Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland. Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care. Results: The intervention strategy resulted in mean cost savings per patient of 512.77 (95 percent confidence interval [CI], 1086.46-91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, 0.0101-0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY. Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice. Copyright © Cambridge University Press 2010.

Influence of compaction procedure on the mechanical behaviour of an unsaturated compacted clay, Part 1: Wetting and Isotropic Compression

The influence of compaction pressure, compaction water content and type of compaction (static or dynamic) on subsequent soil behaviour during wetting and isotropic loading has been investigated by conducting controlled-suction tests on samples of unsaturated compacted speswhite kaolin. The results are interpreted within the context of an elastoplastic framework for unsaturated soils, to examine which compaction-induced effects can be explained simply by variation in the initial state of the soil and which require that soils produced by different compaction procedures are modelled as fundamentally different materials. The compaction pressure influences initial state, by affecting the initial position of the yield surface, but it also influences, to a limited degree, the positions of the normal compression lines for different values of suction. The compaction water content influences the initial suction, but also has a significant influence (greater than does compaction pressure) on the positions of the normal compression lines. A change from static to dynamic compaction has no significant effect on subsequent behaviour

Influence of compaction procedure on the mechanical behaviour of an unsaturated compacted clay. Part 2: shearing and constitutive modelling

The influence of compaction pressure, compaction water content and type of compaction (static or dynamic) on subsequent soil behaviour was investigated by conducting controlled-suction triaxial tests on samples of unsaturated compacted speswhite kaolin. Compaction pressure influences initial state, by determining the initial position of the yield surface, thus affecting, among other things, the shape of stress–strain curves during shearing. Compaction pressure also influences, to a limited degree, the positions of the normal compression lines for different values of suction, but it has no effect on critical state relationships. The effect of compaction pressure can probably be modelled solely in terms of initial state if an anisotropic elastoplastic model incorporating rotational hardening is employed, whereas the parameters defining the slopes and intercepts of the normal compression lines for different values of suction require adjustment with variation of compaction pressure if a conventional isotropic hardening elastoplastic model is employed. Compaction water content influences the initial suction, but also has a substantial influence on normal compression lines and a noticeable effect on the volumetric behaviour at critical states. It is likely that soil samples compacted at different water contents will have to be modelled as different materials, irrespective of whether an isotropic or anisotropic hardening elastoplastic model is employed. A change from static to dynamic compaction has no significant effect on subsequent behaviour.

Government intervention in a dynamic economy

From the late 1970s onwards, the view that government intervention could provide a means of overcoming market failure in advanced was increasingly questioned. For some, intervention was to be discouraged because it interfered with individual liberty. For others, what was problematic was the welfare economist's assumption of an autonomous state acting in the public interest. Finally, there was the issue of the state's ability to achieve what it set out to do. Government failure it was argued was just as pervasive as market failure and no antidote to it. This paper critically evaluates such arguments in relation to competition, industrial change, innovation, and competitive advantage in production.

Home is Where the Human is?:Ethics, Intervention and Hospitality in Kosovo

The human is frequently made central to the way international ethics is thought and practiced. Yet, frequently, the human can be used to close down ethical options rather than open them up. This article examines the case of British foreign policy in Kosovo. It argues that the human in this context was placed at the centre of ethical action, but was discursively constructed as a silent, biopolitial mass which could only be saved close to its territorially qualified home. It could not be protected by being brought to the UK. To remain human, the subject of ethical concern, the Kosovan refugee, had to remain near Kosovo. This construction of the human-home relationship meant that military humanitarian intervention became the only ethical policy available; hospitality, a welcoming of the Kosovan refugee into the British home, was ruled out. This article questions such a construction of the human, listening to the voices of Kosovan refugees to open up the relationship between the human and its home. The complexity that results shows that a more nuanced view of the human would not allow itself to be co-opted so easily to a simplistic logic of intervention. Rather, it could enable the possibility of hospitality as another way of practicing international ethics.

Annotation of Case C-272/94, Criminal proceedings against Michel Guiot and Climatec SA, ECR 1996 I-1905

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