Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

Contamination of Donana food-chains after the Aznalcollar mine disaster

On 25 April 1998 part of the tailings pond dike of the Aznalcollar Zn mine north of the Guadalquivir marshes (Donana) in southern Spain collapsed releasing an estimated 5 million m³ of acidic metal-rich waste. This event contaminated farmland and wetland up to >40 km downstream, including the 900-ha 'Entremuros', an important area for birds within the Donana world heritage site. In spite of the contamination, birds continued to feed in this area. Samples of two abundant macrophytes (Typha dominguensis and Scirpus maritimus) were taken from the Entremuros and nearby uncontaminated areas; these plants are important food items for several bird species. Analyses showed that in the Entremuros mean plant tissue concentrations of Cd were 3-40-fold (0.8-7.4 ppm) and Zn 20-100-fold (20-3384 ppm) greater than those from control areas. Comparable dietary concentrations of Zn have been reported to cause severe physiological damage to aquatic birds under experimental conditions. Elevated Cd concentrations are of concern as Cd bioconcentrates and is a cumulative poison. Metals released in this accident are moving into this food-chain and present a considerable risk to species feeding on Typha sp. and Scirpus sp. Many other food-webs exist in this area and require detailed examination to identify the species at risk, and to facilitate the management of these risks to minimise future impacts to the wildlife of Donana. Copyright (C) 1999 Elsevier Science Ltd.

Measuring non-use value of environmental goods using the contingent valuation method:problems of information and cognition and the application of cognitive questionnaire design methods

Much interest now focuses on the use of the contingent valuation method (CVM) to assess non-use value of environmental goods. The paper reviews recent literature and highlights particular problems of information provision and respondent knowledge, comprehension and cognition. These must be dealt with by economists in designing CVM surveys for eliciting non-use values. Cognitive questionnaire design methods are presented which invoke concepts from psychology and tools from cognitive survey design (focus groups and verbal reports) to reduce a complex environmnetal good into a meaningful commodity that can be valued by respondents in a contingent market. This process is illustrated with examples from the authors' own research valuing alternative afforestation programmes. -Authors

72 Potential for airborne bacterial contamination in an outpatient respiratory clinic

The Development and Testing of a New Version of the Cognitive Reflection Test Applying Item Response Theory (IRT)

The cognitive reflection test (CRT) is a short measure of a person's ability to resist intuitive response tendencies and to produce a normatively correct response, which is based on effortful reasoning. Although the CRT is a very popular measure, its psychometric properties have not been extensively investigated. A major limitation of the CRT is the difficulty of the items, which can lead to floor effects in populations other than highly educated adults. The present study aimed at investigating the psychometric properties of the CRT applying item response theory analyses (a two-parameter logistic model) and at developing a new version of the scale (the CRT-long), which is appropriate for participants with both lower and higher levels of cognitive reflection. The results demonstrated the good psychometric properties of the original, as well as the new scale. The validity of the new scale was also assessed by measuring correlations with various indicators of intelligence, numeracy, reasoning and decision-making skills, and thinking dispositions. Moreover, we present evidence for the suitability of the new scale to be used with developmental samples. Finally, by comparing the performance of adolescents and young adults on the CRT and CRT-long, we report the first investigation into the development of cognitive reflection.

Dual-Hop Cognitive Amplify-and-Forward Relaying Networks over η− μ Fading Channels

This paper presents a thorough performance analysis of dual-hop cognitive amplify-and-forward (AF) relaying networks under spectrum-sharing mechanism over independent non-identically distributed (i.n.i.d.) &#x100000; fading channels. In order to guarantee the quality-of-service (QoS) of primary networks, both maximum tolerable peak interference power Q at the primary users (PUs) and maximum allowable transmit power P at secondary users (SUs) are considered to constrain transmit power at the cognitive transmitters. For integer-valued fading parameters, a closed-form lower bound for the outage probability (OP) of the considered networks is obtained. Moreover, assuming arbitrary-valued fading parameters, the lower bound in integral form for the OP is derived. In order to obtain further insights on the OP performance, asymptotic expressions for the OP at high SNRs are derived, from which the diversity/coding gains and the diversity-multiplexing gain tradeoff (DMT) of the secondary network can be readily deduced. It is shown that the diversity gain and also the DMT are solely determined by the fading parameters of the secondary network whereas the primary network only affects the coding gain. The derived results include several others available in previously published works as special cases, such as those for Nakagami-m fading channels. In addition, performance evaluation results have been obtained by Monte Carlo computer simulations which have verified the accuracy of the theoretical analysis.

Secure Switch-and-Stay Combining (SSSC) for Cognitive Relay Networks

In this paper, we study a two-phase underlay cognitive relay network, where there exists an eavesdropper who can overhear the message. The secure data transmission from the secondary source to secondary destination is assisted by two decode-and-forward (DF) relays. Although the traditional opportunistic relaying technique can choose one relay to provide the best secure performance, it needs to continuously have the channel state information (CSI) of both relays, and may result in a high relay switching rate. To overcome these limitations, a secure switch-and-stay combining (SSSC) protocol is proposed where only one out of the two relays is activated to assist the secure data transmission, and the secure relay switching occurs when the relay cannot support the secure communication any longer. This security switching is assisted by either instantaneous or statistical eavesdropping CSI. For these two cases, we study the system secure performance of SSSC protocol, by deriving the analytical secrecy outage probability as well as an asymptotic expression for the high main-to-eavesdropper ratio (MER) region. We show that SSSC can substantially reduce the system complexity while achieving or approaching the full diversity order of opportunistic relaying in the presence of the instantaneous or statistical eavesdropping CSI.