Evaluation of routine microbiological techniques for establishing the diagnosis of catheter-related bloodstream infection caused by coagulase-negative staphylococci

Microbiological diagnosis of catheter-related bloodstream infection (CR-BSI) is often based on isolation of indistinguishable micro-organisms from an explanted catheter tip and blood culture, confirmed by antibiograms. Whether phenotypic identification of coagulase-negative staphylococci (CoNS) allows an accurate diagnosis of CR-BSI to be established was evaluated. Eight patients with a diagnosis of CR-BSI had CoNS isolated from pure blood cultures and explanted catheter tips which were considered as indistinguishable strains by routine microbiological methods. For each patient, an additional three colonies of CoNS isolated from the blood and five from the catheter tip were subcultured and further characterized by antibiogram profiles, analytical profile index (API) biotyping and PFGE. PFGE distinguished more strains of CoNS compared to API biotyping or antibiograms (17, 10 and 11, respectively). By PFGE, indistinguishable micro-organisms were only isolated from pure blood and catheter tip cultures in four out of eight (50%) patients thus supporting the diagnosis of CR-BSI. In another patient, indistinguishable micro-organisms were identified in both cultures; however, other strains of CoNS were also present. The remaining three patients had multiple strains of CoNS, none of which were indistinguishable in the tip and blood cultures, thus questioning the diagnosis of CR-BSI. Phenotypic characterization of CoNS lacked discriminatory power. Current routine methods of characterizing a limited number of pooled colonies may generate misleading results as multiple strains may be present in the cultures. Multiple colonies should be studied using a rapid genotypic characterization method to confirm or refute the diagnosis of CR-BSI. © 2007 SGM.

Introduction to organisational behaviour

Introduction to Organisational Behaviour is the first truly integrated multimedia package for introductory OB modules. It provides a rigorous critique of the essential organisational behaviour topics in a creative, interactive and visual way. Key features include: - Practitioner case studies presenting real organisational dilemmas accompanied by video interviews online where the practitioners talk about approaches and solutions - Tailored tutor resources online, recognising that you have different needs - one area is designed for new OB lecturers; the other contains materials for more experienced OB lecturers - An underpinning focus on employability skills, with tips in the book on how each topic could be linked to different skills and professionally produced video demonstrations online - A global perspective reflecting today's market-place, integrated through global examples and theories including those from developing countries - Innovative learning features including ethical dilemmas, best and worst practice examples, taking your learning further, review and discussion questions, applying theory to practice and a glossary - Written by a team of experts at prestigious UK-based and international institutions - A foreword by Richard Atfield of the Higher Education Academy. Online resources For tutors: - Interviews with practitioners - Demonstrations of employability skills - Additional short and long case study per chapter with questions - Additional discussion and assignment questions - Tutorial activities - PowerPoint slides - Guidance notes - Figures and tables from the book For students: - Web links including YouTube links and links to seminal articles

How to write successful business and management essays

How to Write Successful Business and Management Essays is a systematic guide to successfully producing written work for business and management degrees. The authors address the all too common pitfalls of essay assignments, as well as providing students with a step-by-step programme to approach essay questions, both in coursework and exam contexts. Starting with the basics this book helps develop skills through the use of examples, exercises and checklists. Helpful features include: - Annotated essay examples, showing both good and bad points - Tips on time management and motivation, note taking and effective reading - Final checklists to use before you hand in - Explanation of what the markers are looking for – and how to give it to them Many students find referencing particularly confusing so the book provides detailed but easy-to-use information on what referencing is and how to do it properly.

Navigating through the maze: the practical issues of conducting research for novices

New postgraduate students embark on their research journey typically with little or no experience in doing research. Supervisors and other more experienced student researchers might help them to find their feet during the first few weeks of their research by sharing their own experience of how they solved similar problems during their research. In this way each novice researcher can learn and benefit from other researchers´ ways of resolving problems. This paper discusses the real concerns that researchers reflected upon during a two-day research workshop, where researchers share problems, exchange ideas for overcoming them and learn from each other´s experiences of conducting research. The output from the workshop is in the form of hints and tips that can guide novice researchers when faced with initial problems. The paper can also be used by a department to induct a novice researcher into their environment.

