A prospective clinical trial to evaluate the microbial barrier of a needleless connector

Needleless connectors are being increasingly used for direct access to intravascular catheters. However, the potential for microbial contamination of these devices and subsequent infection risk is still widely debated. In this study the microbial contamination rate associated with three-way stopcock luers with standard caps attached was compared to those with Y-type extension set luers with Clearlink® needleless connectors attached. Fifty patients undergoing cardiothoracic surgery who required a central venous catheter (CVC) as part of their peri- and postoperative management were studied for microbial contamination of CVC luers following 72 hrs in situ. Each patient's CVC was randomly designated to have either the three-way stopcocks with caps (control patients) or Clearlink® Y-type extension sets (test patients). Prior to, and following each manipulation of the three-way stopcock luers or Clearlink® devices, a 70% (v/v) isopropyl alcohol swab was used for disinfection of the connections. The microbial contamination of 393 luers, 200 with standard caps and 193 with Clearlink® attached, was determined. The internal surfaces of 20 of 200 (10%) three-way stopcock luers with standard caps were contaminated with micro-organisms whereas only one of 193 (0.5%) luers with Clearlink® attached was contaminated (P < 0.0001). These results demonstrate that the use of the Clearlink® device with a dedicated disinfection regimen reduces the internal microbial contamination rate of CVC luers compared with standard caps. The use of such needle-free devices may therefore reduce the intraluminal risk of catheter-related bloodstream infection and thereby supplement current preventive guidelines. © 2006 The Hospital Infection Society.

Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

State–society relations in a dynamic framework:the case of the Far East and Sub-Saharan Africa

According to the textbook approach, the developmental states of the Far East have been considered as strong and autonomous entities. Although their bureaucratic elites have remained isolated from direct pressures stemming from society, the state capacity has also been utilised in order to allocate resources in the interest of the whole society. Yet, society – by and large –has remained weak and subordinated to the state elite. On the other hand, the general perception of Sub-Saharan Africa (SSA) has been just the opposite. The violent and permanent conflict amongst rent-seeking groups for influence and authority over resources has culminated in a situation where states have become extremely weak and fragmented, while society – depending on the capacity of competing groups for mobilising resources to organise themselves mostly on a regional or local level (resulting in local petty kingdoms) – has never had the chance to evolve as a strong player. State failure in the literature, therefore, – in the context of SSA – refers not just to a weak and captured state but also to a non-functioning, and sometimes even non-existent society, too. Recently, however, the driving forces of globalisation might have triggered serious changes in the above described status quo. Accordingly, our hypothesis is the following: globalisation, especially the dynamic changes of technology, capital and communication have made the simplistic “strong state–weak society��� (in Asia) and “weak state–weak society��� (in Africa) categorisation somewhat obsolete. While our comparative study has a strong emphasis on the empirical scrutiny of trying to uncover the dynamics of changes in state–society relations in the two chosen regions both qualitatively and quantitatively, it also aims at complementing the meaning and essence of the concepts and methodology of stateness, state capacity and state-society relations, the well-known building blocks of the seminal works of Evans (1995), Leftwich (1995), Migdal (1988) or Myrdal (1968).

Plant closures and taskforce responses:an analysis of the impact of and policy response to MG Rover in Birmingham

This paper explores the socio-economic impacts and associated policy responses to the collapse of MG Rover at Longbridge in Birmingham. Critically, it attempts to move beyond a ‘standard’ taskforce narrative that emphasizes the role of the regional response. While recognizing that significant policy ‘successes’ were indeed evident at the regional level in anticipating and responding to the crisis, a wider perspective is required that situates this taskforce response in (1) a fuller understanding of labour market precariousness (that in turn mitigates some of its policy ‘successes’), and (2) more local perspectives that highlight the local impacts of closure, the role of the neighbourhood level officials and the third sector in mediating these. Taking this broader perspective suggests that longer-term, workers face a precarious situation and the need for policies to create and sustain ‘good quality’ jobs remains paramount. Adding in more local perspectives, a key lesson from the Longbridge experience for dealing with closures more generally is that the public policy responses must be: multidimensional in that they transcend narrow sector-based concerns and addresses broader spatial impacts; inclusive in that they build on a broad coalition of economic and social stakeholders; and long-term in that they acknowledge that adaptation takes many years. If anything, the Birmingham Longbridge experience demonstrates the difficulty of achieving such responses in the context of crisis where action is imperative and deliberation a luxury.

A coordinated control scheme for power demand changes in a PMSG based multi-terminal DC wind farm

Although maximum power point tracking (MPPT) is crucial in the design of a wind power generation system, the necessary control strategies should also be considered for conditions that require a power reduction, called de-loading in this paper. A coordinated control scheme for a proposed current source converter (CSC) based DC wind energy conversion system is presented in this paper. This scheme combines coordinated control of the pitch angle, a DC load dumping chopper and the DC/DC converter, to quickly achieve wind farm de-loading. MATLAB/Simulink simulations and experiments are used to validate the purpose and effectiveness of the control scheme, both at the same power level. © 2013 IEEE.

America in global context:German entrepreneurs around the world (1871-1918)

The United States was undoubtedly the most important, but by no means the only country of destination for German immigrant entrepreneurs. German industrialists, merchants, and other entrepreneurs could be found in virtually all world regions where international trade or local markets promised satisfactory returns. They were globally dispersed manifestations – and motors – of Germany’s expanding economy between unification in 1871 and the First World War.