which fibrillar Aβ is still accumulating in the early stages of clinical disease but approaching a relative plateau, a point at which Aβ may uncouple from neurodegenerative processes including synaptic loss. Future research should investigate the relationship between Aβ deposition and synaptic loss in larger cohorts beginning preclinically and followed longitudinally in conjunction with other biomarkers.
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http://dx.doi.org/10.1186/s13195-020-00742-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786921PMC
January 2021

Cognitively Impaired Older Persons' and Caregivers' Perspectives on Dementia-Specific Advance Care Planning.

J Am Geriatr Soc 2021 Apr 20;69(4):932-937. Epub 2020 Nov 20.

Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Background/objectives: Advance care planning (ACP) traditionally involves asking individuals about their treatment preferences during a brief period of incapacity near the end of life. Because dementia leads to prolonged incapacity, with many decisions arising before a terminal event, it has been suggested that dementia-specific ACP is necessary. We sought to elicit the perspectives of older adults with early cognitive impairment and their caregivers on traditional and dementia-specific ACP.

Design: Qualitative study with separate focus groups for patients and caregivers.

Setting: Memory disorder clinics.

Participants: Twenty eight persons aged 65+ with mild cognitive impairment or early dementia and 19 caregivers.

Measurements: Understanding of dementia trajectory and types of planning done; how medical decisions would be made in the future; thoughts about these decisions.

Results: No participants had engaged in any written form of dementia-specific planning. Barriers to dementia-specific ACP emerged, including lack of knowledge about the expected trajectory of dementia and potential medical decisions, the need to stay focused in the present because of fear of loss of self, disinterest in planning because the patient will not be aware of decisions, and the expectation that involved family members would take care of issues. Some patients had trouble engaging in the discussion. Patients had highly variable views on what the quality of their future life would be and on the leeway their surrogates should have in decision making.

Conclusions: Even among patients with early cognitive impairment seen in specialty clinics and their caregivers, most were unaware of the decisions they could face, and there were many barriers to planning for these decisions. These issues would likely be magnified in more representative populations, and highlight challenges to the use of dementia-specific advance directive documents.
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http://dx.doi.org/10.1111/jgs.16953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300881PMC
April 2021

In vivo measurement of widespread synaptic loss in Alzheimer's disease with SV2A PET.

Alzheimers Dement 2020 07 13;16(7):974-982. Epub 2020 May 13.

Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, Connecticut.

Introduction: Synaptic loss is a robust and consistent pathology in Alzheimer's disease (AD) and the major structural correlate of cognitive impairment. Positron emission tomography (PET) imaging of synaptic vesicle glycoprotein 2A (SV2A) has emerged as a promising biomarker of synaptic density.

Methods: We measured SV2A binding in 34 participants with early AD and 19 cognitively normal (CN) participants using [ C]UCB-J PET and a cerebellar reference region for calculation of the distribution volume ratio.

Results: We observed widespread reductions of SV2A binding in medial temporal and neocortical brain regions in early AD compared to CN participants. These reductions were largely maintained after correction for volume loss and were more extensive than decreases in gray matter volume.

Conclusion: We were able to measure widespread synaptic loss due to AD using [ C]UCB-J PET. Future studies will continue to evaluate the utility of SV2A PET for tracking AD progression and for monitoring potential therapies.
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http://dx.doi.org/10.1002/alz.12097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383876PMC
July 2020

Emotional touchpoints; the feelings nurses have about explaining multi-resistant organisms to colonised patients.

Infect Dis Health 2020 03 25;25(2):113-123. Epub 2020 Jan 25.

Office of the Deputy Vice-Chancellor (Research & Industry Engagement), LaTrobe University, Melbourne, 3086, Australia; School of Humanities and Languages, UNSW Sydney, 2052, Australia; Ethics, Policy and Public Engagement Theme, Australian Research Council, Centre of Excellence for Electromaterials Science (ACES), La Trobe University, Melbourne, 3086, Australia. Electronic address:

Background: Nurses face challenges when providing information about multi-resistant organisms (MROs), and related hospital policies, to patients found to be colonised, and may be concerned for their own safety when caring for MRO-colonised people. Resultant emotional responses may influence behaviours of staff caring for these patients. This study aimed to identify the feelings experienced by nurses when talking about MROs with patients. Secondary objectives were to learn about staff behaviours towards MRO-colonised patients, and to explore the utility of Emotional Touchpoints methodology in this context.