Infection risk associated with a closed luer access device

The potential for microbial contamination associated with a recently developed needleless closed luer access device (CLAD) (Q-Syte™ Becton Dickinson, Sandy, UT, USA) was evaluated in vitro. Compression seals of 50 multiply activated Q-Syte devices were inoculated with Staphylococcus epidermidis NCTC 9865 in 25% (v/v) human blood and then disinfected with 70% (v/v) isopropyl alcohol followed by flushing with 0.9% (w/v) sterile saline. Forty-eight of 50 (96%) saline flushes passed through devices that had been activated up to a maximum of 70 times remained sterile. A further 25 Q-Syte CLADs that had undergone multiple activations were challenged with prefilled 0.9% (w/v) sterile saline syringes, the external luer tips of which had been inoculated with S. epidermidis NCTC 9865 prior to accessing the devices. None of the devices that had been accessed up to 70 times allowed passage of micro-organisms, despite challenge micro-organisms being detected on both the syringe tip after activation and the compression seals before decontamination. These findings suggest that the Q-Syte CLAD may be activated up to 70 times with no increased risk of microbial contamination within the fluid pathway. The device may also offer protection from the external surface of syringe tips contaminated with micro-organisms. © 2005 Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Factors associated with lobe division in the lichen Parmelia conspersa (Ehrh. ex. Ach.)Ach.

The factors associated with lobe division were studied in thalli of the lichen Parmelia conspersa (Ehrh. ex Ach.)Ach. Lobe division was studied in sequences of adjacent lobes using spatial pattern analysis. In five large thalli, lobe division within the thallus margin was randomly distributed. Correlations between the degree of lobe division, the radial growth of the lobe and lobe morphology were studied in six thalli. Lobe division was positively correlated with either lobe width or area in four thalli. Correlations were observed with radial growth or morphology of the adjacent lobes in two thalli. Dividing and non-dividing lobes were removed from large thalli and glued to pieces of slate with their tips either at the same level or in front of neighbouring lobes. Dividing lobes divided more rapidly when their tips were glued in front of their neighbours. The levels of ribitol, arabitol and mannitol were measured within a 2 mm region of the tip in dividing and non-dividing lobes on four occasions in 1994. Carbohydrate levels were significantly increased in dividing compared with non-dividing lobes. In addition, the mean size of the algal cells was greater in non-dividing compared with dividing lobes especially at the lobe base. However, the percentage of zoosporangia and aplanosporangia did not vary significantly in dividing and non-dividing lobes. These results suggest that: 1) the pattern of lobe division within the thallus margin may be random, 2) lobe division may be determined by lobe size and the location of the lobe tip relative to the neighbouring lobes and 3) there may be an increase in the productivity of lobes associated with lobe division.

Flow and pressure drop on the shellside of cylindrical heat exchangers

This work presents pressure distributions and fluid flow patterns on the shellside of a cylindrical shell-and-tube heat exchanger. The apparatus used was constructed from glass enabling direct observation of the flow using a dye release technique and had ten traversable pressure instrumented tubes permitting detailed pressure distributions to be obtained. The `exchanger' had a large tube bundle (278 tubes) and main flow areas typical of practical designs. Six geometries were studied: three baffle spacings both with and without baffle leakage. Results are also presented of three-dimensional modelling of shellside flows using the Harwell Laboratory's FLOW3D code. Flow visualisation provided flow patterns in the central plane of the bundle and adjacent to the shell wall. Comparison of these high-lighted significant radial flow variations. In particular, separated regions, originating from the baffle tips, were observed. The size of these regions was small in the bundle central plane but large adjacent to the shell wall and extended into the bypass lane. This appeared to reduce the bypass flow area and hence the bypass flow fraction. The three-dimensional flow modelling results were presented as velocity vector and isobar maps. The vector maps illustrated regions of high and low velocity which could be prone to tube vibration and fouling. Separated regions were also in evidence. A non-uniform crossflow was discovered with, in general, higher velocities in the central plane of the bundle than near the shell wall._The form of the isobar maps calculated by FLOW3D was in good agreement with experimental results. In particular, larger pressure drops occurred across the inlet than outlet of a crossflow region and were higher near the upstream than downstream baffle face. The effect of baffle spacing and baffle leakage on crossflow and window pressure drop measurements was identified. Agreement between the current measurements, previously obtained data and commonly used design correlations/models was, in general, poor. This was explained in terms of the increased understanding of shellside flow. The bulk of previous data, which dervies from small-scale rigs with few tubes, have been shown to be unrepresentative of typical commerical units. The Heat Transfer and Fluid Flow Service design program TASC provided the best predictions of the current pressure drop results. However, a number of simple one-dimensional models in TASC are, individually, questionable. Some revised models have been proposed.

