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SIGNpost 00706

SIGN *SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00706 Incinerators + Supply + Job + Abstracts + News 10 July 2013

CONTENTS
1. Ebook: Travels with an incinerator by Jim Picken
2. UNICEF: 2012 Supply Annual Report – available online
3. Abstract: Lessons from the eradication of smallpox: an
interview with D. A. Henderson
4. Abstract: Global epidemiology of hepatitis C virus infection: new
estimates of age-specific antibody to HCV seroprevalence
5. Abstract: Theatre and laboratory workers’ awareness of and safety
practices against hepatitis B and C infection in a suburban university
teaching hospital in Nigeria
6. Abstract: Prevalence of hepatitis C virus infection among recyclable
waste collectors in Central-West Brazil
7. Abstract: Comparison of the accelerated and standard vaccination
schedules against hepatitis B in healthcare workers
8. Abstract: Intravenous diuretic delivery in the home
9. Abstract: The effects, safety and acceptability of compact, pre-filled,
autodisable injection devices when delivered by lay health workers
10. Extract: The AutoShield Pen Needle is useful for preventing accidental
puncture while administering insulin to others by injection
11. Abstract: Usage and perceptions of pen injectors for diabetes
management: a survey of type 2 diabetes patients in the United States
12. Abstract: Use of microneedle array devices for continuous glucose
monitoring: a review
13. Abstract: Improving physician hand hygiene compliance using
behavioural theories: a study protocol
14. Abstract: Ultrasound-Guided vs. Blind Steroid Injections in Carpal
Tunnel Syndrome: A Single-Blind Randomized Prospective Study
15. Abstract: Using electronic communication safely in health care
settings
16. Abstract: iPads, droids, and bugs: Infection prevention for mobile
handheld devices at the point of care
17. Abstract: Recommendations for waste management
18. Abstract: Contemporary review of injectable facial fillers
19. Abstract: Complications Following Injection of Soft-Tissue Fillers
20. Abstract: Recommended precaution procedures protect healthcare workers
from Crimean-Congo hemorrhagic fever virus
21. No Abstract: Knowledge and self-perceived practices regarding
infection control among nursing students of a tertiary care hospital
22. No Abstract: Safety of allergen injection immunotherapy in real life
23. Job Notice: Senior Supply Chain Management Advisor, Tanzania
24. New Issue of the USAID | DELIVER PROJECT’s Supply Chain Management
Newsletter
25. News
– Saudi Arabia: HIV-tainted blood recipient demands SR 50 m damages
– Global: New WHO Guidelines on HIV Treatment and Prevention
– Malaysia: Methadone, syringe plans prevented 3,100 AIDS cases

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1488

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
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Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

Visit the SIGNpostOnline archives at: http://signpostonline.info

Highlights and news on Facebook: http://facebook.com/SIGN.Moderator

Selected updates at: http://twitter.com/#!/signmoderator
__________________________________________________________________
________________________________*_________________________________

1. Ebook: Travels with an incinerator by Jim Picken

Here is an e-book telling the story of the development and introduction of
a low cost injection waste incinerator by an early SIGN and TECHNET
contributor – Professor James (Jim) Picken at De Montfort University.
__________________________________________________________________
Travels with an incinerator

In the early 2000’s the World Health Organisation (WHO) approached De
Montfort University in Leicester and asked if they could design an
incinerator that could burn medical waste and syringes, the presence of
which, in the poorer countries in Africa and Asia, were causing
preventable deaths and poor health.

The Author of this E book Professor James (Jim) Picken was at that time
head of a commercial projects department of the University and undertook
the project and was successful in creating a design that was tested and
proved to be able to achieve the temperature of 1000 degrees centigrade
and satisfactorily burn the items specified.

Having accepted the design WHO then asked Jim if he would visit countries
where these problems were prevalent and show local people how to build and
operated the incinerator.

The book is an account of these visits showing the the difficulties-
politics and prejudices- and some times dangerous conditions in which he
had to work, one time close to explosions in the Sri Lanca civil war zone.
It describes in detail the culture and environments in which the local
people lived, with coloured pictures of the many areas he visited and his
association with Medican sans frontier.

Available from the Amazon Kindle Book Store as an E book – Travels with an
Incinerator by Jim Picken priced £2.00 or US$ 2.99

http://tinyurl.com/puj2eou
__________________________________________________________________
________________________________*_________________________________

2. UNICEF: 2012 Supply Annual Report – available online
__________________________________________________________________
2012 Supply Annual Report – available online
Thomas Sorensen, Chief of Knowledge Management, UNICEF Supply Division

It is my pleasure to share with you the 2012 UNICEF Supply Annual Report.

http://www.unicef.org/supply/index_report.html

The theme of this year’s report, Supply Chains for Children, focuses on
UNICEF’s collaboration with partners, governments and industry to improve
efficiency and effectiveness in securing and delivering life-saving
products (including vaccines) to support programmes and emergencies.

The report also focuses on the work we are doing to strengthen our own
capacity in supply chain management. The range of activities highlighted
includes the implementation of VISION, and the delivery of support. As a
result of tremendous efforts from colleagues from procurement to logistics
to monitoring and evaluation, we are beginning to see clear advantages in
terms of visibility, efficiency and oversight. With less than a thousand
days to meet the Millennium Development Goals, the Supply Community’s
intensified efforts to ensuring sustainable supplies and in-country
delivery aim to strengthen interfaces between the links in the supply
chain, supporting countries to meet their national objectives in
children’s health and improving their capacity to respond to emergencies.

