Tangled Webs : Using Bayesian Networks in the Fight Against Infection

Bayesian networks (BNs) provide a statistical modelling framework which is ideally suited for modelling the many factors and components of complex problems such as healthcare-acquired infections. The methicillin-resistant Staphylococcus aureus (MRSA) organism is particularly troublesome since it is resistant to standard treatments for Staph infections. Overcrowding and understa�ng are believed to increase infection transmission rates and also to inhibit the effectiveness of disease control measures. Clearly the mechanisms behind MRSA transmission and containment are very complicated and control strategies may only be e�ective when used in combination. BNs are growing in popularity in general and in medical sciences in particular. A recent Current Content search of the number of published BN journal articles showed a fi�ve fold increase in general and a six fold increase in medical and veterinary science from 2000 to 2009. This chapter introduces the reader to Bayesian network (BN) modelling and an iterative modelling approach to build and test the BN created to investigate the possible role of high bed occupancy on transmission of MRSA while simultaneously taking into account other risk factors.

Reasons for non-urgent presentations to the emergency department in Saudi Arabia

Background The majority of patients who attend emergency departments (EDs) in Saudi Arabia have non-urgent problems, resulting in overcrowding, excessive waiting times and delayed care for more acutely ill patients. The purpose of this research was to examine the reasons for non-urgent visits to a Saudi ED and factors associated with patient perceptions of urgency. Methods We administered a survey to 350 consecutively presenting Canadian Triage and Acuity Scale (CTAS) IV or V adult patients at a large tertiary ED in Riyadh region, Saudi Arabia, during 25 days of data collection in March 2013. Results Over half of the sample usually visited the ED to access healthcare. The most common reasons for attending the ED were not having a regular healthcare provider (63%), being able to receive care on the same day (62%), and the convenience of and access to medical care 24/7 (62%). Approximately two-thirds of CTAS V patients and one-third of CTAS IV patients believed their condition was more urgent than their triage nurse rating. Conclusion Multiple factors influence non-urgent visits to the ED in the Saudi context including insufficient community awareness of the role of the ED and perceived lack of access to primary healthcare services.

Pheromone-mediated mass trapping and population diversion as strategies for suppressing Carpophilus spp. (Coleoptera: Nitidulidae) in Australian stone fruit orchards

1 Five experiments were conducted during 1995-99 in stone fruit orchards on the Central Coast and in inland New South Wales, Australia, on the use of synthetic aggregation pheromones and a coattractant to suppress populations of the ripening fruit pests Carpophilus spp. (Coleoptera: Nitidulidae). 2 Perimeter-based suppression traps baited with pheromone and coattractant placed at 3m intervals around small fruit blocks, caught large numbers of Carpophilus spp. Very small populations of Carpophilus spp. occurred within blocks, and fruit damage was minimal. 3 Carpophilus spp. populations in stone fruit blocks 15-370m from suppression traps were also small and non-damaging, indicating a large zone of pheromone attractivity. 4 Pheromone/coattractant-baited suppression traps appeared to divert Carpophilus spp. from nearby (130 m) ripening stone fruit. Ten metal drums containing decomposing fruit, baited with pheromone and treated with insecticide, attracted Carpophilus spp. and appeared to reduce populations and damage to ripening fruit at distances of 200-500 m. Populations and damage were significantly greater within 200m of the drums and may have been caused by ineffective poisoning or poor quality/overcrowding of fruit resources in the drums. 5 Suppression of Carpophilus spp. populations using synthetic aggregation pheromones and a coattractant appears to be a realistic management option in stone fruit orchards. Pheromone-mediated diversion of beetle populations from ripening fruit may be more practical than perimeter trapping, but more research is needed on the effective range of Carpophilus pheromones and the relative merits of trapping compared to attraction to insecticide-treated areas.

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Healthcare-Associated Infections in Pediatrics

Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery. The studies were carried out at the Hospital for Children and Adolescents of Helsinki University Central Hospital. Epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined and they were genotyped. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for the patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs in these patients. During 1999-2006, the overall annual BSI rate was 1.6/1,000 patient days (range by year, 1.2–2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. The NICU was overcrowded during the S. marcescens clusters. A negative correlation between C. parapsilosis BSIs and fluconazole use in the NICU was detected, and the isolates derived from a single initially susceptible strain became less susceptible to fluconazole over time. Eighty postoperative HAIs, including all severe infections, were detected during hospitalization after open-heart surgery; 34% of those HAIs were SSIs and 25% were BSIs. The postdischarge study found 65 infections that were likely to be associated with hospitalization. The majority (89%) of them were viral respiratory or gastrointestinal infections, and these often led to rehospitalizations. The annual hospital-wide BSI rates were stable, and the significant variation detected in some units could not be seen in overall rates. Further studies with data adequately adjusted for risk factors are needed to assess BSI rates in the patient groups with the highest rates (hematology, neonatology). The outbreak investigations showed that horizontal transmission was common in the NICU. Overcrowding and lapses in hand hygiene probably contributed to the spreading of the pathogens. Following long-term use of fluconazole in the NICU, resistance to fluconazole developed in C. parapsilosis. Almost one-fourth of the patients who underwent open-heart surgery acquired at least one HAI. All severe HAIs were detected during hospitalization. The postdischarge study found numerous viral infections, which often caused rehospitalization.

Human Ecology in India Some Historical Perspectives

Before the spread of extensive settled cultivation, the Indian subcontinent would have been inhabited by territorial hunter–gatherers and shifting cultivators with cultural traditions of prudent resource use. The disruption of closed material cycles by export of agricultural produce to centres of non-agricultural population would have weakened these traditions. Indeed, the fire-based sacrificial ritual and extensive agricultural settlements might have catalysed the destruction of forests and wildlife and the suppression of tribal peoples during the agricultural colonization of the Gangetic plains. Buddhism, Jainism and later the Hindu sects may have been responses to the need for a reassertion of ecological prudence once the more fertile lands were brought under cultivation. British rule radically changed the focus of the country's resource use pattern from production of a variety of biological resources for local consumption to the production of a few commodities largely for export. The resulting ecological squeeze was accompanied by disastrous famines and epidemics between the 1860s and the 1920s. The counterflows to tracts of intensive agriculture have reduced such disasters since independence. However, these are quite inadequate to balance the state-subsidized outflows of resources from rural hinterlands. These imbalances have triggered serious environmental degradation and tremendous overcrowding of the niche of agricultural labour and marginal cultivator all over the country.

Medidas Provisórias e a relação Executivo x Legislativo : uma visão do sobrestamento de pauta

Verifica o impacto que o sobrestamento de pauta, instituído pela Emenda Constitucional n. 32/2001, concebida para refrear o uso exacerbado de medidas provisórias, ocasionou na agenda do Legislativo. Tendo-se como premissa que a relação entre o Legislativo e o Executivo caracteriza-se pelo sistema presidencialista de coalizão e que as medidas provisórias configuram o principal instrumento utilizado pelo Executivo para controlar a agenda política do País, aborda o instituto das MP desde a sua inserção na Constituição de 1988 até as propostas atuais de modificação para se traçar um histórico do caminho percorrido pelo Parlamento brasileiro na tentativa de conter o abuso do poder legiferante do Executivo e impedir o esvaziamento das competências precípuas do Poder Legislativo. Investiga por que o Legislativo não tem conseguido frear a produção de medidas provisórias, considerando-se que essa é a vontade de seus representantes. Concentra-se no problema do sobrestamento de pauta do Poder Legislativo decorrente da não apreciação de medida provisória em até quarenta e cinco dias contados da sua publicação, como determina o § 6º do art. 62 do atual texto da Constituição Federal.

Dynamics of pneumococcal nasopharyngeal carriage in healthy children attending a day care center in northern Spain. Influence of detection techniques on the results

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I. The crystal structure of a new dimer of triphenylfluorocyclobutadiene. II. A low temperature refinement of the cyanuric triazide structure

I. THE CRYSTAL STRUCTURE OF A NEW DIMER OF TRIPHENYLFLUOROCYCLOBUTADIENE

The crystal structure of thermal isomer of the “head-to-head” dimer of triphenylfluorocyclobutadiene was determined by the direct method. The Σ₂ relationship involving the low angle reflections with the largest E’s were found and solved for the signs by the symbolic method of Zachariasen. The structure was seen in the electron density map and the E-map, and was refined antisotropically by the method of least squares. The residual R was 0.065.

The structure is a gem-difluorohexaphenyldihydropentalene. All of the phenyl groups are planar as it is the cyclopentadiene ring of the dihydropentalene skeleton. Overcrowding at the position of the flourines causes some deviations from the normal bond angles in the cyclopentene ring.

The list of observed and calculated structure factors on pages 32-34 will not be legible on the microfilm. Photographic copies may be obtained from the California Institute of Technology.