Lobe formation and division in the foliose lichen Xanthoparmelia conspersa

New lobe development and lobe division was studied in the foliose lichen Xanthoparmelia conspersa (Ehrh. ex. Ach.) Hale. In thalli with either the centre or margin removed, the inside edge of the perimeter, the outer edge of the reproductive centre, and fragments derived from the thallus perimeter all regenerated growing points (‘lobe primordia’) within a year. Thalli possessing isidia had the greatest ability to regenerate growing points. In reproductive thalli, there was a positive correlation between the density of new growing points and thallus size. When fragments were cut from the perimeters of mature X. conspersa thalli and glued to pieces of slate, the ratio of growing points to mature lobes increased over 54 months. Lobes within a thallus exhibited different degrees of bifurcation. In some bifurcating lobes, the point of origin of the bifurcation advanced at the same rate as the lobe tips over 4 months but in most lobes, the bifurcation point either advanced less rapidly than the lobe tips or retreated from its original location. Removing adjacent lobes had no significant effect on the radial growth of a lobe over 4 months or on the location of the bifurcation point but it increased the number of growing points. These results suggest that for X. conspersa: 1) all portions of of thalli can regenerate growing points, 2) few growing points actually develop into mature lobes, 3) individual lobes within a thallus grow and divide differently, and 4) adjacent lobes inhibit the development of growing points on their neighbours.

The source, cost and prevention of central venous catheter-related infection

Central venous catheters have become an integral part of patient management however they are associated with many complications including infection. Despite efforts being made to reduce the incidence of such infect ions the problem continues to increase and has resource implications for the Health Service. Studies relating to the source of microorganisms causing CVC-associated infection, the cost of such infections and the efficacy of an antimicrobial catheter have been undertaken. Thirty patients who required a CVC as part of their medical management and underwent cardiac surgery had the distal tips of their catheters sampled whilst in situ. Sampling took place within 1 h of catheter placement. Bacteria were isolated from 16% of the catheter distal tips sampled in situ. The guidewires used to insert the devices were also contaminated (50%). When CVC were inserted via a protective sheath, avoiding contact with the skin. the incidence of microbial contamination was reduced. These findings suggest that despite rigorous skin disinfection and strict aseptic technique, viable microorganisms are impacted onto the distal tip of CVC during the insertion procedure. Needleless intravascular access devices have been introduced in order to reduce the incidence of need1estick injury. However, it was unclear whether such connectors would act as a portal of entry for microorganisms to CVC. The efficacy of these devices was investigated. Within the controlled laboratory environment it was demonstrated that needleless devices, when challenged with microorganisms, did not allow the passage of microbes when flu id was injected. This therefore suggested that the devices should not increase the risk of catheter colonisation. When used in clinical practice however microbial contamination of the needleless connectors was 55 % in comparison to the routinely used luer connectors (23%). The cost of infections associated with CVC was determined. Twenty patients catheterised with a CVC designed for long term use who were admitted to hospital with a presumptive diagnosis of catheter-related infection were studied. The treatment given specifically for this infection was costed. The mean cost of such an infection was £ 1781.81. Throughout the UK this may amount to £1.565.906 per annum. The cost of infections associated with CVC designed for short term use was estimated to be between 5 and 7 million pounds per annum in the UK. In an attempt to reduce both the incidence and cost of catheter- related infection antimicrobial CVC have been developed. The efficacy of a novel polyurethane CVC impregnated on both the internal and external catheter surface with the quaternary ammonium compound benzalkonium chloride was investigated. Eighty eight patients received an antimicrobial catheter and 78 patients a conventional polyurethane CVC. The anti-microbial CVC resulted in a reduction in microbial colonisation of the external and internal polymer surfaces as compared to the control device. The observed reduction in microbial colonisation with the anti-microbial CVC may decrease the likelihood of subsequent infection offering a useful approach to the prevention of catheter-related infections.