Methods: A qualitative study using an adapted Emotional Touchpoints method delivered as a paper survey tool for data collection. Content analysis and inductive coding of responses was used to identify key themes.

Results: 53 nurses participated. 'Nervous', 'Concerned' and 'Knowledgeable' were the most commonly selected adjectives chosen to describe their feelings. Reasons for these choices were themed as 'Empowerment through knowledge', 'Performance anxiety', 'Concern for the patient' and 'Concern for professional reputation'. Social or temporal distancing, and the need for staff and other patients to be protected from contagion were key themes for the behaviours these nurses had witnessed towards patients.

Conclusion: Talking about MROs with patients can elicit strong emotional responses in nurses, and MRO-colonised patients may be treated and spoken about in a discriminatory fashion. Infection prevention and control teams should recognise this and focus on the person rather than the pathogen when educating and supporting nurses. Recommendations for practice are made to support improved wellbeing of nurses as well as MRO colonised patients.
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http://dx.doi.org/10.1016/j.idh.2019.12.006DOI Listing
March 2020

PET imaging of mGluR5 in Alzheimer's disease.

Alzheimers Res Ther 2020 01 18;12(1):15. Epub 2020 Jan 18.

Alzheimer's Disease Research Unit, Yale University School of Medicine, One Church Street, 8th Floor, New Haven, CT, 06510, USA.

Background: Metabotropic glutamate subtype 5 receptors (mGluR5) modulate synaptic transmission and may constitute an important therapeutic target in Alzheimer's disease (AD) by mediating the synaptotoxic action of amyloid-β oligomers. We utilized the positron emission tomography (PET) radioligand [F]FPEB to investigate mGluR5 binding in early AD.

Methods: Sixteen individuals with amnestic mild cognitive impairment (MCI) due to AD or mild AD dementia who were positive for brain amyloid were compared to 15 cognitively normal (CN) participants who were negative for brain amyloid. Diagnostic groups were well balanced for age, sex, and education. Dynamic PET scans were acquired for 60 min, starting at 60 min after the initial administration of up to 185 MBq of [F]FPEB using a bolus-plus-constant-infusion method (K = 190 min). Equilibrium modeling with a cerebellum reference region was used to estimate [F]FPEB binding (BP) to mGluR5. Analyses were performed with and without corrections for gray matter atrophy and partial volume effects.

Results: Linear mixed model analysis demonstrated a significant effect of group (p = 0.011) and the group × region interaction (p = 0.0049) on BP. Post hoc comparisons revealed a significant reduction (43%) in mGluR5 binding in the hippocampus of AD (BP = 0.76 ± 0.41) compared to CN (BP = 1.34 ± 0.58, p = 0.003, unpaired t test) participants, and a nonsignificant trend for a reduction in a composite association cortical region in AD (BP = 1.57 ± 0.25) compared to CN (BP = 1.86 ± 0.63, p = 0.093) participants. Exploratory analyses suggested additional mGluR5 reductions in the entorhinal cortex and parahippocampal gyrus in the AD group. In the overall sample, hippocampal mGluR5 binding was associated with episodic memory scores and global function.

Conclusions: [F]FPEB-PET revealed reductions in hippocampal mGluR5 binding in early AD. Quantification of mGluR5 binding in AD may expand our understanding of AD pathogenesis and accelerate the development of novel biomarkers and treatments.
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http://dx.doi.org/10.1186/s13195-020-0582-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969979PMC
January 2020

Are Contact Precautions ethically justifiable in contemporary hospital care?

Nurs Ethics 2019 Mar 15;26(2):611-624. Epub 2017 Jun 15.

University of NSW Arts & Social Sciences, Sydney NSW, Australia.

