A point-prevalence survey of antimicrobial utilisation within New Brunswick hospitals to focus antimicrobial stewardship efforts and decrease low-value care.

Introduction: Il est important de minimiser le gaspillage et les risques associés aux soins sans valeur. La gestion de l’utilisation des antimicrobiens vise à optimiser leur emploi et doit être adaptée au milieu et à sa population. Objectifs: Évaluer les profiles d’utilisation actuels des antimicrobiens et fixer des objectifs pour les interventions en matière de gestion des antimicrobiens. Méthode: Vingt-et-un hôpitaux du Nouveau-Brunswick offrant des soins de courte durée en médecine générale, en chirurgie et en pédiatrie ont pris part à une enquête sur la prévalence ponctuelle. Tous les patients admis aux hôpitaux participants et ayant reçu au moins un antimicrobien systémique ont été inscrits à l’étude. Les principaux critères d’évaluation étaient le profil d’utilisation, selon l’indication et l’antimicrobien prescrit, le bienfondé de l’utilisation et la durée de la prophylaxie chirurgicale. Des statistiques descriptives et un test d’indépendance 2 furent utilisés pour l’analyse de données. Résultats: L’enquête a été menée de juin à août 2012. Un total de 2244 patients ont été admis pendant la durée de l’étude et 529 (23,6%) ont reçu un antimicrobien. Au total, 691 antimicrobiens ont été prescrits, soit 587 (85%) pour le traitement et 104 (15%) pour la prophylaxie. Les antimicrobiens les plus souvent prescrits pour le traitement (n=587) étaient des classes suivantes : quinolones (25,6%), pénicillines à spectre étendu (10,2%) et métronidazole (8,5%). Les indications les plus courantes du traitement étaient la pneumonie (30%), les infections gastro-intestinales (16%) et les infections de la peau et des tissus mous (14%). Selon des critères définis au préalable, 23% (n=134) des ordonnances pour le traitement étaient inappropriées et 20% (n=120) n’avaient aucune indication de documentée. Les domaines où les ordonnances étaient inappropriées étaient les suivants : défaut de passage de la voie intraveineuse à la voie orale (n=34, 6%), mauvaise dose (n=30, 5%), traitement d’une bactériurie asymptomatique (n=24, 4%) et doublement inutile (n=22, 4%). Dans 33% (n=27) des cas, les ordonnances pour la prophylaxie chirurgicale étaient pour une période de plus de 24 heures. Conclusions: Les résultats démontrent que les efforts de gestion des antimicrobiens doivent se concentrer sur les interventions conventionnelles de gestion de l’utilisation des antimicrobiens, l’amélioration de la documentation, l’optimisation de l’utilisation des quinolones et la réduction au minimum de la durée de la prophylaxie chirurgicale.

Women and political change in kerala since independence

even after 45 years of independence, it is seen that women are still left cum the periphery cnf the political process. Effective and meaningful participation of women in politics remains elusive for most of them. The representation of women in the state legislatures and in both Houses of Parliament has been very marginal. The percentage of women members in the LokSabha to the total membership of the body has never touched a two-digit figure so far. Within these 45 years, India could field only five women as Union Cabinet Ministers. In the case of the various states also, the position of women's participation in political activities is not very different. On the whole, it is seen that in independent India the role played by women in the electoral politics of the country or in the day to day activities of the different political parties is very" ineffective and insignificant. The present study was undertaken to make an assessment of women's involvement in the political process of Kerala since independence. This small state in the southernmost part of India claims ‘that it possesses certain. unique features in its social fabric that makes it different from the rest of the country as far as the place of women in society is concerned.

