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This paper describes the design and optimization of a 10 ml cartridge for patient sample processing using a 3.5 GHz (empty resonant frequency) TM010 cylindrical microwave cavity. The cartridge has been designed to augment a novel approach for the rapid diagnosis of M. tuberculosis (the causative agent of Ttuberculosis), which uses the direct application of microwaves to a bacteria-containing sample to release pathogen-specific DNA. The target bacterial DNA is then captured and recovered using magnetic nanoparticles coated with pathogen-specific DNA probes. Excitation parameters were optimized using three surrogates for M. tuberculosis, namely, M. smegmatis, M. abscessus, and M. bovis suspended in water and simulated sputum. The paper also explores the mechanism of microwave-mediated DNA release from bacteria using scanning electron microscopy. Examination of bacteria exposed to microwaves at power levels known to mediate the release of DNA reveals no obvious signs of permanent cell disruption, suggesting that a more subtle interaction is taking place. Finally, the presence of microwave-liberated M. bovis DNA was able to be detected at a level of sensitivity comparable to that achieved using microscopy. [ABSTRACT FROM AUTHOR]

Background: The introduction of new healthcare roles internationally has had mixed results with some evidence that variations can be accounted for by the manner of their introduction rather than role content. Explanation may be found partly in the ways in which new roles establish a workplace jurisdiction; that is, recognition in the workplace of a role's legitimate rights to undertake a particular scope of practice. Objective: To explore the factors that influence the development of workplace jurisdiction of new nursing roles. Design and setting: Critical realist multiple case study design within two NHS Acute Hospital Trusts in England and two new nursing roles as embedded units of analysis in each case (n = 4 roles). In Phase 1, data were collected through semi-structured interviews (n = 21), non-participant observation of committees (n = 11), partial participant observation and shadowing of the role holders' working day (n = 9), together with analysis of organisational documents (n = 33). In Phase 2, follow up interviews with role-holders (n = 4) were conducted. Participants Staff in new nursing roles (n = 4) were selected purposively as embedded units according to the theoretical framework and other informants (n = 17) were selected according to the study propositions. Results: Qualitative analysis demonstrated that different role drivers produced two different role types, each of whom faced different challenges in negotiating the implementation of the role in the workplace. Negotiation of workplace jurisdiction was shown to be dependent on sharing social identities with co-workers. Four major workplace identities were found: professional, speciality, organisational and relational. Conclusion: The current focus on setting legal and public jurisdictions for new nursing roles through national standards and statutory registration needs to be complemented by a better understanding of how workplace jurisdiction is achieved. This study suggests that social identity is a significant determinant. [ABSTRACT FROM AUTHOR]

Summary As our understanding of the role of ultraviolet (UV) radiation exposure in causing skin cancer continues to be enhanced, it is important that clinicians and researchers are familiar with the various methods for assessing photodamage to skin. This paper provides a systematic review of the published literature on invasive and noninvasive methods used to quantify lifetime UV exposure ('photoageing'). Clinical examination, histopathology, immunohistochemistry, skin surface topography and ultrasound, in addition to newer technologies such as reflectance confocal microscopy, optical coherence tomography and multiphoton tomography, are reviewed. It is concluded that histopathological solar elastosis alone should not be viewed as a 'gold standard' diagnostic test and that there is no single method available to give accurate quantification of the degenerative changes associated with photodamage. Although additional research into sensitivity and specificity is still needed, skin surface topography currently has the most support in the literature as a valid and reliable noninvasive tool for the assessment of photoageing. [ABSTRACT FROM AUTHOR]