Hospital infection control practices known as Contact Precautions are recommended for the management of people with pathogens such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci. Background: The patient is isolated, and staff are required to wear gloves, and a gown or apron when providing care. A notice is displayed to remind staff of these requirements and an 'alert' message is placed in the patient's medical record. Objective: The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today's healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.
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http://dx.doi.org/10.1177/0969733017709335DOI Listing
March 2019

Maintenance of memory for melodies: Articulation or attentional refreshing?

Psychon Bull Rev 2017 12;24(6):1964-1970

Department of Psychology, Lafayette College, Oechsle Hall, 350 Hamilton Street, Easton, Pennsylvania, 18042, USA.

Past research on the effects of articulatory suppression on working memory for nonverbal sounds has been characterized by discrepant findings, which suggests that multiple mechanisms may be involved in the rehearsal of nonverbal sounds. In two experiments we examined the potential roles of two theoretical mechanisms of verbal working memory-articulatory rehearsal and attentional refreshing-in the maintenance of memory for short melodies. In both experiments, participants performed a same-different melody comparison task. During an 8-s retention interval, interference tasks were introduced to suppress articulatory rehearsal, attentional refreshing, or both. In Experiment 1, only the conditions that featured articulatory suppression resulted in worse memory performance than in a control condition, and the suppression of both attentional refreshing and articulatory rehearsal concurrently did not impair memory more than articulatory suppression alone. Experiment 2 reproduced these findings and also confirmed that the locus of interference was articulatory and not auditory (i.e., the interference was not attributable to the sound of participants' own voices during articulatory suppression). Both experiments suggested that articulatory rehearsal played a role in the maintenance of melodies in memory, whereas attentional refreshing did not. We discuss potential theoretical implications regarding the mechanisms used for the rehearsal of nonverbal sounds in working memory.
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http://dx.doi.org/10.3758/s13423-017-1269-9DOI Listing
December 2017

Reflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia.

Am J Infect Control 2015 Dec 20;43(12):1310-5. Epub 2015 Aug 20.

Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia. Electronic address:

Background: Within the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support individual auditors and local sustainability of the hand hygiene auditing program.

Method: This qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role.

Results: Twenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role.

Conclusion: Hand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support individual hand hygiene auditors.
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http://dx.doi.org/10.1016/j.ajic.2015.07.009DOI Listing
December 2015

A traumatic case of fat embolism.

BMJ Case Rep 2013 Jul 5;2013. Epub 2013 Jul 5.

Department of Trauma and Orthopaedics, Royal Cornwall Hospital Trust, Truro, UK.

A fit and healthy 47-year-old woman developed type I respiratory failure 2 days following surgical fixation for a left intertrochanteric neck of femur fracture. She presented to the acute trauma unit following a fall off a horse and had a long dynamic hip screw fixation in theatre. Postoperatively, she became confused and hypoxic. Her chest X-ray was inconclusive and her CT pulmonary angiogram showed diffuse patchy ground glass shadowing in keeping with acute respiratory distress syndrome. Following review by intensive care and respiratory physicians, a diagnosis of acute lung injury secondary to fat embolism was reached. The patient made a good recovery on the orthopaedic ward with supportive treatment.
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http://dx.doi.org/10.1136/bcr-2013-200142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736448PMC
July 2013

North Carolina dental hygiene students' opinions about tobacco cessation education and practices in their programs.

J Dent Educ 2009 May;73(5):539-49

Clayton State University, Morrow, Georgia, USA.

Inadequate training in tobacco cessation counseling (TCC) is a recognized, but mutable, barrier to implementation of tobacco cessation education (TCE) and intervention strategies in dental practice. The objective of this study was to identify the opinions and practices of senior dental hygiene (DH) students in North Carolina regarding their didactic training in TCE and integration of TCE into their clinical curricula. A pilot-tested questionnaire designed by the authors was administered to a cross-sectional, non-random convenience sample of 241 graduating senior DH students enrolled in all twelve North Carolina DH educational programs. Response rate was 65 percent (n=156). Of the respondents, 99 percent agreed that hygienists should be trained to provide TCE. Nearly all respondents (99 percent) had one or more patients who smoked, and 81 percent had one or more patients who used spit tobacco. Eighty-nine percent had one or more patients who had expressed a desire to quit. Most students were comfortable providing TCC to both smokers (92 percent) and spit tobacco users (93 percent); however, 26 percent reported that they were not comfortable providing quit messages to patients unwilling to quit. Enhancements to TCE in DH curricula may increase hygienists' incorporation of TCE into their future practice.
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May 2009

Listeria monocytogenes--which of your patients is not at risk?

