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Atusingwize E, Musinguzi G, Ndejjo R, Buregyeya E, Kayongo B, Mubeezi R, Mugambe RK, Ali Halage A, Sekimpi DK, Bazeyo W, Wang JS, Ssempebwa JC. Occupational safety and health regulations and implementation challenges in Uganda. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:58-65. [PMID: 30222090 DOI: 10.1080/19338244.2018.1492895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
The burden of occupational diseases and injuries is high in developing countries due to several challenges including poor regulatory frameworks. To explore the status of occupational safety and health (OSH) policies and related implementation challenges in Uganda, we reviewed OSH regulations and conducted key informant interviews with stakeholders. We found that the existing OSH laws were largely outdated compared to the current needs of workplaces. Challenges affecting implementation are related to: gaps in the legal framework, low public awareness about OSH, poor planning, and limited human capacity, transparency, and accountability. Measures to address these gaps including training, upgrading OSH laws and policies, and prioritization are warranted to improve the status of OSH in Uganda.
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Affiliation(s)
- Edwinah Atusingwize
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Geofrey Musinguzi
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Rawlance Ndejjo
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Esther Buregyeya
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Barbara Kayongo
- b Ministry of Gender, Labor and Social Development , Kampala , Uganda
| | - Ruth Mubeezi
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Richard K Mugambe
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Abdullah Ali Halage
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Deogratious K Sekimpi
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
- c Uganda National Association of Community and Occupational Health , Kampala , Uganda
| | - William Bazeyo
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
| | - Jia-Sheng Wang
- d Department of Environmental Health Sciences , College of Public Health, University of Georgia , Athens , GA , USA
| | - John C Ssempebwa
- a Department of Disease Control and Environmental Health , School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda
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Early Onset of Tenofovir-Related Fanconi Syndrome in a Child with Acute Hepatitis B: A Case Report and Systematic Review of Literature. Case Reports Hepatol 2017; 2017:3921027. [PMID: 29270324 PMCID: PMC5705871 DOI: 10.1155/2017/3921027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022] Open
Abstract
Tenofovir disoproxil fumarate- (TDF-) related nephropathy is known to be a long-term complication of this drug, more commonly observed in HIV-infected patients, but occurring also in hepatitis B. Cases of Fanconi Syndrome associated with TDF have been reported in adult patients, usually as a long-term complication of chronic hepatitis B treatment. We present here a case of a 12-year-old male developing a severe acute HBV hepatitis treated with TDF. The patient achieved an early virological and biochemical response, but with a subsequent onset of proximal renal tubular damage, consistent with Fanconi Syndrome. After withdrawing this drug and switching to Entecavir, a complete resolution of tubulopathy and, after 6 months, a complete HBsAg seroconversion occurred. To our knowledge, this is the first report of an early renal injury due to TDF-therapy in a pediatric patient treated for acute hepatitis B.
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Fisher M, Henrickson M. Are statutory protections sufficient to protect people living with HIV who are employed in the medical workplace? INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1398387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Meaghan Fisher
- School of Social Work, Massey University, Auckland, New Zealand
| | - Mark Henrickson
- School of Social Work, Massey University, Auckland, New Zealand
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Abstract
As of January 2016, 1,633 laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection and 587 MERS-related deaths have been reported by the World Health Organization globally. Middle East Respiratory Syndrome Coronavirus may occur sporadically in communities or may be transmitted within families or hospitals. The number of confirmed MERS-CoV cases among healthcare workers has been increasing. Middle East Respiratory Syndrome Coronavirus may also spread through aerosols generated during various dental treatments, resulting in transmission between patients and dentists. As MERS-CoV cases have also been reported among children, pediatric dentists are at risk of MERS-CoV infection. This review discusses MERS-CoV infection in children and healthcare workers, especially pediatric dentists, and considerations pertaining to pediatric dentistry. Although no cases of MERS-CoV transmission between a patient and a dentist have yet been reported, the risk of MERS-CoV transmission from an infected patient may be high due to the unique work environment of dentists (aerosol generation).
