The antimicrobial efficacy of copper alloy furnishing in the clinical environment:a crossover study

Objective. To determine whether copper incorporated into hospital ward furnishings and equipment can reduce their surface microbial load. Design. A crossover study. Setting. Acute care medical ward with 19 beds at a large university hospital. Methods. Fourteen types of frequent-touch items made of copper alloy were installed in various locations on an acute care medical ward. These included door handles and push plates, toilet seats and flush handles, grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps, and sink fittings. Their surfaces and those of equivalent standard items on the same ward were sampled once weekly for 24 weeks. The copper and standard items were switched over after 12 weeks of sampling to reduce bias in usage patterns. The total aerobic microbial counts and the presence of indicator microorganisms were determined. Results. Eight of the 14 copper item types had microbial counts on their surfaces that were significantly lower than counts on standard materials. The other 6 copper item types had reduced microbial numbers on their surfaces, compared with microbial counts on standard items, but the reduction did not reach statistical significance. Indicator microorganisms were recovered from both types of surfaces; however, significantly fewer copper surfaces were contaminated with vancomycin-resistant enterococci, methicillin-susceptible Staphylococcus aureus, and coliforms, compared with standard surfaces. Conclusions. Copper alloys (greater than or equal to 58% copper), when incorporated into various hospital furnishings and fittings, reduce the surface microorganisms. The use of copper in combination with optimal infection-prevention strategies may therefore further reduce the risk that patients will acquire infection in healthcare environments.

A composite leading indicator of the inflation cycle for the Euro area

We evaluate the performance of composite leading indicators of turning points of inflation in the Euro area, constructed by combining the techniques of Fourier analysis and Kalman filters with the National Bureau of Economic Research methodology. In addition, the study compares the empirical performance of Euro Simple Sum and Divisia monetary aggregates and provides a tentative answer to the issue of whether or not the UK should join the Euro area. Our findings suggest that, first, the cyclical pattern of the different composite leading indicators very closely reflect that of the inflation cycle for the Euro area; second, the empirical performance of the Euro Divisia is better than its Simple Sum counterpart and third, the UK is better out of the Euro area. © 2005 Taylor & Francis Group Ltd.

Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care

Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved.

Development and validaton of an indicator to compare antibiotic usage in secondary care in England

The use of antibiotics was investigated in twelve acute hospitals in England. Data was collected electronically and by questionnaire for the financial years 2001/2, 2002/3 and 2003/4. Hospitals were selected on the basis of their Medicines Management Self-Assessment Scores (MMAS) and included a cohort of three hospitals with integrated electronic prescribing systems. The total sample size was 6.65% of English NHS activity for 2001/2 based on Finished Consultant Episode (FCE) numbers. Data collected included all antibiotics dispensed (ATC category J01), hospital activity FCE's and beddays, Medicines Management Self-assessment scores, Antibiotic Medicines Management scores (AMS), Primary Care Trust (PCT) of origin of referral populations, PCT antibiotic prescribing rates, Index of Multiple Deprivation for each PCT. The DDD/FCE (Defined Daily Dose/FCE) was found to correlate with the DDD 100beddays (r = 0.74 pindicator for identifying hospitals that require further study. Antibiotic use increased from a mean 4.16 DDD/FCE in 2001/2 to 4.35 DDD/FCE in 2003/4. Antibiotic use in the electronic prescribing cohort was found to be lower, than the sample mean at 3.48 DDD/FCE in 2001/2 and 3.34 DDD/FCE in 2003/4. The MMAS and AMS were found to correlate (r = 0.74 pindicators of antibiotic use. A number of indicators are proposed as triggers for further investigation including a proportion of 0.24 for the ratio of third generation to first/second generation cephalosporin use, and five percent as the limit for parenteral quinolone DOD of total quinolone DOD usage. It was possible to demonstrate a correlation between the IMD 2000 and primary care antibiotic prescribing rates but not between primary and secondary care antibiotic prescribing rates for the same referral population or between the weighted mean IMD 2000 for each hospital's referral population and the hospital antibiotic prescribing rate.