A tale of two logits, compositional data analysis and zero observations

The application of compositional data analysis through log ratio trans- formations corresponds to a multinomial logit model for the shares themselves. This model is characterized by the property of Independence of Irrelevant Alter- natives (IIA). IIA states that the odds ratio in this case the ratio of shares is invariant to the addition or deletion of outcomes to the problem. It is exactly this invariance of the ratio that underlies the commonly used zero replacement procedure in compositional data analysis. In this paper we investigate using the nested logit model that does not embody IIA and an associated zero replacement procedure and compare its performance with that of the more usual approach of using the multinomial logit model. Our comparisons exploit a data set that com- bines voting data by electoral division with corresponding census data for each division for the 2001 Federal election in Australia

La influencia de la construcción de identidad cultural vietnamita en la guerra de independencia de Vietnam (1946-1954)

La presente investigación tiene como objetivo explicar la influencia de la construcción de identidad cultural vietnamita en la Guerra de Independencia de Vietnam entre 1946 y 1954. Se argumenta que la construcción de identidad cultural justificó, promovió y legitimó la guerra de independencia como instrumento político ya que –en tanto proceso relacional– generó durante la colonización francesa prácticas de diferenciación fundamentadas en la reivindicación de los valores, tradiciones, costumbres, creencias y símbolos vietnamitas en torno a la resistencia. Ello propició una ruptura en las relaciones políticas imperantes, lo que condujo a la búsqueda de un nuevo orden social basado en la autodeterminación. Se utiliza una metodología de tipo cualitativa, fundamentada en el análisis documental e historiográfico.

Estimating numbers of infectious units from serial dilution assays

The paper concerns the design and analysis of serial dilution assays to estimate the infectivity of a sample of tissue when it is assumed that the sample contains a finite number of indivisible infectious units such that a subsample will be infectious if it contains one or more of these units. The aim of the study is to estimate the number of infectious units in the original sample. The standard approach to the analysis of data from such a study is based on the assumption of independence of aliquots both at the same dilution level and at different dilution levels, so that the numbers of infectious units in the aliquots follow independent Poisson distributions. An alternative approach is based on calculation of the expected value of the total number of samples tested that are not infectious. We derive the likelihood for the data on the basis of the discrete number of infectious units, enabling calculation of the maximum likelihood estimate and likelihood-based confidence intervals. We use the exact probabilities that are obtained to compare the maximum likelihood estimate with those given by the other methods in terms of bias and standard error and to compare the coverage of the confidence intervals. We show that the methods have very similar properties and conclude that for practical use the method that is based on the Poisson assumption is to be recommended, since it can be implemented by using standard statistical software. Finally we consider the design of serial dilution assays, concluding that it is important that neither the dilution factor nor the number of samples that remain untested should be too large.

The effectiveness of non-executive directors in Chinese state-owned enterprises

Purpose – The primary aim of this paper is to examine whether boards of directors with independent members function as effective corporate governance mechanisms in Chinese State-Owned Enterprises(SOEs), by analysing four characteristics of non-executive directors (NEDs) that impact on their effectiveness, namely their degree of independence, information, incentive, and competence. Design/methodology/approach – Being exploratory in nature, the research uses qualitative methods for data collection. It is based on an interpretivist perspective of social sciences, analysing and explaining the factors that influence the effectiveness of NEDs. Findings – The findings indicate that the NED system is weak in China as a result of the concentrated ownership structure, unique business culture, intervention of controlling shareholders and the lack of understanding of the benefits brought by NEDs. Research limitations/implications – The paper examines the salient features of and challenges to the system of NEDs of SOEs in present-day China. It provides an understanding of how the various perceptions of the board, gathered from in-depth interviews of corporate directors, leads to new interpretations of board effectiveness. The research, however, is limited owing to a relatively small sample size and the sensitive nature of the information collected. Originality/value – The study aims to fill gaps in the literature and contribute to it by assessing the “real” views and perceptions of NEDs in China in an institutional environment significantly different from that of the USA, the UK and other western economies.

