Infection Control in design and construction work

Objective: To clarify how infection control requirements are represented, communicated, and understood in work interactions through the medical facility construction project life cycle. To assist project participants with effective infection control management by highlighting the nature of such requirements and presenting recommendations to aid practice. Background: A 4-year study regarding client requirement representation and use on National Health Service construction projects in the United Kingdom provided empirical evidence of infection control requirement communication and understanding through design and construction work interactions. Methods: An analysis of construction project resources (e.g., infection control regulations and room data sheets) was combined with semi-structured interviews with hospital client employees and design and construction professionals to provide valuable insights into the management of infection control issues. Results: Infection control requirements are representationally indistinct but also omnipresent through all phases of the construction project life cycle: Failure to recognize their nature, relevance, and significance can result in delays, stoppages, and redesign work. Construction project resources (e.g., regulatory guidance and room data sheets) can mask or obscure the meaning of infection control issues. Conclusions: A preemptive identification of issues combined with knowledge sharing activities among project stakeholders can enable infection control requirements to be properly understood and addressed. Such initiatives should also reference existing infection control regulatory guidance and advice.

Modeling the mechanisms that control in-stream dissolved organic carbon dynamics in upland and forested catchments

[1] We present a new, process-based model of soil and stream water dissolved organic carbon (DOC): the Integrated Catchments Model for Carbon (INCA-C). INCA-C is the first model of DOC cycling to explicitly include effects of different land cover types, hydrological flow paths, in-soil carbon biogeochemistry, and surface water processes on in-stream DOC concentrations. It can be calibrated using only routinely available monitoring data. INCA-C simulates daily DOC concentrations over a period of years to decades. Sources, sinks, and transformation of solid and dissolved organic carbon in peat and forest soils, wetlands, and streams as well as organic carbon mineralization in stream waters are modeled. INCA-C is designed to be applied to natural and seminatural forested and peat-dominated catchments in boreal and temperate regions. Simulations at two forested catchments showed that seasonal and interannual patterns of DOC concentration could be modeled using climate-related parameters alone. A sensitivity analysis showed that model predictions were dependent on the mass of organic carbon in the soil and that in-soil process rates were dependent on soil moisture status. Sensitive rate coefficients in the model included those for organic carbon sorption and desorption and DOC mineralization in the soil. The model was also sensitive to the amount of litter fall. Our results show the importance of climate variability in controlling surface water DOC concentrations and suggest the need for further research on the mechanisms controlling production and consumption of DOC in soils.

Eutrophication control in river-systems: an application of INCA-P to the River Lugg

The Integrated Catchments model of Phosphorus dynamics (INCA-P) was applied to the River Lugg to determine the key factors controlling delivery of phosphorus to the main channel and to quantify the relative contribution of diffuse and point sources to the in-stream phosphorus (P) load under varying hydrological conditions. The model is able to simulate the seasonal variations and inter-annual variations in the in-stream total-phosphorus concentrations. However, difficulties in simulating diffuse inputs arise due to equifinality in the model structure and parameters. The River Lugg is split into upper and lower reaches. The upper reaches are dominated by grassland and woodland, so the patterns in the stream-water total-phosphorus concentrations are typical of diffuse source inputs; application of the model leads to estimates of the relative contribution to the in-stream P load from diffuse and point sources as 9:1. In the lower reaches, which are more intensively cultivated and urbanised, the stream-water total-phosphorus concentration dynamics are influenced more by point-sources; the simulated relative diffuse/point contribution to the in-stream P load is 1: 1. The model set-up and simulations are used to identify the key source-areas of P in the catchment, the P contribution of the Lugg to the River Wye during years with contrasting precipitation inputs, and the uptake and release of P from within-reach sediment. In addition, model scenarios are run to identify the impacts of likely P reductions at sewage treatment works on the in-stream soluble-reactive P concentrations and the suitability of this as a management option is assessed for reducing eutrophication.

Strengthening argumentation in medical explanations by text planning revision

Explanations are an important by-product of medical decisionsupport activities, as they have proved to favour compliance and correct treatment performance. To achieve this purpose, these texts should have a strong argumentation content and should adapt to emotional, as well as to rational attitudes of the Addressee. This paper describes how Rhetorical Sentence Planning can contribute to this aim: the rulebased plan discourse revision is introduced between Text Planning and Linguistic Realization, and exploits knowledge about the user personality and emotions and about the potential impact of domain items on user compliance and memory recall. The proposed approach originates from analytical and empirical evaluation studies of computer generated explanation texts in the domain of drug prescription. This work was partially supported by a British-Italian Collaboration in Research and Higher Education Project, which involved the Universities of Reading and of Bari, in 1996.

Strategies, effectiveness and rationale of vector-borne disease control in the pastoralist system of south-western Uganda

In Uganda, control of vector-borne diseases is mainly in form of vector control, and chemotherapy. There have been reports that acaricides are being misused in the pastoralist systems in Uganda. This is because of the belief by scientists that intensive application of acaricide is uneconomical and unsustainable particularly in the indigenous cattle. The objective of this study was to investigate the strategies, rationale and effectiveness of vector-borne disease control by pastoralists. To systematically carry out these investigations, a combination of qualitative and quantitative research methods was used, in both the collection and the analysis of data. Cattle keepers were found to control tick-borne diseases (TBDs) mainly through spraying, in contrast with the control of trypanosomosis for which the main method of control was by chemotherapy. The majority of herders applied acaricides weekly and used an acaricide of lower strength than recommended by the manufacturers. They used very little acaricide wash, and spraying was preferred to dipping. Furthermore, pastoralists either treated sick animals themselves or did nothing at all, rather than using veterinary personnel. Oxytetracycline (OTC) was the drug commonly used in the treatment of TBDs. Nevertheless, although pastoralists may not have been following recommended practices in their control of ticks and tick-borne diseases, they were neither wasteful nor uneconomical and their methods appeared to be effective. Trypanosomosis was not a problem either in Sembabule or Mbarara district. Those who used trypanocides were found to use more drugs than were necessary.