The development and stability analysis of a nonlinear growth model for microorganisms

A nonlinear dynamic model of microbial growth is established based on the theories of the diffusion response of thermodynamics and the chemotactic response of biology. Except for the two traditional variables, i.e. the density of bacteria and the concentration of attractant, the pH value, a crucial influencing factor to the microbial growth, is also considered in this model. The pH effect on the microbial growth is taken as a Gaussian function G0e-(f- fc)2/G1, where G0, G1 and fc are constants, f represents the pH value and fc represents the critical pH value that best fits for microbial growth. To study the effects of the reproduction rate of the bacteria and the pH value on the stability of the system, three parameters a, G0 and G1 are studied in detail, where a denotes the reproduction rate of the bacteria, G0 denotes the impacting intensity of the pH value to microbial growth and G1 denotes the bacterial adaptability to the pH value. When the effect of the pH value of the solution which microorganisms live in is ignored in the governing equations of the model, the microbial system is more stable with larger a. When the effect of the bacterial chemotaxis is ignored, the microbial system is more stable with the larger G1 and more unstable with the larger G0 for f0 > fc. However, the stability of the microbial system is almost unaffected by the variation G0 and G1 and it is always stable for f0 < fc under the assumed conditions in this paper. In the whole system model, it is more unstable with larger G1 and more stable with larger G0 for f0 < fc. The system is more stable with larger G1 and more unstable with larger G0 for f0 > fc. However, the system is more unstable with larger a for f0 < fc and the stability of the system is almost unaffected by a for f0 > fc. The results obtained in this study provide a biophysical insight into the understanding of the growth and stability behavior of microorganisms.

Role of copper in reducing hospital environment contamination

The environment may act as a reservoir for pathogens that cause healthcare-associated infections (HCAIs). Approaches to reducing environmental microbial contamination in addition to cleaning are thus worthy of consideration. Copper is well recognised as having antimicrobial activity but this property has not been applied to the clinical setting. We explored its use in a novel cross-over study on an acute medical ward. A toilet seat, set of tap handles and a ward entrance door push plate each containing copper were sampled for the presence of micro-organisms and compared to equivalent standard, non-copper-containing items on the same ward. Items were sampled once weekly for 10 weeks at 07:00 and 17:00. After five weeks, the copper-containing and non-copper-containing items were interchanged. The total aerobic microbial counts per cm2 including the presence of ‘indicator micro-organisms’ were determined. Median numbers of microorganisms harboured by the copper-containing items were between 90% and 100% lower than their control equivalents at both 07:00 and 17:00. This reached statistical significance for each item with one exception. Based on the median total aerobic cfu counts from the study period, five out of ten control sample points and zero out of ten copper points failed proposed benchmark values of a total aerobic count of <5 cfu/cm2. All indicator micro-organisms were only isolated from control items with the exception of one item during one week. The use of copper-containing materials for surfaces in the hospital environment may therefore be a valuable adjunct for the prevention of HCAIs and requires further evaluation.

Selection & development of short-term project team members:developmental stability as an indicator of interpersonal skills

Short-term project teams do not have the advantage of prior performance or long-term membership to facilitate development of effective team performance. Research suggests interpersonal skills are crucial to success but this is under researched longitudinally. Evolutionary psychology can provide a lens to explain how people develop differing levels of interpersonal skills via the relationship between fluctuating asymmetry and pro-social behaviours. This research aims to investigate the relationship between fluctuating asymmetry and interpersonal skills, the impact of training and to further the evolutionary psychology field by embedding research in a real-world context as opposed to solely in laboratory or student settings.

Measuring productive efficiency using Nerlovian profit efficiency indicator and metafrontier analysis

The aim of this paper is to illustrate the measurement of productive efficiency using Nerlovian indicator and metafrontier with data envelopment analysis techniques. Further, we illustrate how profit efficiency of firms operating in different regions can be aggregated into one overarching frontier. Sugarcane production in three regions in Kenya has been used to illustrate these concepts. Results show that the sources of inefficiency in all regions are both technical and allocative, but allocative efficiency contributes more to the overall Nerlovian (in)efficiency indicator. © 2011 Springer-Verlag.

Biodeterioration of harvested sugar cane in Jamaica

The microbiological, physical and chemical changes which occur instored, harvested sugarcane were studied in Jamaica and the United Kingdom.The degree of deterioration was proportional to time of storage, and wasrevealed by a statistically significant reduction in sucrose content.Other symptoms included a fall in pH, and increases in reducing sugars,dextran, viscosity, and microbial count. Cut cane was universally infectedwith Leuconostoc mesenteroides, which reached a maximum count of 107 to 108organisms per ml. juice within. 3 to 4 days of harvest. Counts of othermicroorganisms were generally insignificant, except for occasional lactobacilli.A new dextran-forming species was named Lactobacillus confusus.Microorganisms isolated from deteriorated cane were screened for theirability to cause deterioration of a sterile, synthetic cane juice. L. mesenteroides strains were the most deteriogenic, but attempts toreproduce the symptoms of "sour" cane by inoculation of this organism intocut cane were only partially successful. L. mesenteroides was present in the soil and the epiphytic flora of the stalk. The principal vector of infection appeared to be the cutters' machete, especially in wet weather. Cane harvested by a chopper machine deteriorated more rapidly than hand-cut whole-stalks. Economic losses due to deterioration of harvested cane were estimated to be 9.2% of the initial recoverable sugar for the 1969 crop at Frome Estate, Jamaica. Dextran content was a useful indicator of cane biodeterioration. The dextran content of mill juices was correlated with rainfall, and significant correlations were obtained between dextran content and viscosity of mill syrups and the amount of sugar lost in final molasses; it also caused the formation of elongated crystals. Attempts to control sour cane by chemical and physical methods were unsuccessful, and it was concluded that the only solution is to mill cane within 24 hours of harvest. A novel method for removal of dextran from mill juices by enzymic treatment with dextranase was developed and patented.