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Affiliation(s)
- Fares S Al-Sehaibany
- Division of Pediatric Dentistry, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Work-Related Accidents and Sharp Injuries in Paramedics-Illustrated with an Example of a Multi-Specialist Hospital, Located in Central Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080901. [PMID: 28796193 PMCID: PMC5580604 DOI: 10.3390/ijerph14080901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Abstract
(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005-2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics.
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Ishimaru T, Wada K, Arphorn S, Smith DR. Attitudes of nurses toward HIV-infected colleagues in Japan. Contemp Nurse 2016; 53:133-142. [PMID: 27790951 DOI: 10.1080/10376178.2016.1254565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nurses may be unwilling to accept HIV-infected colleagues who can continue to work with patients if the provider-to-patient transmission risks have been appropriately assessed. AIMS To assess the factors associated with nurses' willingness to accept HIV-infected colleagues as coworkers. DESIGN Descriptive and cross-sectional. METHODS An anonymous online survey targeting Japanese nurses working in hospitals or clinics (n = 992). Logistic regression analysis was used to evaluate factors associated with their willingness to accept HIV-positive colleagues before or after a risk assessment. RESULTS Respondents who avoided contact with, and expressed discriminatory views about, HIV-infected colleagues were less willing to accept them. After undertaking an appropriate risk assessment, a high level of knowledge regarding HIV transmission increased the likelihood of acceptance towards HIV-infected colleagues. CONCLUSIONS The use of risk assessment may increase nurses' willingness to accept HIV-infected colleagues, particularly among co-workers with a high level of knowledge about HIV.
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Affiliation(s)
- Tomohiro Ishimaru
- a Department of Occupational Health and Safety, Faculty of Public Health , Mahidol University , 420/1 Rajvithee Rd., Rachathewee, Bangkok 10400 , Thailand.,b Occupational Health Training Center, University of Occupational and Environmental Health , 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555 , Japan
| | - Koji Wada
- c Bureau of International Health Cooperation, National Center for Global Health and Medicine , 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655 , Japan
| | - Sara Arphorn
- a Department of Occupational Health and Safety, Faculty of Public Health , Mahidol University , 420/1 Rajvithee Rd., Rachathewee, Bangkok 10400 , Thailand
| | - Derek R Smith
- d College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , QLD 4811 , Australia
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Frickmann H, Schmeja W, Reisinger E, Mittlmeier T, Mitzner K, Schwarz NG, Warnke P, Podbielski A. Risk Reduction of Needle Stick Injuries Due to Continuous Shift from Unsafe to Safe Instruments at a German University Hospital. Eur J Microbiol Immunol (Bp) 2016; 6:227-237. [PMID: 27766172 PMCID: PMC5063016 DOI: 10.1556/1886.2016.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/01/2016] [Indexed: 12/02/2022] Open
Abstract
This study assessed protective effects of a continuous introduction of safe instruments in terms of reduction of needle stick injuries. The retrospective study analyzed correlations between the increasing proportion of safe instruments and a reduction of the incidence of needle stick injuries linked to such instruments in a German university hospital over 5 years. Incidents declined about 17.6% from 80.3 incidents per 1000 employees to 66.2, associated with an increase in the proportions of injuries due to instruments without protective mechanisms such as scalpels or hypodermic needles by 12.2%. For injuries due to venipuncture cannulae in various surgical and internal medicine departments, there was a negative association between the proportion of safe instruments and the incidence of injuries. For injection needles, portacath needles, and lancets in selected internal medicine departments, the number of injuries also dropped during this study interval. However, there was no clear-cut association with the percentage of safe instruments. This observational study suggests a correlation between the implementation of use of safe instruments and the reduction of needle stick injuries in a case of a graduated implementation. However, the effects are much less pronounced than in previous interventional studies.