Modelling disease spread and control in networks: implications for plant sciences

Networks are ubiquitous in natural, technological and social systems. They are of increasing relevance for improved understanding and control of infectious diseases of plants, animals and humans, given the interconnectedness of today's world. Recent modelling work on disease development in complex networks shows: the relative rapidity of pathogen spread in scale-free compared with random networks, unless there is high local clustering; the theoretical absence of an epidemic threshold in scale-free networks of infinite size, which implies that diseases with low infection rates can spread in them, but the emergence of a threshold when realistic features are added to networks (e.g. finite size, household structure or deactivation of links); and the influence on epidemic dynamics of asymmetrical interactions. Models suggest that control of pathogens spreading in scale-free networks should focus on highly connected individuals rather than on mass random immunization. A growing number of empirical applications of network theory in human medicine and animal disease ecology confirm the potential of the approach, and suggest that network thinking could also benefit plant epidemiology and forest pathology, particularly in human-modified pathosystems linked by commercial transport of plant and disease propagules. Potential consequences for the study and management of plant and tree diseases are discussed.

Climate and biological control in organic crops

Organic farming has increased in popularity in recent years, primarily as a response to the perceived health and conservation benefits. While it is likely that conventional farming will be able to respond rapidly to variations in pest numbers and distribution resulting from climatic change, it is not clear if the same is true for organic farming. Few studies have looked at the responses of biological control organisms to climate change. Here, I review the direct and indirect eects of changes in temperature, atmospheric carbon dioxide and other climatic factors on the predators, parasitoids and pathogens of pest insects in temperate agriculture. Finally, I consider what research is needed to manage the anticipated change in pest insect dynamics and distributions.

Multi-agent building control in shared environment

Multi-agent systems have been adopted to build intelligent environment in recent years. It was claimed that energy efficiency and occupants' comfort were the most important factors for evaluating the performance of modem work environment, and multi-agent systems presented a viable solution to handling the complexity of dynamic building environment. While previous research has made significant advance in some aspects, the proposed systems or models were often not applicable in a "shared environment". This paper introduces an ongoing project on multi-agent for building control, which aims to achieve both energy efficiency and occupants' comfort in a shared environment.

Development and experimental identification of a biomechanical model of the trunk for functional electrical stimulation control in paraplegia

Objectives. Theoretic modeling and experimental studies suggest that functional electrical stimulation (FES) can improve trunk balance in spinal cord injured subjects. This can have a positive impact on daily life, increasing the volume of bimanual workspace, improving sitting posture, and wheelchair propulsion. A closed loop controller for the stimulation is desirable, as it can potentially decrease muscle fatigue and offer better rejection to disturbances. This paper proposes a biomechanical model of the human trunk, and a procedure for its identification, to be used for the future development of FES controllers. The advantage over previous models resides in the simplicity of the solution proposed, which makes it possible to identify the model just before a stimulation session ( taking into account the variability of the muscle response to the FES). Materials and Methods. The structure of the model is based on previous research on FES and muscle physiology. Some details could not be inferred from previous studies, and were determined from experimental data. Experiments with a paraplegic volunteer were conducted in order to measure the moments exerted by the trunk-passive tissues and artificially stimulated muscles. Data for model identification and validation also were collected. Results. Using the proposed structure and identification procedure, the model could adequately reproduce the moments exerted during the experiments. The study reveals that the stimulated trunk extensors can exert maximal moment when the trunk is in the upright position. In contrast, previous studies show that able-bodied subjects can exert maximal trunk extension when flexed forward. Conclusions. The proposed model and identification procedure are a successful first step toward the development of a model-based controller for trunk FES. The model also gives information on the trunk in unique conditions, normally not observable in able-bodied subjects (ie, subject only to extensor muscles contraction).

Coordination and control in project-based work: digital objects and infrastructures for delivery

A major infrastructure project is used to investigate the role of digital objects in the coordination of engineering design work. From a practice-based perspective, research emphasizes objects as important in enabling cooperative knowledge work and knowledge sharing. The term ‘boundary object’ has become used in the analysis of mutual and reciprocal knowledge sharing around physical and digital objects. The aim is to extend this work by analysing the introduction of an extranet into the public–private partnership project used to construct a new motorway. Multiple categories of digital objects are mobilized in coordination across heterogeneous, cross-organizational groups. The main findings are that digital objects provide mechanisms for accountability and control, as well as for mutual and reciprocal knowledge sharing; and that different types of objects are nested, forming a digital infrastructure for project delivery. Reconceptualizing boundary objects as a digital infrastructure for delivery has practical implications for management practices on large projects and for the use of digital tools, such as building information models, in construction. It provides a starting point for future research into the changing nature of digitally enabled coordination in project-based work.