Authors:
Joanna Harris

Aust Nurs J 2008 Jul;16(1):26-8

Public Health Unit, South East Sydney and Illawarra Area Health Service.

Listeria monocytogenes is an environmental bacterium that is capable of causing infection (known as listeriosis) in vulnerable people who generally acquire the organism following the ingestion of contaminated foods. Pregnant women are a particular risk group, as listeriosis in pregnancy is associated with an increased risk of spontaneous abortion, stillbirth, neonatal septicaemia and meningitis. The immunocompromised, and people over the age of 65 to 70 are also at increased risk of listeriosis. Listeriosis can present in a number of ways and may lead to significant morbidity. The mortality rate is between 11% and 60% depending on the age of the patient and the clinical presentation of the infection. There has been wide coverage in both medical and public media of the risk of listeriosis in pregnancy, but little has been published in general nursing journals. The objective of this article is to raise nurses' awareness of listeriosis enabling them to offer optimum advice to vulnerable patients.
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July 2008

Lack of change in serum angiotensin-converting enzyme activity during the menstrual cycle.

J Renin Angiotensin Aldosterone Syst 2006 Dec;7(4):231-5

Rayne Institute, UCL Centre for Cardiovascular Genetics, 5 University Street, London, UK.

Introduction: The Deletion (D) rather than Insertion (I) variant of the angiotensin-converting enzyme (ACE) gene is associated with higher circulating ACE activity. Meanwhile, coronary risk rises with the menstrual nadir in oestrogen levels, exogenous oestrogen reduces serum ACE activity (with a greater reduction the higher the baseline ACE activity), and pharmacological reduction in ACE activity is cardioprotective. Alterations in coronary risk associated with the menstrual cycle may thus be mediated through (genotype-dependent) changes in ACE activity. We have examined this hypothesis.

Materials And Methods: Twenty-three healthy female subjects (12 II, 11 DD genotype) were studied. None were taking oral contraceptive agents. Blood was assayed for oestrogen, follicle stimulating hormone (FSH), luteinising hormone (LH), progesterone and ACE activity every three days throughout their menstrual cycle.

Results: ACE activity was unrelated to oestrogen, FSH or LH during the menstrual cycle, irrespective of ACE genotype.

Conclusions: The increase in myocardial ischaemia during low oestrogen phases of the menstrual cycle does not appear mediated through a fall in serum ACE activity.
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http://dx.doi.org/10.3317/jraas.2006.043DOI Listing
December 2006

The largest outbreak of measles in the United States during 1999: imported measles and pockets of susceptibility.

J Infect Dis 2004 May;189 Suppl 1:S78-80

Epidemic Intelligence Service (State Branch, Division of Applied Public Health Training), Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

The largest measles outbreak in the United States during 1999 was traced to a 34-year-old minister with an undocumented history of vaccination, infected while traveling outside the United States. Local health departments in the Central Virginia Health District performed an epidemiological and laboratory investigation that identified 14 additional confirmed cases of measles, including 2 in health care providers and 5 in congregation members. Eight cases (53%) occurred among adults aged 30-35 years and 7 (47%) among children aged 13 months to 8 years. Although no religious exemptions were cited, only 2 case patients had documented proof of vaccination. This outbreak demonstrates the potential for limited indigenous spread of measles that occurs when imported cases expose susceptible groups. Almost half of the imported measles cases in the United States occur in US residents returning from foreign travel. Vaccination is highly recommended for all overseas travelers who are without documented proof of adequate immunization or measles immunity.
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http://dx.doi.org/10.1086/377697DOI Listing
May 2004
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