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Affiliation(s)
- Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
| | - Wibke Schmeja
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
| | - Emil Reisinger
- Department of Tropical Medicine and Infectious Diseases, University Medicine Rostock, Germany
| | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, University Medicine Rostock, Germany
| | - Karen Mitzner
- Central Pharmaceutical Facility, University Medicine Rostock, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology Group, Bernhard Nocht Institute of Tropical Medicine Hamburg, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
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Valeriani F, Protano C, Gianfranceschi G, Cozza P, Campanella V, Liguori G, Vitali M, Divizia M, Romano Spica V. Infection control in healthcare settings: perspectives for mfDNA analysis in monitoring sanitation procedures. BMC Infect Dis 2016; 16:394. [PMID: 27507586 PMCID: PMC4977761 DOI: 10.1186/s12879-016-1714-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate sanitation procedures and monitoring of their actual efficacy represent critical points for improving hygiene and reducing the risk of healthcare-associated infections. Presently, surveillance is based on traditional protocols and classical microbiology. Innovation in monitoring is required not only to enhance safety or speed up controls but also to prevent cross infections due to novel or uncultivable pathogens. In order to improve surveillance monitoring, we propose that biological fluid microflora (mf) on reprocessed devices is a potential indicator of sanitation failure, when tested by an mfDNA-based approach. The survey focused on oral microflora traces in dental care settings. METHODS Experimental tests (n = 48) and an "in field" trial (n = 83) were performed on dental instruments. Conventional microbiology and amplification of bacterial genes by multiple real-time PCR were applied to detect traces of salivary microflora. Six different sanitation protocols were considered. A monitoring protocol was developed and performance of the mfDNA assay was evaluated by sensitivity and specificity. RESULTS Contaminated samples resulted positive for saliva traces by the proposed approach (CT < 35). In accordance with guidelines, only fully sanitized samples were considered negative (100 %). Culture-based tests confirmed disinfectant efficacy, but failed in detecting incomplete sanitation. The method provided sensitivity and specificity over 95 %. CONCLUSIONS The principle of detecting biological fluids by mfDNA analysis seems promising for monitoring the effectiveness of instrument reprocessing. The molecular approach is simple, fast and can provide a valid support for surveillance in dental care or other hospital settings.
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Affiliation(s)
- Federica Valeriani
- Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Gianluca Gianfranceschi
- Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy
| | - Paola Cozza
- Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy
| | - Vincenzo Campanella
- Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy
| | - Giorgio Liguori
- Hygiene and Epidemiology Chair, University "Parthenope", Naples, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Maurizio Divizia
- Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy
| | - Vincenzo Romano Spica
- Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy.
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Abstract
This article will present a critical review of the literature relating to the use of double gloves during surgery in order to identify best practice by using available resources and to improve health care. During surgery there is an increased risk of exposure to blood and, as a result, pathogens can be transferred through contact between the patient and surgical team. Health professionals working in the operating room are prone to frequent exposure to patients' blood and body fluids (Davanzo et al, 2008 ; Au et al, 2008 ; Myers et al, 2008). Several researchers have also demonstrated that the highest incidence of blood and body fluid exposure is in the operating room during surgical procedures (Ganczak et al, 2006 ; Myers et al, 2008 ; Naghavi and Sanati, 2009).
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Phillips EK, Owusu-Ofori A, Jagger J. Bloodborne Pathogen Exposure Risk Among Surgeons in Sub-Saharan Africa. Infect Control Hosp Epidemiol 2015; 28:1334-6. [DOI: 10.1086/522681] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Accepted: 07/30/2007] [Indexed: 12/31/2022]
Abstract
To document the frequency and circumstances of bloodborne pathogen exposures among surgeons in sub-Saharan Africa, we surveyed surgeons attending the 2006 Pan-African Association of Surgeons conference. During the previous year, surgeons sustained a mean of 3.1 percutaneous injuries, which were typically caused by suture needles. They sustained a mean of 4.1 exposures to blood and body fluid, predominantly from blood splashes to the eyes. Fewer than half of the respondents reported completion of hepatitis B vaccination, and postexposure prophylaxis for human immunodeficiency virus was widely available. Surgeons reported using hands-free passing and blunt suture needles. Non-fluid-resistant cotton gowns and masks were the barrier garments worn most frequently.
