Microbial load in instruments used in surgeries classified as clean

Introduction / objectives The number of orthopedic surgery, especially surgery of total hip and knee, have been more frequent due to technological advances. This study aims to determine the microbial load in the instruments used in clean surgeries, quantifying and identifying the genus and species of microbial growth.Methods Orthopedic surgical instruments were immersed, after use, in sterile water, sonicated in ultrasonic washer and consecutively shaken. Then, the lavage was filtered through a 0.45micron membrane, the result was incubated in aerobic medium, anaerobic medium and medium for fungi and yeasts. Results In clean surgeries, results showed that 47% of used instruments had microbiological growth in the range of 1 to 100 CFU/instrument. The most prevalent organism was Staphylococcus coagulase negative (28%), followed by Bacillus subtilis (11%).This study refuted the hypothesis that clean surgeries happen in micro-organismsfree surgery field. Conclusion The microbiological findings reinforce the importance of antibiotic prophylaxis, practice already well established for this category of surgical procedure.

Space-temporal dynamics of limnological variables in a floodplain wetland located at Ribeira do Iguape Valley (São Paulo, Brazil) at different hydrological periods

AIM: The main goal of this research was to investigate the influence of the hydrological pulses on the space-temporal dynamics of physical and chemical variables in a wetland adjacent to Jacupiranguinha River (São Paulo, Brazil); METHODS: Eleven sampling points were distributed among the wetland, a tributary by its left side and the adjacent river. Four samplings were carried out, covering the rainy and the dry periods. Measures of pH, dissolved oxygen, electrical conductivity and redox potential were taken in regular intervals of the water column using a multiparametric probe. Water samples were collected for the nitrogen and total phosphorus analysis, as well as their dissolved fractions (dissolved inorganic phosphorus, total dissolved phosphorus, ammoniacal nitrogen and nitrate). Total alkalinity and suspended solids were also quantified; RESULTS: The Multivariate Analysis of Variance showed the influence of the seasonality on the variability of the investigated variables, while the Principal Component Analysis gave rise in two statistical significant axes, which delimited two groups representative of the rainy and dry periods. Hydrological pulses from Jacupiranguinha River, besides contributing to the inputs of nutrients and sediments during the period of connectivity, accounted for the decrease in spatial gradients in the wetland. This "homogenization effect" was evidenced by the Cluster Analysis. The research also showed an industrial raw effluent as the main point source of phosphorus to the Jacupiranguinha River and, indirectly, to the wetland; CONCLUSIONS: Therefore, considering the scarcity of information about the wetlands in the study area, this research, besides contributing to the understanding of the influence of hydrological pulses on the investigated environmental variables, showed the need for adoption of conservation policies of these ecosystems face the increase anthropic pressures that they have been submitted, which may result in lack of their ecological, social and economic functions.

Prospect on intergalactic magnetic field measurements with gamma-ray instruments

Observing high-energy gamma-rays from Active Galactic Nuclei (AGN) offers a unique potential to probe extremely tiny values of the intergalactic magnetic field (IGMF), a long standing question of astrophysics, astropa rticle physics and cosmology. Very high energy (VHE) photons from blazars propagating along the line of sight interact with the extragalactic background light (EBL) and produce e + e − pairs. Through inverse-Compton interaction, mainly on the cosmic microwave background (CMB), these pairs generate secondary GeV-TeV compo- nents accompanying the primary VHE signal. Such secondary components would be detected in the gamma-ray range as delayed “pair echos” for very weak IGMF ( B< 10 − 16 G ), while they should result in a spatially extended ga mma-ray emission around the source for higher IGMF values ( B> 10 − 16 G ). Coordinated observations with space (i.e. Fermi) and ground- based gamma-ray instruments, such as the pre sent Cherenkov experiments H.E.S.S., MAGIC and VERITAS, the future Cherenkov Telescope Array (CTA) Observatory, and the wide-field detectors such as HAWC and LHAASO, should allow to analyze and finally detect such echos, extended emission or pair halos, and to further characterize the IGMF.