Aim: The aim of the RCN dignity survey was to gain the perspectives of nurses, healthcare assistants and nursing students regarding the maintenance and promotion of dignity in everyday practice. This article presents survey respondents' experiences of providing dignified care for older people. Method: A survey questionnaire was developed including fixed response and free text questions. A survey link was emailed to RCN members. Of the 2,048 respondents, 1,110 (54 per cent) worked with older people. These responses were analysed using an Excel spreadsheet for the quantitative data and the free text data were analysed thematically. Results: The respondents perceived that the physical environment and organisation influenced the provision of dignified care. Respondents described how they endeavoured to promote dignity during care activities which might threaten dignity through thoughtful planning, sensitive communication, preserving privacy and promoting choice. Conclusion: A conducive physical care environment, a supportive organisation and individual nurses' actions can do much to promote the dignity of older people while they are undergoing health care. [ABSTRACT FROM AUTHOR]

AIM: To explore the perspectives of nurses working with children and young people on dignified care and the challenges of providing such care. METHODS: A questionnaire was developed including fixed response and free text questions. A survey link was emailed to RCN members. Of the 2,048 respondents, 149 worked mainly with children and young people. From their responses, quantitative data were analysed using a spreadsheet and free text data were analysed thematically according to the question topics. RESULTS: Only 34 per cent of respondents reported having enough time to devote to the dignity of patients and clients. Many respondents (74 per cent: sometimes; 8 per cent always) felt distressed or upset that they were unable to give the kind of dignified care they aspired to. The physical care environment and organisation influenced the provision of dignified care but respondents described how they endeavoured to promote dignity during care activities through thoughtful planning, communication and preserving privacy. CONCLUSION: Nurses can do much to promote the dignity of children and young people in their care. [ABSTRACT FROM AUTHOR]

Aim: Anthrax is caused by the bacterium Bacillus anthracis. Although primarily a disease of animals, it can also infect man, sometimes with fatal consequences. As a result of concerns over the illicit use of this organism, considerable effort is focussed on the development of therapies capable of conferring protection against anthrax. This brief review will describe the efforts being made to address these issues. Methods and Results: A review of the literature and the proceedings of the sixth international conference on anthrax, held in Santa Fe, USA in 2005 shows intense activity, but there has been as yet no real progress. While effective antibiotics, antitoxins and vaccines are available, concerns over their toxicity and the emergence of resistant strains have driven the development of second-generation products. The principal target for vaccine development is Protective Antigen (PA), the nontoxic cell-binding component of anthrax lethal toxin. While the recombinant products currently undergoing human clinical trials will offer considerable advantages in terms of reduced side effects and ease of production, they would still require multiple, needle-based dosing, and the inclusion of the adjuvant alum makes them expensive to administer and stockpile. To address these issues, researchers are developing vaccine formulations, which stimulate rapid protection following needle-free injection (nasal, oral or transcutaneous), and are stable at room temperature to facilitate stockpiling and mass vaccination programs. Conclusions: An array of medical countermeasures targeting B. anthracis will become available over the next 5–10 years. Significance and Impact of the Study: The huge investment of research dollars is expected to dramatically expand the knowledge base. A better understanding of basic issues, such as survival in nature and pathogenesis in humans, will facilitate the development of new modalities to eliminate the threat posed by this organism. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore the transitional phase between experimental and regular smoking from the perspective of teens. METHOD: Narrative analysis of semistructured, individual interviews. RESULTS: The need to belong and immediate social gain are major themes influencing teen smoking decisions. CONCLUSIONS: Our findings have significance for public health workers planning and implementing tobacco-use prevention programs aimed at teens whose smoking behaviors are not yet determined by nicotine addiction. How such programs have been traditionally framed and the ways in which peer influence and risk behaviors have been addressed may be largely irrelevant to the rationale of the adolescents themselves. [ABSTRACT FROM AUTHOR]

This paper argues that the current involvement of end users in the design of technological artefacts is too superficial. It is common to involve people in requirements generation, but rarely in product inception or design. A study is reported involving five households in central Scotland, who were each visited on three occasions, using a new investigative framework. Illustrative examples are provided of the strengths and weaknesses of the methods used. Despite the latter, it is demonstrated that the general public can both generate and critique design ideas and that valuable contributions to understanding people's relationships with technologies can be expected both from children and from the elderly. [ABSTRACT FROM AUTHOR]