The report also details challenges and achievements in creating healthy
markets and milestones in product and technological innovation, and
provides UNICEF’s expenditure on supplies and services, valued at $2.468
billion.

Supply Division has been vigorously following up on our commitment to
drive down prices and increase value for money. Procurement strategies
aimed at increasing the availability and affordability of essential
commodities have contributed to $197 million in actual savings in 2012.
Based on current contracts and demand, the projected savings in the next
five years will be a minimum of $810 million.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Lessons from the eradication of smallpox: an
interview with D. A. Henderson
__________________________________________________________________

Lessons from the eradication of smallpox: an interview with D. A.
Henderson

D. A. Henderson and Petra Klepac

Phil. Trans. R. Soc. B 5 August 2013 vol. 368 no. 1623 20130113

It has been more than 35 years since the last naturally occurring case of
smallpox. Sufficient time has passed to allow an objective overview of
what were the key factors in the success of the eradication effort and
what lessons smallpox can offer to other campaigns. Professor D. A.
Henderson headed the international effort to eradicate smallpox.

Here, we present a summary of D. A. Henderson’s perspectives on the
eradication of smallpox. This text is based upon the Unither Baruch
Blumberg Lecture, delivered by D. A. Henderson at the University of Oxford
in November 2012 and upon conversations and correspondence with Professor
Henderson.

http://rstb.royalsocietypublishing.org/content/368/1623/20130113.full
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Global epidemiology of hepatitis C virus infection: new
estimates of age-specific antibody to HCV seroprevalence
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23172780

Hepatology. 2013 Apr;57(4):1333-42. doi: 10.1002/hep.26141.

Global epidemiology of hepatitis C virus infection: new estimates of age-
specific antibody to HCV seroprevalence.

Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

In efforts to inform public health decision makers, the Global Burden of
Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate
the burden of disease using available parameters. This study was conducted
to collect and analyze available prevalence data to be used for estimating
the hepatitis C virus (HCV) burden of disease.

In this systematic review, antibody to HCV (anti-HCV) seroprevalence data
from 232 articles were pooled to estimate age-specific seroprevalence
curves in 1990 and 2005, and to produce age-standardized prevalence
estimates for each of 21 GBD regions using a model-based meta-analysis.

This review finds that globally the prevalence and number of people with
anti-HCV has increased from 2.3% (95% uncertainty interval [UI]:
2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million
between 1990 and 2005.

Central and East Asia and North Africa/Middle East are estimated to have
high prevalence (>3.5%); South and Southeast Asia, sub-Saharan Africa,
Andean, Central, and Southern Latin America, Caribbean, Oceania,
Australasia, and Central, Eastern, and Western Europe have moderate
prevalence (1.5%-3.5%); whereas Asia Pacific, Tropical Latin America, and
North America have low prevalence (<1.5%).

Conclusion: The high prevalence of global HCV infection necessitates
renewed efforts in primary prevention, including vaccine development, as
well as new approaches to secondary and tertiary prevention to reduce the
burden of chronic liver disease and to improve survival for those who
already have evidence of liver disease.

Copyright © 2012 American Association for the Study of Liver Diseases.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Theatre and laboratory workers’ awareness of and safety
practices against hepatitis B and C infection in a suburban university
teaching hospital in Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527056/

Pan Afr Med J. 2012;13:2.

Theatre and laboratory workers’ awareness of and safety practices against
hepatitis B and C infection in a suburban university teaching hospital in
Nigeria.

Okwara EC, Enwere OO, Diwe CK, Azike JE, Chukwulebe AE.

Department of Chemical Pathology, Imo State University Teaching Hospital,
Orlu, Imo State, Nigeria.

INTRODUCTION: The consistent use of barrier protection among theatre
workers is low in this region, so also is hepatitis B virus (HBV)
vaccination. We assessed the level of awareness of HBV and hepatitis C
virus (HCV), HBV vaccination and adoption of safety measures by theatre
and laboratory workers.

METHODS: Structured questionnaires were administered to these workers
which assessed level of knowledge of the viruses, practice of barrier
protection and level of HBV vaccination.

RESULTS: Of 169 participants 32.5% were laboratory workers, 67.5% were
theatre workers; 29.6% males, 70.4% females. Most 94% (159) were aware
that HBV and HCV are viral infections, while 77% (127) and 72.1% (119)
knew HBV and HCV are transmitted through blood transfusion and needle
stick injuries; a correct knowledge was significantly better among
respondents with tertiary education (OR 2.7; 95%CI 1.2-6.3 and OR 2.3;
95%CI 1.0-5.1 respectively). Although 49.1% (80) were aware unprotected
sex was a route of transmission, laboratory staff was twice as likely to
have this knowledge (OR 2.1; 95% CI 1.08-4.08). Only 67.5% (114) use
safety measures consistently, while 86 (54.8%) had received the vaccine of
which only 48 (29.78% of total respondents) had completed three (3) doses;
more likely among those with tertiary education (OR 2.6; 95%CI 1.2-5.8).

CONCLUSION: Most (94%) workers were aware of the risk of HBV and HCV and
HBV vaccine (92.9%) but only few (29.78%) completed vaccination.
Unfortunately, only 2/3 use protective measures consistently. There is
need to make vaccination of health care workers against HBV infection a
firm policy and ensure complete and consistent adherence to work standard
safety measures.

KEYWORDS: HBV vaccination, HCV, HIV, healthcare workers, safety measures

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527056/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Prevalence of hepatitis C virus infection among recyclable
waste collectors in Central-West Brazil
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23828009

Mem Inst Oswaldo Cruz. 2013 Jun;108(4).

Prevalence of hepatitis C virus infection among recyclable waste
collectors in Central-West Brazil.

