Genetic characterization of clinical isolates of Clostridium difficile using an optimized RAPD protocol and PCR ribotyping reveals strain diversity between two tertiary referral Trusts in the West Midlands, UK

Epidemiological investigations of Clostridium difficile often focus on differences between separate geographical areas. In this investigation, two populations of C. difficile recovered from separate tertiary referral Trusts within the West Midlands, UK, were characterized using both PCR ribotyping and an optimized RAPD (random amplification of polymorphic DNA) protocol. The PCR ribotyping and RAPD methodologies identified differences between the two C. difficile populations, in both the prevalence and the diversity of types identified. The use of PCR ribotyping in conjunction with RAPD further categorized different types within defined PCR ribotypes, identifying different types within the same PCR ribotype and therefore providing a greater discriminatory power than either of the methods when used alone. The differences observed in this study between the two Trusts in the distribution of both RAPD 'type' and PCR ribotype demonstrate the diversity that is present amongst isolates of C. difficile within a relatively small geographical area and warrants a need for further investigation into the local epidemiology of C. difficile.

Epidemiology of community-acquired meticillin-resistant Staphylococcus aureus obtained from the UK West Midlands region

Between January 2005 and December 2005, 199 meticillin-resistant Staphylococcus aureus (MRSA) isolates were obtained from nonhospitalised patients presenting skin and soft tissue infections to local general practitioners. The study area incorporated 57 surgeries from three Primary Care Trusts in the Lichfield, Tamworth, Burntwood, North and East Birmingham regions of Central England, UK. Following antibiotic susceptibility testing, pulsed-field gel electrophoresis, Panton-Valentine leukocidin gene detection and SCCmec element assignment, 95% of the isolates were shown to be related to hospital epidemic strains EMRSA-15 and EMRSA-16. In total 87% of the isolate population harboured SCCmec IV, 9% had SCCmec II and 4% were identified as carrying novel SCCmec IIIa-mecI. When mapped to patient home postcode, a diverse distribution of isolates harbouring SCCmec II and SCCmec IV was observed; however, the majority of isolates harbouring SCCmec IIIa-mecI were from patients residing in the north-west of the study region, highlighting a possible localised clonal group. Transmission of MRSA from the hospital setting into the surrounding community population, as demonstrated by this study, warrants the need for targeted patient screening and decolonisation in both the clinical and community environments.

It's in his eyes? The negotiation and interpretation of masculinity using the Dolce et Gabbana's 2005 Print advertising campaign

The concept of 'masculinity' has over more years received increased attention within consumer research discourse suggesting the potential of a 'crisis of masculinity', symptomatic of a growing feminisation, or 'queering' of visual imagery and consumption (e.g. Patterson & Elliott, 2002). Although this corpus of research has served to enrich the broader gender identity debate, it is, arguably, still relatively underdeveloped and therefore warrants further insight and elaboration. The aim of this paper is, therefore, to explore how masculinity is represented and interpreted by men using the Dolce et Gabbana men's 2005 print advertising campaign. The rationale for using this particular campaign is that it is one of the most homoerotic, provocative, and well publicised campaigns to cross over from the 'gay' media to more mainstream UK men's magazines. Masculinity, and what it means to be 'masculine', manifests itself within particular ideological, moral, cultural and hegemonic discourses. Masculinity is not a homogenous term which can be simply reduced, and ascribed, to those born as 'male' rather than 'female'.

Macular pigment optical density in young adults of South Asian origin

Purpose: To assess the range of macular pigment optical density (MPOD) in a healthy group of young adults of South Asian origin; to investigate whether any dietary factors or personal characteristics were related to inter-subject variations in MPOD; and to compare the mean MPOD of the South Asian group with the mean MPOD of a white group. Methods: Heterochromatic flicker photometry was used to measure the MP levels of 169 healthy volunteers, of which 117 were Asian and 52 were white. In addition, the Asian participants completed a questionnaire pertaining to the various physical, ocular, lifestyle, dietary and environmental factors that may be associated with MPOD or age-related macular degeneration (AMD). Results: The mean MPOD of the Asian subjects was 0.43±0.14. The male participants had a higher mean MPOD than the females (0.47±0.13 vs 0.41±0.14, p<0.01). Possible associations also emerged between MPOD and form of refractive correction, and iris colour. No MPOD associations were found for the other variables examined in the questionnaire. The mean MPOD of the white subject group was 0.33±0.13, which was significantly lower than the Asian group (p<0.0005). Conclusions: This study adds to the currently limited information on MPOD in South Asians, and while a comparison between Asians and Whites was not the main focus here, highly significant differences between these two ethnicities were revealed. This provokes the possibility that South Asian individuals could have a lower risk for AMD, and it warrants further study.

Managing risk in enterprise resource planning projects

Enterprise Resource Planning (ERP) projects are strategic and capital intensive, so failure may be costly and even cause bankruptcy of companies. Previous studies have proposed ways for improving implementation, but they are mostly generic and follow standardized project management practices as specified in various standards (e.g. the “project management body of knowledge” of the Project Management Institute). Because ERP is interdisciplinary (involving change management, project management and information technology management), it warrants a customized approach to managing risks throughout the life cycle of implementation and operation. Through a practical case study, this paper demonstrates a qualitative, user friendly approach to ERP project risk management. Firstly, through a literature review it identifies various risk factors in ERP implementation. Secondly, the risk management practices of a UK-based multinational consulting company in one of its clients are evaluated. The risk factors from the case study organization and literature are then compared and discussed.

