Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.
Levels ofDNA sequence polymorphism at the suppressor of forked [su(f)] region in natural populations of Drosophila melanogaster and Drosophila simulans are estimated by restriction map analysis. su(f) is located at the base of the euchromatic portion of the X chromosome where the level of crossing-over per physical length is extremely low. In a survey of 55 aUleles from three natural populations of D. melanogaster, only 2 restriction sites of 27 hexanucleotide and 108 tetranucleotide restriction sites scored are polymorphic. Among 103 afleles from three natural populations of D. simulans, just one polymorphic restriction site is found in 109 tetranucleotide-recognizing restriction sites scored. The few polymorphisms in these surveys yield estimates of per site heterozygosities (0.00, 0.0002, and 0.0005, respectively) at least a factor of 10 less than the average observed at loci located in regions of the genome with normal levels of crossing-over.Because under a broad category of models of molecular evolution (including the neutral theory) a correlation between levels of polymorphism and interspecific divergence is expected, the DNA sequence divergence is examined for the su(f)region. Contrary to the predicted correlation, the estimated divergence (0.12 substitution per silent site) is, in fact, greater than that observed at loci in regions of normal crossing-over. According to an alternative hypothesis (hitchhiking effect model) intraspeciflc polymorphism is swept out of the population in regions of the genome dosely linked to rare but selectively favored variants as they quickly go to fixation; the rate of divergence is, however, unaffected by these rare hitchhiking events. Thus, the observed paucity ofpolymorphism and lack of correlation with divergence are in accord with the (7) on the fourth chromosome] have found that the amount of polymorphism is significantly reduced. Surprisingly, there is no evidence for reduced divergence (7-9). These results have been interpreted as the consequence of the "hitchhiking effect" under which rare variants that are selectively favored sweep through the population to fixation. A region around the favored variants will hitchhike along, leading to reduced polymorphism in that part of the chromosome that is tightly linked. The region affected is much larger if crossing-over is reduced. But this hypothesis predicts normal levels of divergence between species (11,12). Indeed, the studies of the y-ASC and CiD region support this prediction. Our first goal is to examine the level of polymorphism in a third region of extremely reduced crossing-over per physical length-i.e., in the suppressor of forked locus, su(f), at the base of the X chromosome (28). Specifically, the DNA sequence variation in the su(f) region is surveyed in samples of alleles from natural populations of Drosophila melanogaster and Drosophila simulans. We find very little polymorphism in both species. The second goal is determination of the relative (to other loci) divergence of the su(f) sequences sinc...
Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017. 29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback. Evidence of effectiveness was found in all categories but the best quality evidence was on multimodal interventions and surveillance, monitoring, and feedback. We call for improvements in study design, reporting of research, and quality of evidence particularly from low-income countries, to strengthen the uptake and international relevance of IPC interventions.
ObjectiveTo synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).MethodsPRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.ResultsOverall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.ConclusionsThis is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.