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Mutters NT, Hägele U, Hagenfeld D, Hellwig E, Frank U. Compliance with infection control practices in an university hospital dental clinic. GMS HYGIENE AND INFECTION CONTROL 2014; 9:Doc18. [PMID: 25285262 PMCID: PMC4184038 DOI: 10.3205/dgkh000238] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice. Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well. Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control procedures.
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Affiliation(s)
- Nico T Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg, Germany
| | - Ulrike Hägele
- Centre for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Germany
| | - Daniel Hagenfeld
- Heidelberg University Hospital, Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg, Germany
| | - Elmar Hellwig
- Centre for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Germany
| | - Uwe Frank
- Department of Environmental Health Sciences, University Medical Center, Freiburg, Germany
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Ford DA. Implementing AORN recommended practices for sharps safety. AORN J 2014; 99:106-20. [PMID: 24369976 DOI: 10.1016/j.aorn.2013.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/04/2013] [Accepted: 11/18/2013] [Indexed: 11/25/2022]
Abstract
Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.
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Black L. Ditch the pinch: bilateral exposure injuries during subcutaneous injection. Am J Infect Control 2013; 41:815-9. [PMID: 23394858 DOI: 10.1016/j.ajic.2012.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Subcutaneous injection into an elevated skin fold poses a risk of "bilateral exposure" injury whereby the needle pierces the opposite side of a skin fold and subsequently enters the tissue of the health care worker (HCW). METHODS Retrospective review was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Data from 2,402 injuries occurring during subcutaneous injection were included for analysis. Descriptive data, statistical comparisons, and a logistic regression model reporting relative risk are provided. RESULTS Eighty-five bilateral exposure injuries were identified between 2000 and 2009, representing 3.5% (n/N=85/2,402) of all injection-related percutaneous injuries. 65.4% Of the variance in bilateral exposure injury occurrence is explained through examination of the following: (1) manual elevation ("pinching") subcutaneous tissue prior to injection; (2) thin/emaciated patient; (3) injection of insulin; (4) injection of heparin; (5) injection of enoxaparin (Lovenox); (6) if a safety device was used; and (7) whether the health care worker was wearing gloves at the time of the injury (χ(2)7 = 424.2; P<.01). CONCLUSION Manual tissue elevation should be avoided to minimize the risk of bilateral exposure injuries.
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Calore BL, Cheung RC, Giori NJ. Prevalence of hepatitis C virus infection in the veteran population undergoing total joint arthroplasty. J Arthroplasty 2012; 27:1772-6. [PMID: 22770853 DOI: 10.1016/j.arth.2012.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/19/2012] [Indexed: 02/01/2023] Open
Abstract
Many orthopedic surgeons train or are employed at the Department of Veterans Affairs (VA) hospitals. We sought to determine the prevalence of hepatitis C antibody-positive and hepatitis C-viremic patients in the VA population undergoing total joint arthroplasty. In this prospective cohort study, 381 of 408 patients undergoing primary total joint arthroplasty for 22 consecutive months were tested for hepatitis C virus (HCV) infection preoperatively. Thirty-two (8.4%) of 381 patients were positive for hepatitis C virus antibody. Seventeen were actually viremic at the time of total joint arthroplasty (4.5%). The prevalence of detectable hepatitis C antibody in VA patients undergoing total joint arthroplasty is about 6 times the general population (1.3%). Surgeons practicing on populations with a high prevalence of hepatitis C such as this should do all they can to minimize the risk of sharps injury.