AIM: This project aimed to improve the recruitment of locally qualifying student nurses. BACKGROUND: Newly qualified nurses are an important resource, but the recruitment rate of locally qualifying nurses appeared to be low in one acute hospital NHS Trust. A collaborative working party was established, to address this situation. METHOD: A survey approach was used to collect data from one group of qualifying students prior to a new strategy for recruitment being implemented. Two subsequent groups of qualifying students were surveyed to evaluate the new strategy, and again 6 months post-employment. FINDINGS: After implementation of the new strategy, recruitment rose from 22% to 82%, with 41% of respondents stating that it had influenced their decision to stay in the Trust. Reasons given for recruitment to the Trust included convenience, familiarity, loyalty, enjoyment of clinical placements and perceived supportiveness of the Trust. CONCLUSIONS: Recruitment of qualifying students to their local Trust can be approached more effectively and good results obtained. The benefits of working collaboratively in relation to recruitment issues are also highlighted. [ABSTRACT FROM AUTHOR]

Reports on the development of novel vaccines against Bacillus anthracis, bacterium that cause the disease anthrax. Brief overview of the organism and its pathogenesis; Problems in the standardization of the vaccines; High cost of production.

The purpose of this study was to gain an understanding of the nature of empathy, as perceived and experienced by registered nurses. A phenomenological approach was selected, with nine experienced staff nurses working in surgical settings being interviewed using an open, unstructured approach. Empathy was evidently felt to be beneficial, displayed both nonverbally and through the nurse's actions, and therefore the ability to empathize, and to feel empathy with the individual patient, needs supporting and promoting in nurses. The importance of learning from experience (both personal and professional), and the ability to communicate effectively, are both highlighted by this study. The nature of empathy is evidently multi-faceted, and the presence of empathy is influenced by a complex relationship between the individual nurse, patient and the environment. It should be recognized that environmental issues, such as high workload and stress, also affect ability to empathize. [ABSTRACT FROM AUTHOR]

The aim of this small study was to explore nurse teachers' feelings about participating in clinical practice. An exploratory design was used entailing focused interviews with 10 nurse teachers which explored their current participation in clinical practice and their feelings about this. Other areas addressed were the perceived benefits and negative effects of participating in practice, as well as the factors which may inhibit or enable teachers participating in practice. It was found that while half the teachers had some participation in practice, only one participated on a regular basis. The teachers were generally dissatisfied with their current level of clinical practice. The teachers identified a number of potential benefits of practising, including keeping in touch with clinical practice, maintenance of clinical skills, improved relationships with trained staff and the opportunity to use knowledge and skills in practice. Perceived negative effects were that their clinical participation may be misinterpreted, or may impinge on other aspects of the role. Some also felt that the limited time which they would have available, would lead to their clinical practice being ineffective. The two major factors which affected whether nurse teachers were able to participate in practice were time and the college philosophy/culture. Other important factors were support from clinical staff, clinical confidence, and the teacher's role perception and attitude towards practice. As recent publications have inferred the need for nurse teachers to remain involved in clinical practice, teachers need to identify how clinical practice may best be achieved, and clarify their aims for practising. Different models of practice may be appropriate for individual teachers. It seems that a supportive environment and a college culture which values nurse teachers practising would be beneficial if clinical practice is to become part of the teacher's role. [ABSTRACT FROM AUTHOR]