Phytoplankton community composition and size-abundance spectra in areas of the Alborán sea with different hydrological characteristics

[EN] Size-abundance spectra (SAS) were analyzed in different phytoplankton assemblages of the Alborán Sea collected in areas with contrasting hydrological features (upwelling areas and anticyclonic gyre). Abundance of micro-plankton cells decreased following the hydrological gradient from the most productive stations towards offshore stations. This size-fraction of phytoplankton was dominated by diatoms. Pico-plankton followed an opposite gradient. Concordantly, the slope of the SAS trended to decrease from coastal areas (upwelling) towards the anticyclonic gyre. However, phytoplankton assemblages featuring similar SAS values presented a quite different taxonomical composition of their diatom communities. According to the previous available information about the taxonomical composition of the phytoplankton communities in the Alborán Sea, these differences in diatom composition are indicative of differences in productivity of the phytoplankton. Consequently, the utility of phytoplankton SAS as an indicator of changes in the phytoplankton communities of the Alborán Sea is discussed.

Lifecycle analysis for surgery instruments at a hospital

Gli strumenti chirurgici sono importanti “devices” utilizzati come supporto indi-spensabile nella cura di pazienti negli ospedali. Essi sono caratterizzati da un intero ciclo di vita che inizia convenzionalmente nello “Store”, dove gli strumenti sterilizzati sono prelevati per essere utilizzati all’interno delle sale operatorie, e termina nuovamente nello “Store”, dove gli strumenti vengono immagazzinati per essere riutilizzati in un nuovo ciclo. Può accadere che le singole fasi del ciclo subiscano ritardi rispetto ai tempi previ-sti, non assicurando, pertanto, nelle sale operatorie, il corretto numero degli stru-menti secondo i tempi programmati. Il progetto che vado ad illustrare ha come obiettivo l’ottimizzazione del ciclo degli strumenti chirurgici all’interno di un nuovo ospedale, applicando i principi della Lean philosophy ed in particolare i metodi: “Poke Yoke, 5S e tracciabilità”. Per raggiungere tale scopo, il progetto è stato articolato come segue. In un primo momento si è osservato l’intero ciclo di vita degli strumenti nei due principali ospedali di Copenhagen (Hervel e Gentofte hospital). Ciò ha permesso di rilevare gli steps del ciclo, nonché di riscontrare sul campo i principali problemi relativi al ciclo stesso quali: bassa flessiblità, decentramento dei differenti reparti di cleaning e di store rispetto alle operation theatres ed un problema nel solleva-mento degli strumenti pesanti. Raccolte le dovute informazioni, si è passati alla fase sperimentale, in cui sono stati mappati due cicli di vita differenti, utilizzando tre strumenti di analisi: • Idef0 che consente di avere una visione gerarchica del ciclo; • Value stream Mapping che permette di evidenziare i principali sprechi del ciclo; • Simulator Tecnomatix che favorisce un punto di vista dinamico dell’analisi. Il primo ciclo mappato è stato creato con il solo scopo di mettere in risalto gli steps del ciclo e alcuni problemi rincontrati all’interno degli ospedali visitati. Il secondo ciclo, invece, è stato creato in ottica Lean al fine di risolvere alcuni tra i principali problemi riscontrati nei due ospedali e ottimizzare il primo ciclo. Si ricordi, infatti, che nel secondo ciclo le principali innovazioni introdotte sono state: l’utilizzo del Barcode e Rfid Tag per identificare e tracciare la posizione degli items, l’uso di un “Automatic and Retrievial Store” per minimizzare i tempi di inserimento e prelievo degli items e infine l’utilizzo di tre tipologie di carrello, per consentire un flessibile servizio di cura. Inoltre sono state proposte delle solu-zioni “Poke-Yoke” per risolvere alcuni problemi manuali degli ospedali. Per evidenziare il vantaggio del secondo ciclo di strumenti, è stato preso in consi-derazione il parametro “Lead time”e le due simulazioni, precedentemente create, sono state confrontate. Tale confronto ha evidenziato una radicale riduzione dei tempi (nonché dei costi associati) della nuova soluzione rispetto alla prima. Alla presente segue la trattazione in lingua inglese degli argomenti oggetto di ri-cerca. Buona lettura.