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Affiliation(s)
- Briana L Calore
- Division of Orthopedic Surgery, Bassett Medical Center, Cooperstown, NY, USA
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15
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Laheij AMGA, Kistler JO, Belibasakis GN, Välimaa H, de Soet JJ. Healthcare-associated viral and bacterial infections in dentistry. J Oral Microbiol 2012; 4:JOM-4-17659. [PMID: 22701774 PMCID: PMC3375115 DOI: 10.3402/jom.v4i0.17659] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/11/2012] [Accepted: 05/11/2012] [Indexed: 12/19/2022] Open
Abstract
Infection prevention in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-transmission are common practice in many countries. However, little is known about the real risks of cross-transmission, specifically in the dental healthcare setting. This paper evaluated the literature to determine the risk of cross-transmission and infection of viruses and bacteria that are of particular relevance in the dental practice environment. Facts from the literature on HSV, VZV, HIV, Hepatitis B, C and D viruses, Mycobacterium spp., Pseudomonas spp., Legionella spp. and multi-resistant bacteria are presented. There is evidence that Hepatitis B virus is a real threat for cross-infection in dentistry. Data for the transmission of, and infection with, other viruses or bacteria in dental practice are scarce. However, a number of cases are probably not acknowledged by patients, healthcare workers and authorities. Furthermore, cross-transmission in dentistry is under-reported in the literature. For the above reasons, the real risks of cross-transmission are likely to be higher. There is therefore a need for prospective longitudinal research in this area, to determine the real risks of cross-infection in dentistry. This will assist the adoption of effective hygiene procedures in dental practice.
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Affiliation(s)
- A M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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Foltzer M, Hamory B. Protecting patients from harm: design and implementation of an institutional bloodborne pathogen protocol. Am J Infect Control 2011; 39:880-4. [PMID: 21741726 DOI: 10.1016/j.ajic.2011.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 01/31/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients are sometimes exposed to the blood of health care workers (HCWs) while receiving medical care. No national guidelines exist that authoritatively articulate the responsibility of HCWs infected with a potentially transmissible bloodborne pathogen (BBP). Geisinger Health System crafted and implemented a policy delineating the responsibilities of an HCW in the event of accidental blood exposure of a patient, specifically addressing HCWs known to be infected with a BBP. METHODS In 2008, a multidisciplinary group convened to review available published resources from the American Medical Association, specialty society positions, state and national guidelines, Centers for Disease Control and Prevention, and Society for Healthcare Epidemiology, as well as selected commentaries. RESULTS A policy was crafted and enacted within a large integrated heath care system that provided clear guidelines and responsibilities for HCWs who are either infected with a BBP or expose patients to blood in the course of providing medical care. This policy balances the rights of both patients and providers. CONCLUSIONS The resources to devise policies regarding BBP exposure to patients are available but require distillation of complex scientific data and social and/or legal opinion or precedent. We offer Geisinger Health System's policy as a workable and readily accessible model that defines the obligations of providers to protect patients in the event of a BBP exposure.
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Jagger J, Berguer R, Phillips EK, Parker G, Gomaa AE. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. AORN J 2011; 93:322-30. [PMID: 21353803 DOI: 10.1016/j.aorn.2011.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.
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Affiliation(s)
- Janine Jagger
- University of Virginia, International Healthcare Worker Safety Center, Charlottesville, VA 22903, USA
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18
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Deuffic-Burban S, Delarocque-Astagneau E, Abiteboul D, Bouvet E, Yazdanpanah Y. Blood-borne viruses in health care workers: prevention and management. J Clin Virol 2011; 52:4-10. [PMID: 21680238 DOI: 10.1016/j.jcv.2011.05.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 05/15/2011] [Accepted: 05/18/2011] [Indexed: 02/07/2023]
Abstract
Three pathogens account for most cases of occupationally acquired blood-borne infection: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The highest proportion of occupational transmission is due to percutaneous injury (PI) via hollow-bore needles with vascular access. We briefly review prevention and management of blood-borne pathogens in health care workers (HCWs) in developed countries. HCW compliance with standard precautions is necessary for prevention of PI. Safety-engineered devices are now being increasingly promoted as an approach to decreasing the rate of PI. Prevention of HBV transmission requires HCW immunization through vaccination against HBV. In non-vaccinated HCWs (or HCWs with an unknown antibody response to vaccination) exposed to an HbsAg-positive or an untested source patient, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible. Although no available prophylaxis exists for HCV, it is crucial to identify HCV exposure and infection in health care settings and to consequently propose early treatment when transmission occurs. Following occupational exposure with potential for HIV transmission, use of antiretroviral post-exposure prophylaxis must be evaluated. Patients need to be protected from blood-borne pathogen-infected HCWs, and especially surgeons performing exposure-prone procedures (EPPs) with risk of transmission to the patient. However, HCWs not performing EPPs should be protected from arbitrary administrative decisions that would restrict their practice rights. Finally, it must be emphasized that occupational blood exposure is of great concern in developing countries, with higher risk of exposure to blood-borne viruses because of a higher prevalence of the latter than in developed countries, re-use of needles and syringes and greater risk of sustaining PI, since injection routes are more frequently used for drug administration than in developed countries.