The study aimed to explore the question, what factors affect student nurse learning in a community setting? A phenomenological approach was taken by carrying out in-depth interviews with eight Project 2000 students who had just completed 8 weeks of community placements. The factors which emerged centred around three themes: the students themselves, the mentors and the placements. Students recognized that their own approach to the placement was important. They found that the role they fulfilled in the placements affected their learning, preferring a participative role to observation only. The role of the mentor was found to be crucial for learning. Important factors were the mentors' knowledge and attitude towards the Project 2000 course and their professionalism (particularly communication skills), as perceived by the students. Also significant were the mentors' skills at facilitating learning in the placements, by encouraging questions and reflection, and organizing a variety of experiences. Factors relating to the placements concerned their relevance to the course (as perceived by the students) and the breadth of experience available. Whilst this was a small sample, from which no generalizations can be made, the study gives insight into students, teachers and community staff of the experience of learning in the community setting. [ABSTRACT FROM AUTHOR]

Bacillus anthracis is a pathogen of animals which rarely infects humans. Its use as a bioweapon has stimulated efforts to develop genetic typing methods and therapeutics to respond to an attack. Of particular concern is the transfer of virulence genes from B. anthracis to other closely related strains of bacillus. [ABSTRACT FROM AUTHOR]

The IgG anti-protective antigen subclass antibody response of individuals who had been infected with anthrax was compared with that of healthy individuals immunized with the UK licensed anthrax vaccine. The predominant subclass in both groups was IgG1. In addition, IgG3 was seen in convalescent serum while vaccinees produced IgG2, IgG3 and IgG4 subclass. The significance of these results is discussed. Further work is required to determine the role of antibodies in mediating protective immunity in man. [ABSTRACT FROM AUTHOR]

Presents the 3rd International Conference on Anthrax in Plymouth, England on September 7-8, 1998. Themes of the scientific presentations; Members of the organizing committee; Sponsors of the conference.

Exosporium components from endospores of Bacillus cereus ATCC 10876 were purified and separated by gel electrophoresis. Several of the proteins for which N-terminal sequences were recovered were found to have homologues in protein databases which have been demonstrated to have enzymic activity in other organisms. Amongst these is a zinc metalloprotease, immune inhibitor A, already described in B. thuringiensis. This has been shown to be present in an active 73 kDa form on the exosporium of B. cereus. Other proteins associated with the exosporium include the molecular chaperone GroEL and a homologue of RocA (1-pyrroline-5-carboxylate dehydrogenase (EC 1.5.1.12)) of B. subtilis. Although these are unlikely to represent integral structural proteins of the exosporium, the observation that they are selectively present in the spore surface layer suggests that this layer may have functional significance. [ABSTRACT FROM AUTHOR]

Clostridium difficile is the primary cause of healthcare-associated diarrhoea globally and produces spores which are resistant to commonly used biocides and are able persist on contaminated surfaces for months. This study examined the effect of sublethal concentrations of the biocide sodium dichloroisocyanurate (Na DCC) on the viability of spores produced by 21 clinical isolates of C. difficile representing a range of PCR ribotypes. Spores exposed to 500 ppm Na DCC for 10 min exhibited between a 4-6 log10 reduction in viability which was independent of spore PCR ribotype. The effect of sublethal concentrations of biocide on the surface properties of exosporium positive and negative clinical isolates was determined using a spore adhesion to hydrocarbon (SATH) assay. These isolates differed markedly in their responses suggesting that exposure to biocide can have a profound effect on hydrophobicity and thus the ability of spores to adhere to surfaces. This raises the intriguing possibility that sublethal exposure to Na DCC could inadvertently promote the spread of the pathogen in healthcare facilities. Significance and Impact of the Study This study is the first to report on changes in Clostridium difficile spore surface property after exposure to sublethal levels of the commonly used biocide sodium dichloroisocyanurate. The implications of these changes to the spore surface include increased adherence of the spores to inorganic surfaces which can directly contribute to persistence and spread of spores within the hospital environment. [ABSTRACT FROM AUTHOR]