Marinho TA, Lopes CL, Teles SA, Reis NR, Carneiro MA, Andrade AA, Martins
RM.

Instituto de Patologia Tropical e Saúde Pública.

The prevalence of hepatitis C virus (HCV) in a population of recyclable
waste collectors (n = 431) was assessed using a cross-sectional survey in
all 15 cooperatives in the city of Goiânia, Central-West Brazil.

The HCV prevalence was 1.6% (95% confidence interval: 0.6-3.6) and a
history of sexually transmitted infections was independently associated
with this infection. HCV RNA (corresponding to genotype 1; subtypes 1a and
1b) was detected in five/seven anti-HCV-positive samples.

Although the study population reported a high rate (47.3%) of sharps and
needle accidents, HCV infection was not more frequent in recyclable waste
collectors than in the general Brazilian population.

Free full text

http://tinyurl.com/omm4t74
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Comparison of the accelerated and standard vaccination
schedules against hepatitis B in healthcare workers
__________________________________________________________________
J Res Med Sci. 2012 Oct;17(10):934-7.

Comparison of the accelerated and standard vaccination schedules against
hepatitis B in healthcare workers.

Ghadiri K, Vaziri S, Afsharian M, Jahanbaksh A, Mansouri F, Sayad M,
Najafi F, Souri B.

Nosocomial Infection Research Center, Kermanshah University of Medical
Sciences, Kermanshah, Iran.

BACKGROUND: For healthcare workers, sometimes the conventional hepatitis-B
virus (HBV) vaccination schedule might not provide seroconversion rapidly
enough. The aim of this study was to compare the efficacy of conventional
HBV vaccination with an accelerated schedule (days 0-1-21).

MATERIALS AND METHODS: In this randomized clinical trial, 161 healthcare
workers were divided into two vaccination groups; group A underwent the
conventional schedule (0-1-6 months) and group B received the accelerated
program (0-10-21 days) of hepatitis B virus vaccine. The anti-HBs antibody
was determined 30 days after completion of the third vaccine injection in
both groups by enzyme immunoassay (EIA) (Abbot, Aux SYMsys). By using the
Fisher’s exact and Wilcoxon tests, the results were analyzed. The
protective level of anti- HBS was defined as titer =10 MIU/ml.

RESULTS: The seroprotection rate, 30 days after vaccination, were similar
in both groups A and B; 96.3% of the participants in group A and 92.6% in
group B had anti-HBS antibody =10 MIU/ml.

CONCLUSION: Our data indicated that compared to the classic HBS
vaccination program an accelerated schedule could also be effective and
achieve seroprotection more rapidly.

KEYWORDS: HBS, healthcare workers, hepatitis-B, vaccination

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698651/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Intravenous diuretic delivery in the home
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23654178

Nurs Times. 2013 Apr 9-15;109(14):20-1.

Intravenous diuretic delivery in the home.

Watson C, Annus C.

East Sussex Healthcare Trust.

The British Heart Foundation is funding a two-year pilot programme at 12
UK sites to assess safe, effective ways for specialist nursing teams to
administer intravenous diuretics at home or in day care.

Initial findings suggest the service is effective, safe and preferred by
patients and carers. It has the potential to reduce inpatient bed days,
making significant savings.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: The effects, safety and acceptability of compact, pre-filled,
autodisable injection devices when delivered by lay health workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23809179

Trop Med Int Health. 2013 Jun 29.

The effects, safety and acceptability of compact, pre-filled, autodisable
injection devices when delivered by lay health workers.

Glenton C, Khanna R, Morgan C, Nilsen ES.

Norwegian Knowledge Centre for the Health Services, Oslo, Norway;
Norwegian branch of the Nordic Cochrane Centre, Oslo, Norway.

OBJECTIVES: To systematically assess (i) the effects and safety and (ii)
the acceptability of using lay health workers (LHWs) to deliver vaccines
and medicines to mothers and children through compact pre-filled
autodisable devices (CPADs).

METHODS: We searched electronic databases and grey literature. For the
systematic review of effects and safety, we sought randomised and non-
randomised controlled trials, controlled before-after studies and
interrupted time series studies. For the systematic review of
acceptability, we sought qualitative studies. Two researchers
independently carried out data extraction, study quality assessment and
thematic analysis of the qualitative data.

RESULTS: No studies met our criteria for the review exploring the effects
and safety of using LHWs to deliver CPADs. For the acceptability review,
six qualitative studies assessed the acceptability of using LHWs to
deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or
oxytocin using Uniject™ devices. All studies took place in low- or middle-
income countries and explored the perceptions of community members, LHWs,
supervisors, health professionals or programme managers. Most of the
studies were of low quality. Recipients generally accepted the
intervention. Most health professionals were confident that LHWs could
deliver the intervention with sufficient training and supervision, but
some had problems delivering supervision. The LHWs perceived Uniject™ as
effective and important and were motivated by positive responses from the
community. However, some LHWs feared the consequences if harm should come
to recipients.

CONCLUSIONS: Evidence of the effects and safety of using CPADs delivered
by LHWs is lacking. Evidence regarding acceptability suggests that this
intervention may be acceptable although LHWs may feel vulnerable to blame.

© 2013 John Wiley & Sons Ltd.
__________________________________________________________________
________________________________*_________________________________

10. Extract: The AutoShield Pen Needle is useful for preventing accidental
puncture while administering insulin to others by injection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22768908

J Diabetes Sci Technol. 2012 May 1;6(3):723-4.

The AutoShield Pen Needle is useful for preventing accidental puncture
while administering insulin to others by injection.