Serodiagnosis of staphylococcal sepsis

The coagulase-negative staphylococci are the most frequent cause of sepsis associated with indwelling intravascular catheters. Current microbiological investigations to support the diagnosis of catheter-related sepsis (CRS) include the culture of blood and catheter tips, however positive results may reflect specimen contamination, or colonisation of the catheter rather than true sepsis. Previous serological approaches to assist in the diagnosis of CRS based on cellular staphylococcal antigens have been of limited value. In this current study, the serodiagnostic potential of an exocellular antigen produced by 7 strains of coagulase-negative staphylococci cultured in brain heart infusion broth was investigated. Antigenic material isolated by gel permeation from liquid culture was characterised by immunological techniques and chemical analysis. Characterisation of the exocellular antigen revealed a novel glycerophosphoglycolipid, termed lipid S. which shared antigenic determinants with lipoteichoic acid, but differed by comprising a glycerophosphate chain length of only 6 units. In addition, lipid S was immunologically distinct from diphosphatidyl glycerol, a constituent cell membrane phospho lipid. An indirect enzyme linked immunosorbent assay (ELISA) based on lipid S was subsequently developed and used to determine serum antibody levels (IgM and IgG) in 67 patients with CRS due to staphylococci, and 67 patients with a central venous catheter (CVC) in situ who exhibited no evidence of sepsis. The sensitivity and specificity of the lipid S IgG ELISA was 75% and 90% respectively whilst the IgM assay had sensitivity and specificity of 52% and 85%. The addition of GullSORereagent to the EL1SA procedure to remove competing serum IgG and rheumatoid factor did not significantly improve the performance of the IgM assay. The serological response in serial serum samples of 13 patients with CRS due to staphylococci was investigated. Elevated levels of antibody were detected at an early stage of infection, prior to the isolation of microorganisms by standard culture methods, and before the clinical presentation of sepsis in 3 patients. The lipid S ELISA was later optimised and a rapid 4-hour assay developed for the serodiagnosis of CRS. Serum IgG levels were determined in 40 patients with CRS due to staphylococci and 40 patients with a CVC in situ who exhibited no evidence of sepsis. The sensitivity and specificity of the rapid IgG assay was 70% and 100% respectively. Elevated serum antibody levels in patients with endocarditis, prosthetic joint infection and pyogenic spondylodiscitis due to Gram-positive cocci were also detected with the lipid S ELISA suggesting that the assay may facilitate the diagnosis of these infections. Unexpected increased levels of anti-lipid S IgG in 31% of control patients with sciatica suggested a possible microbial aetiology of this condition. Further investigation of some of these patients by culture of microdiscectomy tissue removed at operation, revealed the presence of low-virulent microorganisms in 37% of patients of which Propionibacterium aeries accounted for 85% of the positive culture isolates. The results suggested a previously unrecognised association between P. acnes and sciatica, which may have implications for the future management of the condition.

Growth of foliose lichens: a review

This review considers various aspects of the growth of foliose lichens including early growth and development, variation in radial growth rate (RaGR) of different species, growth to maturity, lobe growth variation, senescence and fragmentation, growth models, the influence of environmental variables, and the maintenance of thallus symmetry. The data suggest that a foliose lichen thallus is essentially a ‘colony’ in which the individual lobes exhibit a considerable degree of autonomy in their growth processes. During development, recognisable juvenile thalli are usually formed by 15 months to 4 years while most mature thalli exhibit RaGR between 1 and 5 mm yr-1. RaGR within a species is highly variable. The growth rate-size curve of a foliose lichen thallus may result from growth processes that take place at the tips of individual lobes together with size-related changes in the intensity of competition for space between the marginal lobes. Radial growth and growth in mass is influenced by climatic and microclimatic factors and also by substratum factors such as rock and bark texture, chemistry, and nutrient enrichment. Possible future research topics include: (1) measuring fast growing foliose species through life, (2) the three dimensional changes that occur during lobe growth, (3) the cellular changes that occur during regeneration, growth, and division of lobes, and (4) the distribution and allocation of the major lichen carbohydrates within lobes.