Background: Arm rehabilitation after stroke is a research priority. A Cochrane overview suggests that an augmented dose of at least 20 hours task practice may improve arm function, however the UK health service is unable to provide this face-face. Stroke survivors need to undertake self-practice but adherence is generally low. To encourage stroke survivors to undertake self-practice in an arm rehabilitation trial, we designed an exercise reminder application. Method: • Design: feasibility study including individual interviews. • Sample: N=15 (F=8, M=7) stroke survivors from local support groups: mean age 57 years (range 36-74 years), mean time post-stroke 6.5 years (range 1 month-19 years). Eleven participants reported their stroke as severe. • Methods: participants configured and responded to their preferred reminder. System Usability Scale (SUS) was used to measure usability, NASA Task Load Index (NASA/TLX) to measure workload. Participants were asked whether they would use this application if it was available. Results/Findings: Participants found the application to be usable: mean (SD) SUS Score 76/100 (±12) and low on workload: mean (SD) NASA/TLX score 12/100 (±7). All 15 participants reported they would use the application if available. Discussion: Most participants found the application to be usable and low on workload, despite having experienced a severe stroke. Participants reported they would use this application because they found it easy to use and could configure it for their specific needs. Conclusion: These results suggest that this arm exercise after stroke reminder application was considered user-friendly and feasible. It will now be implemented in the EVERLAP feasibility study on augmented arm rehabilitation. [ABSTRACT FROM AUTHOR]

The RCN is driving a new campaign to ensure that patients and staff are treated with dignity. Pauline Ford and colleagues discuss how the initiative has been tailored to emergency care settings. [ABSTRACT FROM AUTHOR]

Aims To determine the contribution of the exosporium, the outer layer of the Bacillus anthracis spore, to soil attachment. Persistence of spores in soil and their ability to infect animals has been linked to a range of factors which include the presence of organic material and calcium ( OMC), pH > 6·0, temperatures above 15·5°C and cycles of local flooding which are thought to transport buried spores to the surface. Methods and Results The ability of wild type (exosporium +ve) and sonicated (exosporium −ve) spores to bind to soils which differed in their composition was determined using a flow-through soil column-based method. A statistically significant difference ( P < 0·05) in the binding of wild type spores was observed with spores adhering more firmly to the soil with the highest OMC content. We also found that the removal of the exosporium increased the ability of the spore to adhere to both soil types. Conclusion Structures within the exosporium affected the ability of B. anthracis spores to bind to different soil types. Not surprisingly, wild type spores adhered to soil which has been shown to favour the persistence of the pathogen. Significance and Impact of the Study The ability to persist in and colonise the soil surface is a key requirement of a pathogen which infects grazing animals. By characterising the process involved, we will be better placed to develop strategies to disrupt the infection cycle. [ABSTRACT FROM AUTHOR]

Bacillus anthracis is the causative organism of the disease anthrax. The ability of the organism to form resistant spores and infect via the aerosol route has led to it being considered as a potential biological warfare agent. The current available human vaccines are far from ideal, they are expensive to produce, require repeated doses and may invoke transient side-effects in some individuals. There is also evidence to suggest that they may not give full protection against all strains of B. anthracis. A new generation of anthrax vaccine is therefore needed. The use of Lactobacillus as a vector for expression of heterologous proteins from pathogens supplies us with a safe system, which can be given orally. Lactobacilli are commensals of the gut, generally regarded as safe and have intrinsic adjuvanticity. Oral vaccines may stimulate the mucosol immune system to produce local IgA responses in addition to systemic responses. These vectors are delivered at the mucosal surface, the site where the infection actually occurs and where the first line of defence lies. The gene encoding the protective antigen (PA) of B. anthracis, an immunogenic non-toxic component of the two toxins produced, is being cloned into different homologous vectors and subsequently transformed to various Lactobacillus strains. High intracellular expression levels for the PA in Lact. casei were achieved. Mucosal antigen presentation and humoral and cellular immune responses following immunization with transformants expressing PA in various ways (intracellular, surface-anchored and extracellular) are being studied. [ABSTRACT FROM AUTHOR]