Yakushiji F, Funaki Y, Yamakawa K, Kudo A, Fujita H, Yasuda M, Nishimura
A, Nagasawa K, Ishido H, Yoshikawa T, Kinoshita H.

Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440053/

Extract

” Diabetes patients usually perform insulin injection on themselves (self-
injection); however, caregivers also administer insulin to patients
(other-injection).The following popper user interface control may not be
accessible. Tab to the next button to revert the control to an accessible
version.Destroy user interface control1 The use of insulin injection pens
with needles sometimes causes accidental puncture. Furthermore, if the
patient has an infectious disease such as human immunodeficiency virus or
Hepatitis C virus, accidental puncture during other-injection can result
in transmission of the infectious disease to the caregiver.The following
popper user interface control may not be accessible. Tab to the next
button to revert the control to an accessible version.Destroy user
interface control2,The following popper user interface control may not be
accessible. Tab to the next button to revert the control to an accessible
version.Destroy user interface control3 The AutoShield® Pen Needle
(Becton, Dickinson and Company, Franklin Lakes, NJ), which recaps
automatically and prevents accidental puncture,The following popper user
interface control may not be accessible. Tab to the next button to revert
the control to an accessible version.Destroy user interface control4 has
been available in Japan since 2011. However, the ease of use of the
AutoShield has not been evaluated.

We evaluated the ease of use of the AutoShield by comparing it with the
PenNeedle® 32G (Novo Nordisk A/S, Bagsværd, Denmark) in other-injection
settings: injection to the arm and injection to the abdomen. Our study
group included 30 respondents [mean (standard deviation), 38.4 (9.0)
years, (range, 24–59 years)] comprising 15 women (50%) and 15 men (50%).
Respondents answered a questionnaire (Table 1) immediately after
performing injections. Results were scored from 1 to 5. We performed a
comprehensive evaluation and investigated individual questionnaire items
to determine the differences between the AutoShield and the PenNeedle.
Univariate and multivariate analysis were performed using Statview 5.0
software (SAS Institute Inc., Cary, NC) and significance was defined as p
< .05.”

Continues at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440053/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Usage and perceptions of pen injectors for diabetes
management: a survey of type 2 diabetes patients in the United States
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22768901

J Diabetes Sci Technol. 2012 May 1;6(3):686-94.

Usage and perceptions of pen injectors for diabetes management: a survey
of type 2 diabetes patients in the United States.

Toscano D, Brice J, Alfaro C.

Frost & Sullivan, New York, New York 10004, USA. deborah.toscano@frost.com

BACKGROUND: This study was conducted to investigate type 2 diabetes
mellitus (T2DM) patient perceptions of their pen injectors and determine
which features were deemed most important to overall satisfaction.

METHODS: Frost & Sullivan conducted a Web-based survey of T2DM patients in
the United States in November 2010. Survey participants were initially
screened prior to full participation. A total of 1002 adult T2DM patients
who were using a pen injector on a regular basis to administer their
diabetes medication(s) were surveyed. The survey consisted of 24 questions
focused on awareness and current usage of pen injectors by type and brand,
specific features of pen injectors, and patients’ preferences for and
satisfaction with pen injectors.

RESULTS: The majority of surveyed patients were using prefilled pen
injectors as compared with durable pens. The LANTUS SoloSTAR (sanofi-
aventis) was reported to be the most commonly used pen. The LANTUS
SoloSTAR was also ranked highly for overall satisfaction and likelihood of
continued usage. Regardless of brand, most surveyed patients reported that
they were likely to continue using their current pen. In general, the
single most important feature for user satisfaction was an easy push-
button injection.

CONCLUSIONS: Ease of self-administration is of highest priority to users
of pen injectors. Important features facilitating ease of use, such as an
easily depressed push-button injection, are likely to minimize the burden
on T2DM patients, thereby improving compliance and clinical outcomes.

© 2012 Diabetes Technology Society.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440057/

__________________________________________________________________
________________________________*_________________________________

12. Abstract: Use of microneedle array devices for continuous glucose
monitoring: a review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23234256

Diabetes Technol Ther. 2013 Jan;15(1):101-15.

Use of microneedle array devices for continuous glucose monitoring: a
review.

El-Laboudi A, Oliver NS, Cass A, Johnston D.

Diabetes, Endocrinology, and Metabolic Medicine, Imperial College London,
London, United Kingdom.

Microneedle array devices provide the opportunity to overcome the barrier
characteristics of the outermost skin layer, the stratum corneum. This
novel technology can be used as a therapeutic tool for transdermal drug
delivery, including insulin, or as a diagnostic tool providing access to
dermal biofluids, with subsequent analysis of its contents.

Over the last decade, the use of microneedle array technology has been the
focus of extensive research in the field of transdermal drug delivery.
More recently, the diagnostic applications of microneedle technology have
been developed.

This review summarizes the existing evidence for the use of microneedle
array technology as biosensors for continuous monitoring of the glucose
content of interstitial fluid, focusing also on mechanics of insertion,
microchannel characteristics, and safety profile.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Improving physician hand hygiene compliance using
behavioural theories: a study protocol
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23379466

Implement Sci. 2013 Feb 4;8:16.

Improving physician hand hygiene compliance using behavioural theories: a
study protocol.

