Nitric oxide regulation of the central aortae of the toad Bufo marinus occurs independently of the endothelium

Nitric oxide (NO) signalling pathways were examined in the lateral aortae and dorsal aorta of the cane toad Bufo marinus. NADPH diaphorase histochemistry and nitric oxide synthase (NOS) immunohistochemistry found no evidence for endothelial NOS in the endothelium of toad aortae, but it could be readily demonstrated in rat aorta that was used as a control. Immunohistochemistry using a specific neural NOS antibody showed the presence of neural NOS immunoreactivity in the perivascular nerves of the aortae. The anatomical data was supported by in vitro organ bath physiology, which demonstrated that the vasodilation mediated by applied acetylcholine (10^-5 mol l^-1) was not dependent on the presence of the vascular endothelium; however, it was significantly reduced in the presence of a neural NOS inhibitor, vinyl-L-NIO (10-4 mol l^-1). In addition, atropine (10^-6 mol l^-1) (a muscarinic receptor inhibitor), L-NNA (10^-4 mol l^-1) (a NOS inhibitor) and ODQ (10^-5 mol l^-1) (an inhibitor of soluble guanylyl cyclase) abolished the vasodilatory effect of applied acetylcholine. In conclusion, we propose that an endothelial NO system is absent in toad aortae and that NO generated by neural NOS in perivascular nerves mediates vasodilation.

Effectiveness of a care bundle to reduce central line-associated bloodstream infections

OBJECTIVE: To determine the effectiveness of a care bundle, with a novel line maintenance procedure, in reducing the rate of central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU).

DESIGN, PARTICIPANTS AND SETTING: Before-and-after study using CLABSI data reported to the Victorian Healthcare Associated Infection Surveillance System (VICNISS), in adult patients admitted to a tertiary adult ICU in regional Victoria between 1 July 2006 and 30 June 2014. VICNISS-reported CLABSI cases were reviewed for verification. An intervention was implemented in 2009.

INTERVENTION: The care bundle introduced in 2009 included a previously established line insertion procedure and a novel line maintenance procedure comprising Biopatch, daily 2% chlorhexidine body wash, daily ICU central line review, and liaison nurse follow-up of central lines.

MAIN OUTCOME MEASURES: CLABSI rate (cases per 1000 central line days). RESULTS: The average CLABSI rate fell from 2.2/1000 central line days (peak of 5.2/1000 central line days in quarter 4, 2008) during the pre-intervention period to 0.5/1000 central line days (0/1000 central line days from July 2012 to July 2014) during the post-intervention period.

CONCLUSION: Our study suggests that this care bundle, using a novel maintenance procedure, can effectively reduce the CLABSI rate and maintain it at zero out to 2 years.

Post-crisis: rebuilding a company, a reputation, a community

It is well recognised that when an organisation experiences a crisis caused by a natural disaster,publics are less likely to apportion responsibility to that organisation. This contrasts with crisesinvolving events such as product tampering, accidents or management transgressions where thelevel of organisational control is perceived or judged to be greater (Coombs, 2000, p. 86). In 2012,biomedical company Gambro’s manufacturing plant, based in Medolla, a small town of 6000 in theModena region of Italy, was hit by a devastating series of earthquakes. Damage to the plant hadsignificant and immediate impact for employees, customers and other key stakeholders, as operationsceased in the wake of the earthquakes.This chapter will reflect on Gambro’s crisis management response and their crisis communicationstrategies in response to the earthquakes and the ensuing rumours. An analysis ofGambro’s crisis response shows they acted to counteract stakeholder concerns and leveragewell-established stakeholder relationships. As Coombs (2000, 2006, 2007a, 2007b) makes clear,relationships are central to effective crisis management, and, although stakeholders often view anatural disaster as being removed from the organisation’s responsibility, this concession may not exist in a prolonged recovery period or where the stakeholders face a life or death outcome. Thesewere the very conditions Gambro faced. So, a relational approach can add depth to the attributionalanalysis of such a crisis (Coombs 2000, p. 86). To extend the analysis of crises caused bynatural disaster and Gambro’s crisis response, the chapter will also examine crisis communicationstrategies of similar disaster case studies.The international medical-technical company Gambro, headquartered in Sweden, has 13 productionfacilities in more than 90 countries, and employs more than 8000 people worldwide. Gambrohas operated in the Medolla region of Emilia-Romagna since the early 1960s.