II. A LOW TEMPERATURE REFINEMENT OF THE CYANURIC TRIAZIDE STRUCTURE

The structure of cyanuric triazide was refined anisotropically by the method of least squares. Three-dimensional intensity data, which has been collected photographically with MoK_α radiation at -110˚C, were used in the refinement. The residual R was reduced to 0.081.

The structure is completely planar, and there is no significant bond alternation in the cyanuric ring. The packing of the molecules causes the azide groups to deviate from linearity by 8 degrees.

A política pública de emprego: entre a pracarização desprotegida e a precarização protegida. Um estudo comparativo entre Brasil e Itália

Este trabalho discute a política de emprego implementada no Brasil e na Itália nos últimos 10 anos. A ideia central é de que a política de emprego vem sendo alvo de estratégias por parte do Estado brasileiro e italiano como forma de responder ao problema endêmico do desemprego e se encontra dentro das exigências propostas pelas agências multilaterais para minimizar os impactos das mudanças em curso no âmbito do trabalho. Embora o desemprego sempre tenha sido um elemento fundamental na dinâmica das relações sociais de produção capitalista, tendo em vista que a formação de um excedente de trabalhadores é condição fundamental para a extração da taxa de mais-valia, através do trabalho não pago e expropriado pelo capitalista, ele vem sendo considerado como um processo natural, sem qualquer vinculação com a lógica da acumulação capitalista e, portanto, as políticas de emprego revelam-se como medidas pontuais que tendem a responsabilizar os sujeitos pela sua "incapacidade" de se adequar às mudanças em curso. neste sentido, as ações propostas reforçam o incentivo ao empreendedorismo, a precarização das condições de trabalho, no incremento do trabalho feminino e juvenil e na retirada gradativa de direitos sociais e trabalhistas. As consequências não podem ser percebidas igualmente nos dois países, haja vista as condições sócio-históricas que deram luz ao Estado social permitindo que na Itália as mudanças em curso apontem para uma precarização protegida e no Brasil numa precarização desprotegida.

Superpopulação carcerária no Rio de Janeiro regulada pela economia da droga: um efeito da política de criminalização imposta aos jovens residentes das comunidades carentes

Trata-se de estudo sobre a política de criminalização imposta aos jovens residentes das comunidades carentes do Estado do Rio de Janeiro. Pretende-se identificar as visões antagônicas sobre essa questão e as discussões sobre o aumento do uso de drogas, associado à criminalidade e ao interesse de amplos setores da sociedade no combate a esse consumo e ao tráfico. Destacam-se os motivos que pressionam o Estado a construir uma política de combate às drogas, assim como a economia da droga influenciando e determinando os rumos de uma mentalidade que persegue uma eficácia questionável de consumo zero de drogas nas sociedades. Para melhor entendimento dessa questão, pretende-se examinar a influência da política norte-americana antidrogas numa economia globalizada. A análise está fundamentada nos estudos teóricos sobre economia das drogas, redução de danos e na legislação brasileira. Também foram consideradas as fontes orais, extraídas de discursos de parlamentares e especialistas em criminalização de comportamentos transgressores sociais. Os relatos, retirados de periódicos, discursos e entrevistas, receberam a forma de texto-relato, seguindo os métodos utilizados pelas Ciências Sociais.

Cage culture of sea bass in Malaysia

The article discusses the cage culture practice of sea bass (Lates calcarifer) in Malaysia. Problems on feed and seed supply and overcrowding are also discussed. Despite these problems, seabass cage culture still continuously booms.

Studies on mass summer mortality of cultured zhikong scallops (Chlamys farreri Jones et Preston) in China

Mass mortalities of cultured zhikong scallops (Chlamys farreri) have occurred each summer in most culture areas of northern China since 1996. Among the hypothesized causes are high culture density, infectious disease and genetic inbreeding. To investigate these potential agents, C. farreri were deployed at three densities (low, medium and high) at three sites (Jiaonan, Penglai and Yantai) in the summer of 2000. Scallops were sampled for survival, growth and histopathology before, during and after a mortality episode. Most of the mortality occurred in July and August, during and toward the later part of the spawning season, when water temperature reached 23-26 degrees C. Final cumulative mortalities reached 85% to 90% at all three sites. Scallops in the medium and high densities had higher initial death rates than did those at the low density. High densities also inhibited growth. Ciliates from the genus Trichodina, larvae of various organisms and anomalous secretions were observed in sections of the gill cavity, with highest prevalence during and at the end of the mortality period. Prokaryotic inclusion bodies were found in the soft tissues, but their prevalence was low and apparently without correlation with mortalities. Genetic analysis with random amplified polymorphic DNA markers showed slightly lower heterozygosity in the cultured stocks (0.301) than in the wild stocks (0.331). It is possible that the mortalities are caused by a combination of several factors such as stress associated with reproduction, high temperature, overcrowding and poor circulation in the growout cages, opportunistic invaders or pathogens, and possibly inbreeding. (c) 2005 Elsevier B.V. All rights reserved.