A twenty-year independent record of sea surface temperature for climate from Along-track Scanning Radiometers

A new record of sea surface temperature (SST) for climate applications is described. This record provides independent corroboration of global variations estimated from SST measurements made in situ. Infrared imagery from Along-Track Scanning Radiometers (ATSRs) is used to create a 20 year time series of SST at 0.1° latitude-longitude resolution, in the ATSR Reprocessing for Climate (ARC) project. A very high degree of independence of in situ measurements is achieved via physics-based techniques. Skin SST and SST estimated for 20 cm depth are provided, with grid cell uncertainty estimates. Comparison with in situ data sets establishes that ARC SSTs generally have bias of order 0.1 K or smaller. The precision of the ARC SSTs is 0.14 K during 2003 to 2009, from three-way error analysis. Over the period 1994 to 2010, ARC SSTs are stable, with better than 95% confidence, to within 0.005 K yr−1(demonstrated for tropical regions). The data set appears useful for cleanly quantifying interannual variability in SST and major SST anomalies. The ARC SST global anomaly time series is compared to the in situ-based Hadley Centre SST data set version 3 (HadSST3). Within known uncertainties in bias adjustments applied to in situ measurements, the independent ARC record and HadSST3 present the same variations in global marine temperature since 1996. Since the in situ observing system evolved significantly in its mix of measurement platforms and techniques over this period, ARC SSTs provide an important corroboration that HadSST3 accurately represents recent variability and change in this essential climate variable.

The history of the practice of strategy from Antiquity to Napoleon

This chapter outlines the history of the practice of strategy, predating the introduction of the term. It homes in on episodes of European history since Antiquity for which historians claim to have found evidence of the practice of strategy, defined by Kimberly Kagan as ‘the setting of a state’s objectives and of priorities among those objectives’ in order to allocate resources and choose the best means. While focusing only on Europe, this chapter covers case studies over nearly 2500 ranging from the wars of Ancient Greece, of the Romans to Medieval warfare (here with a focus on English history), the warfare of Philip II of Spain, Louis XIV of France, Frederick II of Prussia, the French Revolutionaries and Napoleon.

Selecting algorithms for Earth observation of climate within the European Space Agency Climate Change initiative: introduction to a special issue

This special issue is focused on the assessment of algorithms for the observation of Earth’s climate from environ- mental satellites. Climate data records derived by remote sensing are increasingly a key source of insight into the workings of and changes in Earth’s climate system. Producers of data sets must devote considerable effort and expertise to maximise the true climate signals in their products and minimise effects of data processing choices and changing sensors. A key choice is the selection of algorithm(s) for classification and/or retrieval of the climate variable. Within the European Space Agency Climate Change Initiative, science teams undertook systematic assessment of algorithms for a range of essential climate variables. The papers in the special issue report some of these exercises (for ocean colour, aerosol, ozone, greenhouse gases, clouds, soil moisture, sea surface temper- ature and glaciers). The contributions show that assessment exercises must be designed with care, considering issues such as the relative importance of different aspects of data quality (accuracy, precision, stability, sensitivity, coverage, etc.), the availability and degree of independence of validation data and the limitations of validation in characterising some important aspects of data (such as long-term stability or spatial coherence). As well as re- quiring a significant investment of expertise and effort, systematic comparisons are found to be highly valuable. They reveal the relative strengths and weaknesses of different algorithmic approaches under different observa- tional contexts, and help ensure that scientific conclusions drawn from climate data records are not influenced by observational artifacts, but are robust.

A structure-dynamic approach to cortical organization: Number of paths and accessibility

A structure-dynamic approach to cortical systems is reported which is based on the number of paths and the accessibility of each node. The latter measurement is obtained by performing self-avoiding random walks in the respective networks, so as to simulate dynamics, and then calculating the entropies of the transition probabilities for walks starting from each node. Cortical networks of three species, namely cat, macaque and humans, are studied considering structural and dynamical aspects. It is verified that the human cortical network presents the highest accessibility and number of paths (in terms of z-scores). The correlation between the number of paths and accessibility is also investigated as a mean to quantify the level of independence between paths connecting pairs of nodes in cortical networks. By comparing the cortical networks of cat, macaque and humans, it is verified that the human cortical network tends to present the largest number of independent paths of length larger than four. These results suggest that the human cortical network is potentially the most resilient to brain injures. (C) 2009 Elsevier B.V. All rights reserved.