Squires JE, Suh KN, Linklater S, Bruce N, Gartke K, Graham ID, Karovitch
A, Read J, Roth V, Stockton K, Tibbo E, Woodhall K, Worthington J,
Grimshaw JM.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa,
ON, Canada. jasquires@ohri.ca

BACKGROUND: Healthcare-associated infections affect 10% of patients in
Canadian acute- care hospitals and are significant and preventable causes
of morbidity and mortality among hospitalized patients. Hand hygiene is
among the simplest and most effective preventive measures to reduce these
infections. However, compliance with hand hygiene among healthcare
workers, specifically among physicians, is consistently suboptimal. We aim
to first identify the barriers and enablers to physician hand hygiene
compliance, and then to develop and pilot a theory-based knowledge
translation intervention to increase physicians’ compliance with best hand
hygiene practice.

DESIGN: The study consists of three phases. In Phase 1, we will identify
barriers and enablers to hand hygiene compliance by physicians. This will
include: key informant interviews with physicians and residents using a
structured interview guide, informed by the Theoretical Domains Framework;
nonparticipant observation of physician/resident hand hygiene audit
sessions; and focus groups with hand hygiene experts. In Phase 2, we will
conduct intervention mapping to develop a theory-based knowledge
translation intervention to improve physician hand hygiene compliance.
Finally, in Phase 3, we will pilot the knowledge translation intervention
in four patient care units.

DISCUSSION: In this study, we will use a behavioural theory approach to
obtain a better understanding of the barriers and enablers to physician
hand hygiene compliance. This will provide a comprehensive framework on
which to develop knowledge translation interventions that may be more
successful in improving hand hygiene practice. Upon completion of this
study, we will refine the piloted knowledge translation intervention so it
can be tested in a multi-site cluster randomized controlled trial.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571966/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Ultrasound-Guided vs. Blind Steroid Injections in Carpal
Tunnel Syndrome: A Single-Blind Randomized Prospective Study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23811617

Am J Phys Med Rehabil. 2013 Jun 26.

Ultrasound-Guided vs. Blind Steroid Injections in Carpal Tunnel Syndrome:
A Single-Blind Randomized Prospective Study.

Ustün N, Tok F, Yagz AE, Kizil N, Korkmaz I, Karazincir S, Okuyucu E,
Turhanoglu AD.

From the Department of Physical Medicine and Rehabilitation (NU, AEY, NK,
ADT), Department of Radiology (IK, SK), and Department of Neurology (EO),
Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey; and Physical
Medicine and Rehabilitation Clinic, Iskenderun Military Hospital, Hatay,
Turkey (FT).

OBJECTIVE: The aim of this study was to compare the efficacy and the
safety of ultrasound (US)-guided vs. blind steroid injections in patients
with carpal tunnel syndrome (CTS).

DESIGN: This prospective randomized single-blind clinical trial included
46 patients with CTS (46 affected median nerves). The subjects were
randomized-to either the US-guided or the blind injection group-before
they received 40 mg of methylprednisolone. They were evaluated using the
Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6
wks and 12 wks after injection, and the side effects were noted. RESULTS:

The symptom severity and functional status scores improved significantly
in both groups at 6 wks after treatment, and these improvements persisted
at 12 wks after treatment (all P < 0.05). The improvement in symptom
severity scores in the US-guided group at 12 wks was higher than in the
palpation-guided group (P < 0.05). Average time to symptom relief was
shorter in the US-guided group (P < 0.05). There was no significant
difference between the two groups in terms of side effects (P > 0.05).

CONCLUSIONS: Although both US-guided and blind steroid injections were
effective in reducing the symptoms of CTS and improving the function, an
earlier onset/better improvement of symptom relief suggests that US-guided
steroid injection may be more effective than are blind injections in CTS.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Using electronic communication safely in health care
settings
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23399014

Nurs Womens Health. 2013 Feb-Mar;17(1):59-62.

Using electronic communication safely in health care settings.

Broussard BS, Broussard AB.

Family Birthing Center, Ochsner Medical Center, Baton Rouge, LA, USA.
bsbroussard@cox.net

Nurses are increasingly using mobile and other devices, such as cell
phones, smartphones, tablets, bar-coding scanners, monitoring equipment
and bedside computers, to communicate with members of the health care team
and with patients.

Communication accomplished with such devices includes direct verbal
communication, text-messaging, emailing, obtaining patient care
information and accessing medical records for order entry and for
documenting nursing care.

Problems that could occur with such communication methods include
distraction, errors, de-personalized care, violation of confidentiality
and transmission of nosocomial pathogens.

Policies are needed to prevent inappropriate use of technological devices
in patient care and to promote patient safety and quality care with their
use.

© 2013 AWHONN.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: iPads, droids, and bugs: Infection prevention for mobile
handheld devices at the point of care
__________________________________________________________________
Am J Infect Control. 2013 Jun 28. pii: S0196-6553(13)00799-2.

iPads, droids, and bugs: Infection prevention for mobile handheld devices
at the point of care.

Manning ML, Davis J, Sparnon E, Ballard RM.

Thomas Jefferson University, Jefferson School of Nursing, Philadelphia,
PA. Electronic address: marylouman@gmail.com.

Health care providers are increasingly using wireless media tablets, such
as the Apple iPad, especially in the hospital setting. In the absence of
specific tablet disinfection guidelines the authors applied what is known
about the contamination of other nonmedical mobile communication devices
to create a “common sense” bundle to guide wireless media tablet infection
prevention practices.

Copyright © 2013 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Recommendations for waste management
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23765028

Ann Biol Clin (Paris). 2013 Jun;71 Spec No 1:351-60.

[Recommendations for waste management].

[Article in French]

Vinner E, Odou MF, Fovet B, Ghnassia JC; membres du sous-groupe Processus
supports. Collaborators (22)

Laboratory waste management must ensure the safety of patients and staff,
limiting the environmental impacts and control waste disposal budget.
Sorting of waste must be carried out at the source.