Interactions between the hydrological cycle and atmospheric chemistry

The land-atmosphere exchange of atmospheric trace gases is sensitive to meteorological conditions and climate change. It contributes in turn to the atmospheric radiative forcing through its effects on tropospheric chemistry. The interactions between the hydrological cycle and atmospheric processes are intricate and often involve different levels of feedbacks. The Earth system model EMAC is used in this thesis to assess the direct role of the land surface components of the terrestrial hydrological cycle in the emissions, deposition and transport of key trace gases that control tropospheric chemistry. It is also used to examine its indirect role in changing the tropospheric chemical composition through the feedbacks between the atmospheric and the terrestrial branches of the hydrological cycle. Selected features of the hydrological cycle in EMAC are evaluated using observations from different data sources. The interactions between precipitation and the water vapor column, from the atmospheric branch of the hydrological cycle, and evapotranspiration, from its terrestrial branch, are assessed specially for tropical regions. The impacts of changes in the land surface hydrology on surface exchanges and the oxidizing chemistry of the atmosphere are assessed through two sensitivity simulations. In the first, a new parametrization for rainfall interception in the densely vegetated areas in the tropics is implemented, and its effects are assessed. The second study involves the application of a soil moisture forcing that replaces the model calculated soil moisture. Both experiments have a large impact on the local hydrological cycle, dry deposition of soluble and insoluble gases, emissions of isoprene through changes in surface temperature and the Planetary Boundary Layer height. Additionally the soil moisture forcing causes changes in local vertical transport and large-scale circulation. The changes in trace gas exchanges affect the oxidation capacity of the atmosphere through changes in OH, O$_3$, NO$_x$ concentrations.

Measurement and modeling of cloud condensation nuclei in continental air

Atmospheric aerosol particles serving as cloud condensation nuclei (CCN) are key elements of the hydrological cycle and climate. Knowledge of the spatial and temporal distribution of CCN in the atmosphere is essential to understand and describe the effects of aerosols in meteorological models. In this study, CCN properties were measured in polluted and pristine air of different continental regions, and the results were parameterized for efficient prediction of CCN concentrations.The continuous-flow CCN counter used for size-resolved measurements of CCN efficiency spectra (activation curves) was calibrated with ammonium sulfate and sodium chloride aerosols for a wide range of water vapor supersaturations (S=0.068% to 1.27%). A comprehensive uncertainty analysis showed that the instrument calibration depends strongly on the applied particle generation techniques, Köhler model calculations, and water activity parameterizations (relative deviations in S up to 25%). Laboratory experiments and a comparison with other CCN instruments confirmed the high accuracy and precision of the calibration and measurement procedures developed and applied in this study.The mean CCN number concentrations (NCCN,S) observed in polluted mega-city air and biomass burning smoke (Beijing and Pearl River Delta, China) ranged from 1000 cm−3 at S=0.068% to 16 000 cm−3 at S=1.27%, which is about two orders of magnitude higher than in pristine air at remote continental sites (Swiss Alps, Amazonian rainforest). Effective average hygroscopicity parameters, κ, describing the influence of chemical composition on the CCN activity of aerosol particles were derived from the measurement data. They varied in the range of 0.3±0.2, were size-dependent, and could be parameterized as a function of organic and inorganic aerosol mass fraction. At low S (≤0.27%), substantial portions of externally mixed CCN-inactive particles with much lower hygroscopicity were observed in polluted air (fresh soot particles with κ≈0.01). Thus, the aerosol particle mixing state needs to be known for highly accurate predictions of NCCN,S. Nevertheless, the observed CCN number concentrations could be efficiently approximated using measured aerosol particle number size distributions and a simple κ-Köhler model with a single proxy for the effective average particle hygroscopicity. The relative deviations between observations and model predictions were on average less than 20% when a constant average value of κ=0.3 was used in conjunction with variable size distribution data. With a constant average size distribution, however, the deviations increased up to 100% and more. The measurement and model results demonstrate that the aerosol particle number and size are the major predictors for the variability of the CCN concentration in continental boundary layer air, followed by particle composition and hygroscopicity as relatively minor modulators. Depending on the required and applicable level of detail, the measurement results and parameterizations presented in this study can be directly implemented in detailed process models as well as in large-scale atmospheric and climate models for efficient description of the CCN activity of atmospheric aerosols.

On The Choice and Impacts of Innovative International Food Assistance Instruments

The rise of new food assistance instruments, including local and regional procurement, cash, and vouchers, has surpassed increase in understanding of the tradeoffs among and impacts of these options relative to traditional food aid. Response choices rarely appear to result from systematic response analyses. Further, impacts along multiple dimensions-timeliness, cost-effectiveness, local market effects, recipient satisfaction, food quality, impact on smallholder suppliers, etc.-may be competing or synergistic. No single food assistance tool is always and everywhere preferable. A growing body of evidence, including the papers in this special section, nonetheless demonstrates the clear value-added of new food assistance instruments. (C) 2013 Elsevier Ltd. All rights reserved.