Poverty as an Abuse of Human Rights in Ghana. : A grass roots perspective on poverty and human rights.

The study aimed at getting a grass root opinion on poverty and why Ghana is still poor after 50 years of independence in spite of her richness in natural resources, second largest producer of cocoa in the word and appreciable stable political environment. The opinions of the ordinary people in the Bia district and their observed living conditions was analysed in line with theoretical basis of the study and previous studies to justify the stance that poverty should be considered as an abuse of human rights. It was concluded based on position of informants and previous data available that though many factors have been raised by previous scholars as the cause of poverty, the actions and inactions of both internal and external power-holders is the main source of poverty in Ghana. It was proposed that for poverty to be reduced in a sustainable way there should be strong civil society groups and active citizens through civic education to hold power-holders accountable. Until the actions and inactions of power-holders which have subjected many Ghanaians into intergenerational poverty are seen as human rights abuse, the rights of many Ghanaians would be constantly abused. This will eventually defeat the promotion of human rights culture in Ghana.

Where do children usually play? A qualitative study of parents' perceptions of influences on children's active free-play

This study explored the perceptions of 78 parents from low, mid and high socio-economic areas in Melbourne, Australia to increase understanding of where children play and why. Using an ecological model interviews with parents revealed that safety and social factors emerged as key social themes, facilities at parks and playgrounds, and urban design factors emerged as important physical environment themes. The children's level of independence and attitudes to active free-play were considered to be important individual level influences on active free-play. The study findings have important implications for future urban planning and children's opportunities for active free-play.

Auditor independence: regulation, oversight and inspection

Much of what auditors do is unobservable. Indeed, what goes on in an audit has been described as ‘secret audit business’. Audits in this context are of financial reports and those financial reports are the representations of the management of those companies, not the auditors. The audits of financial reports are of value in that they provide a competent and independent (of auditee management) attestation of the validity of those management representations. This attestation lowers the ‘information risk’ for the users of these financial reports. There has been a marked increase in activity to regulate matters relating to independence. The proposals outlined in CLERP 9 are one example of this. The requirements in the United States under the Sarbanes-Oxley Act are a further example.

Audit firms operate in a highly regulated yet highly competitive market. Evidence exists to suggest that audit firms are active competitors in respect of audit pricing and competency, including specialist industry expertise. Until recently, there has been little or no observable evidence that audit firms compete in respect of independence. The issues as they relate to audit independence are complex. One issue is that threats to independence are frequently subtle and difficult to observe and measure. Hence, controlling the decisions that relate to them cannot rely solely on regulation which itself inevitably relies on crude definitions and imprecise measures. Additionally, further regulation may not achieve the desired end without other processes being but in place in tandem.

This paper argues that:

1. auditors of certain classes of companies (in particular, those that are publicly traded) should be provided with incentives or requirements to have observable processes on independence
2. the means of observability should be in the form of an inspection and review process focussing on issues critical to the audit, such as independence
3. expert persons not having a current or past financial interest in the firm or in the commercial outcomes of the review should be used in the inspection and review process
4. the review process should have wide-ranging powers of inspection to examine the policies, processes, structures and ‘culture’ of audit firms
5. the report of the inspection and review should be made public, unedited and in full, and in a timely fashion. The primary objectives of this proposal are to (1) make more transparent to the market for information the characteristics of the audit firms and their process to ensure audit independence, and (2) provide a rigorous oversight of independence decision-making by persons who have no commercial interest in the outcome of the decision.

The politics of Indonesia

The Politics of Indonesia is the only book to provide a complete analysis of Indonesian politics, from the declaration of independence until the election of Susilo Bambang Yudhoyono in late 2004. The book examines the underlying themes and tensions that affect Indonesian politics, from the dichotomy between the small wealthy elite and the poverty in which most of the population live to the system of corruption and patronage within which the political system and armed forces operate. Analyzing the role and impact of the military, separatism, the media, law, and the economy on Indonesia, this book provides a topical and thought-provoking guide to one of the regions most populous countries, and the largest predominantly Muslim country in the world.