The packaging must be adapted, allowing easy identification of specific
disposal routes. With regard to wastes for human or animal health care
and/or related research (DASRI), packages must comply with the
regulations, standards and ADR if necessary.

Storage provisions differ according to the amount of DASRI produced.

Waste collection is carried out directly on the place of activity by a
certified service provider. Non pre-treated DASRI is incinerated in
specific approved plants for a T ° > 1,200 °C.

Special provisions also exist for chemical waste and radioactive waste,
the latter being regulated by ANDRA.

KEYWORDS: DASRI, ISO 15189, accreditation, environment, sorting, waste
treatment
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Contemporary review of injectable facial fillers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23183718

JAMA Facial Plast Surg. 2013 Jan;15(1):58-64.

Contemporary review of injectable facial fillers.

Kontis TC.

Facial Plastic Surgicenter, Johns Hopkins Medical Institutions, 1838
Greene Tree Rd, Baltimore, MD 21208, USA. tckontis@aol.com

Perhaps the most significant change in facial rejuvenation in the last 10
years has been the introduction of nonsurgical treatments for the
relaxation of facial wrinkles and for the restoration of lost volume.

Fillers such as paraffin and silicone have been used in the past for
volume restoration, but only recently have new fillers been developed
whose safety and efficacy have been supported by clinical research. The
introduction of hyaluronic acid (HA) fillers in 2003 began the filler
revolution and paved the way for development of biostimulatory and
permanent materials.

There is an abundance of high-level evidence-based studies comparing the
HA fillers, calcium hydroxylapatite, and poly(methyl methacrylate) with
collagen and other HA formulations, but there is only limited high-level
data evaluating poly-L-lactic acid.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Complications Following Injection of Soft-Tissue Fillers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23825309

Aesthet Surg J. 2013 Jul 3.

Complications Following Injection of Soft-Tissue Fillers.

Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE.

Dr Ozturk is an Aesthetic Surgery Fellow at the Cleveland Clinic,
Cleveland, Ohio.

Background: Soft-tissue filler injection is a very common procedure in the
United States. Although the safety profile is favorable, adverse events
(AE) can occur, ranging from mild to severe in intensity.Objectives:The
authors performed a literature search to identify the facial sites most
prone to severe complications. They review the course of these
complications and discuss preventive measures.

Methods: The National Library of Medicine, the Cochrane Library, and Ovid
MEDLINE were searched, and relevant articles (published through August
2012) were retrieved based on prespecified inclusion criteria. The
complications reviewed were limited to “severe” events, such as soft-
tissue necrosis, filler embolization, visual impairment, and anaphylaxis.
The filler materials included were those approved by the US Food and Drug
Administration at the time of this study.

Results: Forty-one articles, representing 61 patients with severe
complications, were identified. Data collected from these case reports
included filler type, injection site, complication site, symptom interval,
symptom of complication, time to therapy, modality of treatment, and
outcome.

The most common injection site for necrosis was the nose (33.3%), followed
by the nasolabial fold (31.2%). Blindness was most often associated with
injection of the glabella (50%).

An estimated incidence of 0.0001% for developing a severe complication was
calculated by reviewing society-based filler data and case reports within
same time period.

Conclusions: Although soft-tissue fillers are a popular choice for
minimally invasive rejuvenation of the face, physicians should be aware of
the serious potential adverse effects, recognize their presentations, and
have appropriate treatments readily available.

KEYWORDS: blindness, complication, cosmetic medicine, filler, injectable,
literature review, necrosis
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Recommended precaution procedures protect healthcare workers
from Crimean-Congo hemorrhagic fever virus
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23816412

Int J Infect Dis. 2013 Jun 28. pii: S1201-9712(13)00199-9.

Recommended precaution procedures protect healthcare workers from Crimean-
Congo hemorrhagic fever virus.

Gozel MG, Dokmetas I, Oztop AY, Engin A, Elaldi N, Bakir M.

Department of Infectious Diseases and Clinical Microbiology, Faculty of
Medicine, Cumhuriyet University, 58140 Sivas, Turkey. Electronic address:
mggozel@yahoo.com.

OBJECTIVES: The Crimean-Congo hemorrhagic fever (CCHF) virus can spread
from person to person and may cause nosocomial outbreaks among healthcare
workers (HCWs). The US Centers for Disease Control and Prevention have
recommended the use of personal protective equipment (PPE). We
investigated the compliance of HCWs with PPE usage during the follow-up of
patients, and also the number of risky contacts that occurred between
patients and HCWs. We also aimed to determine the seroprevalence of CCHF
virus in HCWs.

METHODS: This study was conducted at Cumhuriyet University Education and
Research Hospital, a medical center located in a highly endemic area for
CCHF where a total of 1284 confirmed CCHF patients were followed-up
between 2002 and 2012. All HCWs who were at risk of CCHF virus contact and
infection were included in the study. The compliance of the HCWs with PPE
usage and the number of contacts that had occurred were recorded. HCW
serum samples were analyzed for CCHF virus IgM and IgG by ELISA.

RESULTS: The total rates of PPE usage were 93.7% for gowns, 77.4% for
gloves, and 38.9% for masks; the highest compliance was detected in the
infectious diseases ward: 100%, 88.6%, and 82.9%, respectively.

A total of four HCWs had a history of high-risk contact with contaminated
material (**two percutaneous exposure and two mucosal contacts), but the
number of low-risk contacts was quite high. The total seroprevalence rate
was only 0.53%.