Protective antigen (PA), the major protective component of the existing vaccine, is a potent immunogen. Protective antigen in alhydrogel induced a high serum IgG titre (> log10 4) in both the C57B16 and Balb/c mouse and the predominant subclass of antibody induced was IgG1, indicating that the response to PA was predominantly Th2 directed. When plasmid DNA encoding PA was used to immunize the Balb/c mouse, a low serum IgG titre was detected (≤log10 1), which was slightly increased by boosting with plasmid DNA. However, when mice immunized with plasmid DNA were later boosted with rPA, a significant and rapid increase in titre (up to threefold) was observed. Priming mice with PA-encoding plasmid DNA may be a mechanism of enhancing and accelerating the immune response to PA. [ABSTRACT FROM AUTHOR]

There is evidence that inflammatory status may affect cognitive, affective, and health outcomes. In a study of the effects of breast cancer chemotherapy on cognition, baseline (pre-chemotherapy) data were collected from a sample of 97 women, 76 of whom had stage 1–3 cancer. Mean age was 58.9 years (range 45–77); mean education was 15.5 years (range=12–22). Neuropsychological outcomes included executive functioning (Controlled Oral Word Association Test, COWAT), working memory (WAIS Letter-Number Sequencing, LNS), processing speed (Symbol Digit Modalities Test, SDMT), and motor speed (Purdue Pegboard Test, both hands, PPT). The Center for Epidemiologic Studies Depression Scale (CES-D) assessed mood, while items from the SF-36 and Functional Assessment of Cancer Therapy-Breast (FACT-B) measured fatigue and feelings of sickness. Adjusted multiple regression models estimated individual outcomes, controlling for age, education, comorbidity, presence, and stage of cancer. Pro-inflammatory markers included IL-1beta, IL-6, TNF-alpha, and C-reactive protein. All relationships were in the predicted direction, but inflammation was not associated with depression, fatigue, feelings of sickness, or processing speed. Cancer did not predict any outcomes. The relationship between COWAT and TNF-alpha approached significance (p =0.057). Relationships between LNS and IL-1beta (p =0.023), and PPT/IL-1beta and PPT/IL-6 (p <0.01, p <0.0001) were significant. The results suggest changes in blood inflammatory proteins in this population were not associated with changes in affect, but may be important predictors of working memory and fine motor skills. [ABSTRACT FROM AUTHOR]

Bacillus anthracis protective antigen (PA) has been produced from a recombinant B. subtilis and its efficacy, when combined with the Ribi adjuvant (MPL-TDW-CWS) or alhydrogel, has been compared with that of the licensed UK human vaccine, in guinea pigs challenged with aerosolized Ames strain spores. Recombinant PA combined with the Ribi adjuvant performed as well as PA from B. anthracis cultures in previous reports (Ivins & Welkos 1986; Ivins et al. 1990; Turnbull et al. 1991; Jones et al. 1996; McBride et al. 1998) giving protection in 100% of animals exposed to the highest challenge dose of the Ames strain of B. anthracis that can be administered practically (retained lung doses of approximately 106 spores). In attempts at identifying markers of protection in immunized individuals, rPA in combination with the Ribi adjuvant induced a marker IgG2 response in guinea pigs with no significant differences in IgG1 levels when compared with other vaccine formulations (McBride et al. 1998). In BALBc mice, rPA with the Ribi adjuvant induced a higher IgG2a response compared with rPA with anhydrogel and the human vaccine. To examine the role of anti-PA-specific antibodies in protection, guinea pig sera is being passively transferred into guinea pigs and SCID mice, followed by protection. Similarly, B- and T-lymphocytes from immunized BALB/c mice are being separately and passively transferred into SCID mice with subsequent challenge. The neutralizing ability of the PA-specific antibodies is being studied using an in vitro macrophage lysis assay. [ABSTRACT FROM AUTHOR]