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Affiliation(s)
- S Deuffic-Burban
- ATIP-AVENIR, Inserm U995, Université Lille Nord de France, 152 rue du Docteur Yersin, 59120 Loos, France.
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Aultman JM, Borges NJ. The ethics of HIV testing and disclosure for healthcare professionals: what do our future doctors think? MEDICAL TEACHER 2011; 33:e50-e56. [PMID: 21182374 DOI: 10.3109/0142159x.2011.530311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure. METHOD A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author. RESULTS Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals. CONCLUSION This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.
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Affiliation(s)
- Julie M Aultman
- Department of Behavioral and Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, OH 44272-0095, USA.
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20
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Wicker S, Rabenau HF. [HIV, HBV and HCV infected healthcare workers]. Chirurg 2010; 81:935-6. [PMID: 20848070 DOI: 10.1007/s00104-010-1984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Wicker
- Betriebsärztlicher Dienst, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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21
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Husøy AM, Minde T, Knudsen H, Akselsen PE. [Needlestick injuries and reporting routines]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:735-7. [PMID: 20379335 DOI: 10.4045/tidsskr.08.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Health care workers are at risk for transmission of blood-borne agents through percutaneous exposure. Reporting of sharps injuries is essential for instigation of adequate post-exposure prophylaxis and follow-up. We aimed at providing an account of number of sharps injuries reported by type of health care worker and the reporting systems used for injuries that have an inherent risk of transmitting blood-borne agents. MATERIAL AND METHODS The section for HSE (health, safety and environment) at Haukeland University Hospital provided us with an overview of requests for analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise. Injury reports at Haukeland University Hospital from the period 2003 - 2007 (n = 8556) were systematically reviewed. RESULTS On average, 210 sharps injuries are reported annually at Haukeland University Hospital. In addition analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise, were requested annually. 51 % of sharps injuries were reported by nurses, 10 % by laboratory workers, 6 % by doctors and 33 % by others. INTERPRETATION Sharps injuries are often not reported, and especially doctors fail to report them. Of health care workers, nurses report most sharps injuries. Related to numbers employed, laboratory workers report most sharps injuries.
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Affiliation(s)
- Astrid-Mette Husøy
- Laboratorium for klinisk biokjemi, Haukeland universitetssykehus, 5021 Bergen, Norway.
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Jagger J, Berguer R, Phillips EK, Parker G, Gomaa AE. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J Am Coll Surg 2010; 210:496-502. [PMID: 20347743 DOI: 10.1016/j.jamcollsurg.2009.12.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/14/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.
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Affiliation(s)
- Janine Jagger
- University of Virginia, International Healthcare Worker Safety Center, Charlottesville, VA 22903, USA
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Abstract
The risk of hepatitis B and C transmission in health care settings has generated considerable attention within the legal system. This article begins with an overview of the relevant sources of law and then explores legal duties and liability arising from two major categories of risk: occupational risks to health care providers and health care-associated risks to patients and other third parties.