Spaces of observation and obscurity: cinematic prisons of light and dark

In The Eye of Power, Foucault delineated the key concerns surrounding hospital architecture in the latter half of the eighteenth century as being the ‘visibility of bodies, individuals and things'. As such, the ‘new form of hospital' that came to be developed ‘was at once the effect and support of a new type of gaze'. This was a gaze that was not simply concerned with ways of minimising overcrowding or cross-contamination. Rather, this was a surveillance intended to produce knowledge about the pathological bodies contained within the hospital walls. This would then allow for their appropriate classification. Foucault went on to describe how these principles came to be applied to the architecture of prisons. This was exemplified for him in the distinct shape of Bentham's panopticon. This circular design, which has subsequently become an often misused synonym for a contemporary culture of surveillance, was premised on a binary of the seen and the not-seen. An individual observer could stand at the central point of the circle and observe the cells (and their occupants) on the perimeter whilst themselves remaining unseen. The panopticon in its purest form was never constructed, yet it conveys the significance of the production of knowledge through observation that became central to institutional design at this time and modern thought more broadly. What is curious though is that whilst the aim of those late eighteenth century buildings was to produce wellventilated spaces suffused with light, this provoked an interest in its opposite. The gothic movement in literature that was developing in parallel conversely took a ‘fantasy world of stone walls, darkness, hideouts and dungeons…' as its landscape (Vidler, 1992: 162). Curiously, despite these modern developments in prison design, the façade took on these characteristics. The gothic imagination came to describe that unseen world that lay behind the outer wall. This is what Evans refers to as an architectural ‘hoax'. The façade was taken to represent the world within the prison walls and it was the façade that came to inform the popular imagination about what occurred behind it. The rational, modern principles ordering the prison became conflated with the meanings projected by and onto the façade. This confusion of meanings have then been repeated and reenforced in the subsequent representations of the prison. This is of paramount importance since it is the cinematic and televisual representation of the prison, as I argue here and elsewhere, that maintain this erroneous set of meanings, this ‘hoax'.

Melancholy and the Early Modern University

Critics have observed that in early Stuart England, the broad, socially significant concept of melancholy was recoded as a specifically medical phenomenon—a disease rather than a fashion. This recoding made melancholy seem less a social attitude than a private ailment. However, I argue that at the Stuart universities, this recoded melancholy became a covert expression of the disillusionment, disappointment, and frustration produced by pressures there—the overcrowding and competition which left many men “disappointed” in preferment, alongside James I’s unprecedented royal involvement in the universities. My argument has implications for Jürgen Habermas’s account of the emergence of the public sphere, which he claims did not occur until the eighteenth-century. I argue that although the university was increasingly subordinated to the crown’s authority, a lingering sense of autonomy persisted there, a residue of the medieval university’s relative autonomy from the crown; politicized by the encroaching Stuart presence, an alienated community at the university formed a kind of public in private from authority within that authority’s midst. The audience for the printed book, a sphere apart from court or university, represented a forum in which the publicity at the universities could be consolidated, especially in seemingly “private” literary forms such as the treatise on melancholy. I argue that Robert Burton’s exaggerated performance of melancholy in The Anatomy of Melancholy, which gains him license to say almost anything, resembles the performed melancholy that the student-prince Hamlet uses to frustrate his uncle’s attempts to surveil him. After tracing melancholy’s evolving literary function through Hamlet, I go on to discuss James’s interventions into the universities. I conclude by considering two printed (and widely circulated) books by university men: the aforementioned The Anatomy of Melancholy by Burton, an Oxford cleric, and The Temple by George Herbert, who left a career as Cambridge’s public orator to become a country parson. I examine how each of these books uses the affective pattern of courtly-scholarly disappointment—transumed by Burton as melancholy, and by Herbert as holy affliction—to develop an empathic form of publicity among its readership which is in tacit opposition to the Stuart court.