Stereoacuity as an indicator of prism adaptation

Purpose: The purpose of this study was to determine whether stereoacuity can be used as an indicator of prism adaptation. In particular, we wanted to know whether the time required for stereoacuity to return to the initial level after viewing through a prism can be used to determine the degree of adaptation. Materials and Methods: Eighteen subjects participated in this study. Stereoacuity and dissociated phoria were determined using the TNO stereotest and the Maddox rod, respectively. Prism vergences were measured using a prism bar. For each participant, prism power equivalent to the blur point of base-in (BI) and base-out (BO) fusional vergence at 40 cm was divided and placed in front of both eyes. At 0, 3, 6, 9 and 12 min after prism introduction, the stereoacuity was measured, and at 0 and 12 min, the heterophoria was measured. Results: The repeated measures ANOVA showed a significant difference between the mean stereoacuity for BI and BO prisms at the different measurement times (p < 0.05). For BO prism, the initial value was different between 0 and 3 min after the prism introduction, whereas for BI prism, a difference in stereoacuity was found between the pre-prism value and the value at 0, 3 and 6 min. The size of the heterophoria with BO and BI prisms was different from 0 to 12 min (p < 0.05). Conclusion: The time required for stereoacuity to return to baseline level was more than 3 min for BO, and more than 6 min for BI prism. In addition, the time required to return to baseline values was not similar for the stereoacuity and heterophoria. The recovery of stereoacuity is slower when adapting to divergence, as when looking from near to far. This implies that stereopsis responds faster to near targets than to distant one, and may precede complete phoria adaptation. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.

A road safety performance indicator for vehicle fleet compatibility

This paper discusses the development and the application of a safety performance indicator which measures the intrinsic safety of a country's vehicle fleet related to fleet composition. The indicator takes into account both the ‘relative severity’ of individual collisions between different vehicle types, and the share of those vehicle types within a country's fleet. The relative severity is a measure for the personal damage that can be expected from a collision between two vehicles of any type, relative to that of a collision between passenger cars. It is shown how this number can be calculated using vehicle mass only. A sensitivity analysis is performed to study the dependence of the indicator on parameter values and basic assumptions made. The indicator is easy to apply and satisfies the requirements for appropriate safety performance indicators. It was developed in such a way that it specifically scores the intrinsic safety of a fleet due to its composition, without being influenced by other factors, like helmet wearing. For the sake of simplicity, and since the required data is available throughout Europe, the indicator was applied to the relative share of three of the main vehicle types: passenger cars, heavy goods vehicles and motorcycles. Using the vehicle fleet data from 13 EU Member States and Norway, the indicator was used to rank the countries’ safety performance. The UK was found to perform best in terms of its fleet composition (value is 1.07), while Greece has the worst performance with the highest indicator value (1.41).

Low frequency dielectric spectroscopy of bitumen binders as an indicator of adhesion potential to quartz aggregates using Portland cement

The purpose of this investigation was to interpret the bitumen-aggregate adhesion based on the dielectric spectroscopic response of individual material components utilizing their dielectric constants, refractive indices and average tangent of the dielectric loss angle (average loss tangent). Dielectric spectroscopy of bitumen binders at room temperature was performed in the frequency range of 0.01–1000 Hz. Dielectric spectroscopy is an experimental method for characterizing the dielectric permittivity of a material as a function of frequency. Adhesion data has been determined using the Rolling bottle method. The results show that the magnitude of the average tangent of the dielectric loss angle (average loss tangent) depends on bitumen type. The average loss tangent in the frequency range 0.01–1 Hz is introduced as a potential indicator for predicting polarizability and, thereby, adhesion potential of bitumen binders to quartz aggregates when using Portland cement. In order to obtain acceptable adhesion of 70/100 penetration grade bitumen binders and quartz aggregates when using Portland cement, it is suggested that the binder have an average tan δ > 0.035 in the frequency range 0.01–1 Hz.