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Affiliation(s)
- Mary Anne Bobinski
- Faculty of Law, University of British Columbia, 1822 East Mall, Vancouver, British Columbia V6T 1Z1, Canada.
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Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. J Infect Public Health 2008; 1:62-71. [PMID: 20701847 DOI: 10.1016/j.jiph.2008.10.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 10/16/2008] [Accepted: 10/17/2008] [Indexed: 10/21/2022] Open
Abstract
In the United States (U.S.), federal legislation requiring the use of safety-engineered sharp devices, along with an array of other protective measures, has played a critical role in reducing healthcare workers' (HCWs) risk of occupational exposure to bloodborne pathogens over the last 20 years. We present the history of U.S. regulatory and legislative actions regarding occupational blood exposures, and review evidence of the impact of these actions. In one large network of U.S. hospitals using the Exposure Prevention Information Network (EPINet) sharps injury surveillance program, overall injury rates for hollow-bore needles declined by 34%, with a 51% decline for nurses. The U.S. experience demonstrates the effectiveness of safety-engineered devices in reducing sharps injuries, and the importance of national-level regulations (accompanied by active enforcement) in ensuring wide-scale availability and implementation of protective devices to decrease healthcare worker risk.
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Affiliation(s)
- Janine Jagger
- International Healthcare Worker Safety Center, Division of Infectious Diseases, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Kobayashi M, Ikeda K, Arase Y, Suzuki F, Akuta N, Hosaka T, Sezaki H, Yatsuji H, Kobayashi M, Suzuki Y, Watahiki S, Mineta R, Iwasaki S, Miyakawa Y, Kumada H. Change of hepatitis B virus genotypes in acute and chronic infections in Japan. J Med Virol 2008; 80:1880-4. [PMID: 18814241 DOI: 10.1002/jmv.21309] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During 35 years from 1971 to 2005, 153 patients with acute and 4,277 with chronic HBV infection visited the Toranomon Hospital in Tokyo, Japan. They were grouped into seven 5-year periods, and HBV genotypes/subgenotypes were determined. Patients with acute HBV infection were younger (P = 0.046), predominantly male (P = 0.004), possessed higher alanine aminotransferase levels (P < 0.001), positive more frequently for HBeAg (P < 0.001), and had lower HBV DNA loads (P = 0.014) than those with chronic infection. Sexual transmission was more frequent in patients with acute than chronic HBV infection (67% vs. 3%, P < 0.001). The number of patients with acute infection increased throughout 1971-2005. Patients with chronic infection increased since 1971, peaked in 1986-1990 and then decreased. The number of patients increased since 1990-2000 again, however, reflecting recent boost of acute HBV infection. The distribution of HBV genotypes was considerably different between patients with acute and chronic infections (A, B, and C: 28.6%, 10.3%, and 59.5% vs. 3.0%, 12.3%, and 84.5%, respectively, P < 0.001). Since 1991, genotype A foreign to Japan started to increase sharply in patients with acute infection, and gradually in those with chronic infection. There was a trend for the foreign subgenotype B2/Ba to increase recently (P < 0.05). Despite immunoprophylaxis of high-risk babies born to carrier mothers with hepatitis B e antigen, implemented nationally since 1986, acute and chronic infections with HBV have been increasing in Japan. Based on genotypes/subgenotypes changing with time, the resurgence of hepatitis B could be attributed to infections, with foreign HBV genotypes/subgenotypes, spreading swiftly by sexual contact.
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Affiliation(s)
- Mariko Kobayashi
- Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan.
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Dagi TF, Berguer R, Moore S, Reines HD. Preventable errors in the operating room--part 2: retained foreign objects, sharps injuries, and wrong site surgery. Curr Probl Surg 2007; 44:352-81. [PMID: 17588468 DOI: 10.1067/j.cpsurg.2007.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- T Forcht Dagi
- The Harvard-MIT Program in Health Sciences and Technology, The Uniformed Services University of the Health Sciences, Boston, MA, USA
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28
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