CONCLUSIONS: Although the HCWs at our medical center have dealt with an
extremely high number of CCHF patients during the last decade, the total
seropositivity for CCHFV IgG was only 0.53%. This low rate may be a result
of high compliance with PPE usage and also regular education programs.

Copyright © 2013 International Society for Infectious Diseases. Published
by Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

21. No Abstract: Knowledge and self-perceived practices regarding
infection control among nursing students of a tertiary care hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23827482

Am J Infect Control. 2013 Jul 1. pii: S0196-6553(13)00803-1.

Knowledge and self-perceived practices regarding infection control among
nursing students of a tertiary care hospital.

Bota R, Ahmed M, Jamali MS, Azeem Q.

Dow Medical College, Karachi, Pakistan.
Electronic address: Rafaqatmartin@live.com.
__________________________________________________________________
________________________________*_________________________________

22. No Abstract: Safety of allergen injection immunotherapy in real life
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23821836

Eur Ann Allergy Clin Immunol. 2013 Apr;45(2):63-4.

Safety of allergen injection immunotherapy in real life.

Borghesan F, Manzotti G.
__________________________________________________________________
________________________________*_________________________________

23. Job Notice: Senior Supply Chain Management Advisor, Tanzania

Response Date: Jul 18, 2013

Visit the FedBiz website for details: http://tinyurl.com/qhrtzqy
__________________________________________________________________
http://tinyurl.com/qhrtzqy

Senior Supply Chain Management Advisor
Solicitation Number: 621-S-13-002
Agency: Agency for International Development
Office: Overseas Missions
Location: Tanzania USAID-Dar es Salaam

Solicitation Number: 621-S-13-002
Notice Type: Combined Synopsis/Solicitation

Synopsis:

Added: Jun 14, 2013 2:24 am

USAID/Tanzania requires the highly specialized technical services of a
Senior Supply Chain Management System (SCMS) Advisor for the Health
Systems Unit to oversee complex supply chain related activities (including
commodity procurement and systems strengthening) in Tanzania. Broadly,
the aim is development of a streamlined public sector procurement and
distribution system that incorporates essential RCH, FP, TB, Malaria,
HIV/AIDS and other STI related- commodities. Thus, the Senior Advisor
will oversee supply chain activities for the USG President’s Emergency
Plan for AIDS Relief (PEPFAR), President’s Malaria Initiative (PMI),
Family Planning (FP), Maternal and Child Health (MCH), and TB Programs.
This includes non-USG support provided by DFID through the Mission for FP
commodities.

Taken together, USAID’s supply chain portfolio is estimated at USD $40-60
million per year. The Senior Advisor will ensure that sound policy,
strategic and technical analysis occurs in support of these objectives;
monitoring and evaluation systems meet management and reporting
requirements; coordination with USG and other partners serves supply
chain needs; and that reinforcing Tanzania’s sustainable capacity in these
functions is aggressively pursued.

The Senior Advisor will serve both USAID and the USG PEPFAR team as the
principal expert, source of guidance, and representative on Health
Commodities Supply Chain management challenges and issues, opportunities
and progress. In addition, due to procurement skills necessitated by the
position, the incumbent will also manage infrastructure
construction/renovation and equipment maintenance related project
mechanisms for the Mission.

Added: Jun 20, 2013 4:30 am
Modifications notes: The following changes have been made to the original
vacancy announcement package, which are reflected in the final version
dated June 19, 2013:

1) Deadline changed to July 18, 2013 at 5:00 PM EST
2) Clarifications added to specify that the announcement is open to
applications from qualified U.S. Citizens (offshore or resident) and
Third-Country Nationals (TCNs)
3) Erroneous reference to “Senior Energy Advisor” has been removed
4) Duplicative listing of Minimum Qualifications removed
5) Numbering changed
__________________________________________________________________
________________________________*_________________________________

24. New Issue of the USAID | DELIVER PROJECT’s Supply Chain Management
Newsletter
__________________________________________________________________

New Issue of the USAID | DELIVER PROJECT’s Supply Chain Management
Newsletter
The Quarter 2, 2013 issue of the USAID | DELIVER PROJECTs Supply Chain
Management (SCM) Newsletter includes articles about–

– supply chain sustainability through country ownership
– using open source software for logistics management information systems
in Tanzania and Zambia
– the Global Health Supply Chain Summit
– risk management in supply chain management
– public/private partnerships.

After this issue, the SCM Newsletter will transition to a new format; a
short survey is available for your feedback. Read the SCM Newsletter at
http://j.mp/1cS2ILt
__________________________________________________________________
________________________________*_________________________________

25. News

– Saudi Arabia: HIV-tainted blood recipient demands SR 50 m damages
– Global: New WHO Guidelines on HIV Treatment and Prevention
– Malaysia: Methadone, syringe plans prevented 3,100 AIDS cases

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://arabnews.com/news/457475

Saudi Arabia: HIV-tainted blood recipient demands SR 50 m damages

Jeddah: Arab News (09.07.13)

The Administrative Court in Riyadh is currently examining a petition filed
by a child, who was transfused with HIV-contaminated blood samples at a
public hospital in the southern province of Jazan earlier this year.

The lawyer representing the victim Riham Hakami said his client’s demand
of SR 50 million as damages for the life-threatening mistake of the
hospital is far below the international compensation rate for similar
medical errors.

“In some countries the compensation for a similar error is around 160
million euros (SR 800 million) apart from sacking and imprisoning the
responsible officials,” the lawyer said in a statement.

He also demanded holding the doctor legally accountable for his mistake
and hoped that the court would issue its verdict after a few hearings, a
local daily reported yesterday.