Elevated serum free light chains predict cardiovascular events in type 2 diabetes

OBJECTIVE: Elevated polyclonal serum immunoglobulin free light chains (FLCs; combined FLCκ+FLCλ [cFLC]) are associated with adverse clinical outcomes and increased mortality; we investigated cFLC and cardiovascular disease (CVD) events in type 2 diabetes. RESEARCH DESIGN AND METHODS: In a cohort study of 352 south Asian patients with type 2 diabetes, serum cFLC, high-sensitivity C-reactive protein (hsCRP), and standard biochemistry were measured. CVD events over 2 years were recorded and assessed usingmultiple logistic regression. RESULTS: cFLC levels were elevated significantly in 29 of 352 (8%) patients with CVD events during 2 years of follow-up (50.7 vs. 42.8mg/L; P = 0.004). Inmultivariate analysis, elevated cFLC (>57.2 mg/L) was associated with CVD outcomes (odds ratio 3.3 [95% CI 1.3-8.2]; P = 0.012) and remained significant after adjusting for age, albumin-to-creatinine ratio, diabetes duration, or treatment. CONCLUSIONS: cFLC elevation is a novel marker for CVD outcomes in type 2 diabetes that warrants further investigation. © 2014 by the American Diabetes Association.

Regulating audit beyond the crisis:a critical discussion of the EU green paper

With the European Commission making global leadership claims in the field of audit regulation, the content of its 2010 Green Paper on ‘Audit Policy: Lessons from the Crisis’ warrants careful scrutiny. Important issues raised in the Green Paper include regulatory oversight, competition in the audit market, the dangers of having very few firms with the capacity to audit global transnational corporations, professional judgement, innovative audit practices and, last but not least, social responsibility. This article analyses the principal perspectives and assumptions underpinning the construction of the Green Paper. The aims are threefold: to enhance understanding of the contemporary regulatory mindset of the European Commission, contribute to policy debate and inspire future research.

Holonic supply chain:a study from family-based manufacturing perspective

In the contemporary business environment, to adhere to the need of the customers, caused the shift from mass production to mass-customization. This necessitates the supply chain (SC) to be effective flexible. The purpose of this paper is to seek flexibility through adoption of family-based dispatching rules under the influence of inventory system implemented at downstream echelons of an industrial supply chain network. We compared the family-based dispatching rules in existing literature under the purview of inventory system and information sharing within a supply chain network. The dispatching rules are compared for Average Flow Time performance, which is averaged over the three product families. The performance is measured using extensive discrete event simulation process. Given the various inventory related operational factors at downstream echelons, the present paper highlights the importance of strategically adopting appropriate family-based dispatching rule at the manufacturing end. In the environment of mass customization, it becomes imperative to adopt the family-based dispatching rule from the system wide SC perspective. This warrants the application of intra as well as inter-echelon information coordination. The holonic paradigm emerges in this research stream, amidst the holistic approach and the vital systemic approach. The present research shows its novelty in triplet. Firstly, it provides leverage to manager to strategically adopting a dispatching rule from the inventory system perspective. Secondly, the findings provide direction for the attenuation of adverse impact accruing from demand amplification (bullwhip effect) in the form of inventory levels by appropriately adopting family-based dispatching rule. Thirdly, the information environment is conceptualized under the paradigm of Koestler's holonic theory.

The effect of nutritional supplementation on the multifocal electroretinogram in healthy eyes

BACKGROUND: Previous studies have demonstrated an increase in macular pigment optical density (MPOD) with lutein (L)-based supplementation in healthy eyes. However, not all studies have assessed whether this increase in MPOD is associated with changes to other measures of retinal function such as the multifocal ERG (mfERG). Some studies also fail to report dietary levels of L and zeaxanthin (Z). Because of the associations between increased levels of L and Z, and reduced risk of AMD, this study was designed to assess the effects of L-based supplementation on mfERG amplitudes and latencies in healthy eyes. METHODS: Multifocal ERG amplitudes, visual acuity, contrast sensitivity, MPOD and dietary levels of L and Z were assessed in this longitudinal, randomized clinical trial. Fifty-two healthy eyes from 52 participants were randomly allocated to receive a L-based supplement (treated group), or no supplement (non-treated group). RESULTS: There were 25 subjects aged 18-77 (mean age ± SD; 48 ± 17) in the treated group and 27 subjects aged 21-69 (mean age ± SD; 43 ± 16) in the non-treated group. All participants attended for three visits: visit one at baseline, visit two at 20 weeks and visit three at 40 weeks. A statistically significant increase in MPOD (F = 17.0, p ≤ 0.001) and shortening of mfERG ring 2 P1 latency (F = 3.69, p = 0.04) was seen in the treated group. CONCLUSIONS: Although the results were not clinically significant, the reported trend for improvement in MPOD and mfERG outcomes warrants further investigation.