Novel bioactive scaffolds incorporating nanogels as potential drug eluting devices

Big advances are being achieved in the design of new implantable devices with enhanced properties. For example, synthetic porous three-dimensional structures can mimic the architecture of the tissues, and serve as templates for cell seeding. In addition, polymeric nanoparticles are able to provide a programmable and sustained local delivery of different types of biomolecules. In this study novel alternative scaffolds with controlled bioactive properties and architectures are presented. Two complementary approaches are described. Firstly, scaffolds with nanogels as active controlled release devices incorporated inside the three-dimensional structure are obtained using the thermally induced phase separation (TIPS) method. Secondly, a novel coating method using the spraying technique to load these nanometric crosslinked hydrogels on the surface of two-dimensional (2D) and three-dimensional (3D) biodegradable scaffolds is described. The scanning electron microscopy (SEM) images show the distribution of the nanogels on the surface of different substrates and also inside the porous structure of poly-a-hydroxy ester derivative foams. Both of them are compared in terms of manufacturability, dispersion and other processing variables.

A quick guide to surviving redundancy:your essential legal guide

What do you do if your boss calls you in to talk about job cuts? What are your rights? What are his or her rights? Do you know the procedures that should be followed? If redundancy looms, or you just want to be prepared for the worst,you need to know where you stand.Author Kathy Daniels is well placed to help. She writes and lectures extensively on human resources and employee rights, and as a member of the Employment Tribunal she regularly comes face-to-face with redundancy claims. In this easy-to-understand guide she answers all the important questions on redundancy and its aftermath, including: How are staff selected for redundancy? What is voluntary redundancy? Are full-time,part-time and agency staff treated differently? What is the consultation process bosses must adhere to? How much redundancy pay can you expect? How do you take a claim to the Employment Tribunal? As well as covering all the legal dos and don'ts, helpful guidance is provided on: Budgets and personal finances after redundancy Benefits you may be able to claim Coping with stress and strain Finding a new job or changing career The Quick Guide to Surviving Redundancy is full of real-life case studies and top tips on your employment rights. It also includes template letters for a range of redundancy situations.

Green innovation management in the automotive industry

Online case studies. Managing Innovation is an established, bestselling text for MBA, MSc and advanced undergraduate courses on management of technology, innovation management and entrepreneurship. It is also used widely by managers in both the service and manufacturing sectors. Now in its fourth edition, Managing Innovation has been fully revised and updated based on extensive user feedback to incorporate the latest findings and techniques in innovation management. The authors have included a new and more explicit innovation model, which is used throughout the book and have introduced two new features – Research Notes and Views from the Front Line – to incorporate more real life case material into the book. The strong evidence–based and practical approach makes this a must–read for anyone studying or working within innovation. An extensive website accompanies this text at www.managing–innovation.com. Readers can browse an online database of audio and video clips, as well as case study material, interactive exercises and tools for innovation, whilst lecturers can find additional support material including instructor slides and teaching guides and tips. "Tidd and Bessant's text has become a standard for students and practitioners of innovation. They offer a lively account on innovation management full of interesting and new examples, but one that at the same is rigorously anchored in what we have learned over the last thirty years on how to manage that ultimate business challenge of renewing products, processes, and business models. Those who want to innovate must read this book." — Professor Arnoud De Meyer, Director, Judge Business School, University of Cambridge, UK "Innovation matters and this book by two leaders in the field which is clear and practical as well as rigorous should be essential reading for all seeking to study or to become involved in innovation." — Chris Voss, Professor of Operations and Technology Management, London Business School "...comprehensive and comprehensible compendium on the management of innovation. It is very well organized and very well presented. A pedagogic tool that will work at multiple levels for those wishing to gain deeper insights into some of the most challenging and important management issues of the day." — David J. Teece, Thomas W. Tusher Professor in Global Business, Haas School of Business, University of California, Berkeley, USA "Those of us who teach in the field of Innovation Management were delighted when the first edition of this book appeared 11 years ago. The field had long been in need of such a comprehensive and integrated empirically–based work. The fact that this is now the 4th edition is clear testimony to the value of its contribution. We are deeply indebted to the authors for their dedication and diligence in providing us with this updated and expanded volume." — Thomas J. Allen,Howard W. Johnson Professor of Management, MIT Sloan School of Management, USA.