The Ministry of Health issued 11 orders on the basis of the
recommendations of the committee set up by it to probe the medical error
including sacking five senior officials in the health department. The
daily added that it failed to get any comment on the case from the
spokesman of the ministry.

Riham is a sickle-cell anemia patient who has had blood transfusion every
year at the same hospital where the accident took place.

The ministry has described the incident as a grave mistake expressed its
deep apologies to “the girl, her parents, her family and the Saudi
society” and vowed to hold those responsible accountable.

The ministry’s penal actions included the termination of the director of
Jazan General Hospital, the hospital’s medical director and the director
of the laboratory and blood bank. The latter was fined SR 10,000.

Reacting to the medical error, the Human Rights Commission demanded that
the Ministry of Health immediately begin examining blood transfusion
procedures and mechanisms countrywide to ensure such mistakes are not
repeated.

In a recent letter to the Ministry of Health, the National Anti-corruption
Commission demanded that a committee be set up to ensure that both the
citizens and residents get the best possible service in the hospitals
under the ministry.
__________________________________________________________________
__________________________________________________________________
http://www.mediaforfreedom.com/readarticle.php?AID=17767

Global: New WHO Guidelines on HIV Treatment and Prevention

By Bobby Ramakant, Media for Freedom (05.07.13)

During the Seventh IAS Conference on HIV Pathogenesis, Treatment, and
Prevention, the World Health Organization (WHO) released new HIV treatment
and prevention guidelines that recommended offering antiretroviral therapy
(ART) to HIV-infected adults whose CD4 cell count fell to 500 cells per
cubic millimeter or lower. The guidelines also recommended ART for certain
HIV-infected people—children under five, pregnant and breastfeeding women,
partners of uninfected people, those co-infected with hepatitis B, and
people with active TB—regardless of CD4 cell count. The guidelines
endorsed treating adults, pregnant women, adolescents, and older children
with a single, fixed-dose pill containing tenofovir, lamivudine (or
emtricitabine), and efavirenz. WHO updated the guidelines to reflect
recent evidence that “earlier ART” could help HIV-infected people live
longer, healthier lives and reduce HIV transmission substantially.

WHO’s 2010 guidelines, adopted by 90 percent of all countries, recommended
offering ART at 350 CD4 cells per cubic millimeter or lower. By the end of
2012, approximately 9.7 million people were taking ART. Adoption of the
2013 guidelines might prevent 3 million deaths and 3.5 million new HIV
infections between now and 2025.

According to Dr. B.B. Rewari from India’s National AIDS Control
Organization, the new guidelines will help reduce the gap that exists
between the standard of care in developed and developing countries.
Ongoing challenges included increasing HIV testing so that more people
knew their status, supplying ART to those who required it, and retaining
HIV patients in care.

Mitchell Warren, spokesperson for the global advocacy organization AVAC,
urged a comprehensive, coordinated approach that included all options,
including male circumcision, male and female condoms, pre-exposure
prophylaxis, clean needles for injection drug users, and continuing
development of vaccines and HIV microbicides. Other populations that faced
barriers to HIV prevention and care included HIV-infected children, men
who have sex with men, transgender people, sex workers, and injection drug
users.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ormpmcc

Malaysia: Methadone, syringe plans prevented 3,100 AIDS cases

By Hana Naz Harun, New Straits Times, Kuala Lumpur Malaysia (04.07.13)

The Malaysian Health Ministry notes that needle-dependent addicts form the
largest group of HIV victims in Malaysia, representing 67.2 per cent of
66,046 cases since 1986. But the 3,100 cases of averted HIV infections
show that the government’s investment in harm-reduction programmes has
been effective.

KUALA LUMPUR: The government has spent considerable resources and efforts
to control HIV transmission among needle-dependent addicts through harm
reduction programmes, such as methadone maintenance therapy (MMT) and the
needle and syringe exchange programme (NSEP).

Since its inception in 2006, this has prevented 3,100 HIV infections,
according to research conducted by the Centre of Excellence for Research
in AIDS (Ceria), Universiti Malaya.

In a paper titled “Cost effectiveness and return on investment of HIV harm
reduction programmes for injecting drug users in Malay-sia”, Ceria found
the averted infections had resulted in savings of RM2.5 million
(S$995,200) in healthcare costs.

Its lead researcher, Herlianna Naning, said this study, funded by the
World Bank, was strong evidence that such harm-reduction programmes were
effective.

Speaking on the final day of the 7th International AIDS Society Conference
on HIV Pathogenesis, Treatment and Prevention yesterday, Naning said the
government had spent RM22.7 million (S$9.04 million) on HIV-prevention
programmes, of which RM14 million (S$5.57 million) was spent on harm-
reduction programmes, until 2011.

“If this effort is continued in the next 10 years, RM38 million (S$15.13
million) may be saved in direct healthcare costs and more lives can be
saved.”

Quoting the Health Ministry’s Global AIDS Respond Progress Report 2012,
Naning said needle-dependent addicts remained the largest group with HIV
in Malaysia, representing 67.2 per cent of 66,046 cases since 1986.

“Only 12.3 per cent (20,955 people) of them receive MMT and 20.1 per cent
(34,244 people) of them receive NSEP, but this has already brought
positive results.”
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
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Use of trade names and commercial sources is for identification only and
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The SIGN Forum welcomes new subscribers who are involved in injection
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* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
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We would like your help in building this archive. Please send your old
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__________________________________________________________________
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The SIGN Internet Forum was established at the initiative of the World
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The SIGN Secretariat home is the Department of Health Systems Policies and
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The SIGN Forum is moderated by Allan Bass and is hosted on the University
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