Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review)

Background: Nursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection prevention and control strategies are important in preventing and controlling MRSA transmission.

Objectives: To determine the effects of infection prevention and control strategies for preventing the transmission of MRSA in nursing homes for older people.

Search methods: In August 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Database of Abstracts of Reviews of Effects (DARE, The Cochrane Library), Ovid MEDLINE, OVID MEDLINE (In-process and Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Web of Science and the Health Technology Assessment (HTA) website. Research in progress was sought through Current Clinical Trials, Gateway to Reseach, and HSRProj (Health Services Research Projects in Progress).

Selection criteria: All randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection prevention and control interventions in nursing homes for older people were eligible for inclusion.

Data collection and analysis: Two review authors independently reviewed the results of the searches. Another review author appraised identified papers and undertook data extraction which was checked by a second review author.

Main results: For this third update only one study was identified, therefore it was not possible to undertake a meta-analysis. A cluster randomised controlled trial in 32 nursing homes evaluated the effect of an infection control education and training programme on MRSA prevalence. The primary outcome was MRSA prevalence in residents and staff, and a change in infection control audit scores which measured adherence to infection control standards. At the end of the 12 month study, there was no change in MRSA prevalence between intervention and control sites, while mean infection control audit scores were significantly higher in the intervention homes compared with control homes.

Authors' conclusions: There is a lack of research evaluating the effects on MRSA transmission of infection prevention and control strategies in nursing homes. Rigorous studies should be conducted in nursing homes, involving residents and staff to test interventions that have been specifically designed for this unique environment.

Contested urbanism: Access and control issues in Tundikhel, Kathmandu

Contested Open Spaces?: Access and control issues in Tundikhel, Kathmandu

Public spaces play a role of political, economic and cultural transformation of cities and the impact of these transformations on the nature of public space.

Urban open space(s) in Kathmandu have been an important part of the city’s urbanism. Historically they have played an important role in the city as spaces for religious, cultural, social and political and military activities during the 300 years of unified monarchy. Throughout the civil war period (Maoist insurgency between 1996 and 2006) they became material locations for political activities, and a site for protests and dharnas. In post-conflict Kathmandu, especially since the abolition of Monarchy in May 28, 2008, these spaces are increasingly seen being claimed by street hawkers, informal sellers and individuals reflecting a new set of users and functions, whereas a significant part of Tundikhel still remains under the military occupation posing important questions around access, identity and control of an important space.


Public spaces are broadly defined as crossroads where different paths and trajectories meet, sometimes overlapping and other times colliding (Madanipour, 2003). Using Tudikhel in Kathmandu, this research examines the increasing collision and contestations witnessed through social, political and neoliberal interactions. It explores how spaces are constantly
contested, negotiated and as a result reshaped through these interactions. It is observed that multiple forces are at play to gain control and access of this important open space, leading to increasing fragmentation of the space, and erosion of its historic significance both as cultural venue and a symbol of democracy in modern Nepal. It is argued that increasing disconnection of Tudikhel from wider urban setting has contributed to exacerbation of these contestations

High-affinity NO3 --H+ cotransport in the fungus Neurospora:Induction and control by pH and membrane voltate

High-affinity nitrate transport was examined in intact hyphae of Neurospora crassa using electrophysiological recordings to characterize the response of the plasma membrane to NO₃ ^- challenge and to quantify transport activity. The NO₃ ^--associated membrane current was determined using a three electrode voltage clamp to bring membrane voltage under experimental control and to compensate for current dissipation along the longitudinal cell axis. Nitrate transport was evident in hyphae transferred to NO₃ ^--free, N-limited medium for 15 hr, and in hyphae grown in the absence of a nitrogen source after a single 2-min exposure to 100 μM NO₃ ^-. In the latter, induction showed a latency of 40-80 min and rose in scalar fashion with full transport activity mensurable approx. 100 min after first exposure to NO₃ ^-; it was marked by the appearance of a pronounced sensitivity of membrane voltage to extracellular NO₃ ^- additions which, after induction, resulted in reversible membrane depolarizations of (+)54-85 mV in the presence of 50 μM NO₃ ^-; and it was suppressed when NH₄ ⁺, was present during the first, inductive exposure to NO₃ ^-. Voltage clamp measurements carried out immediately before and following NO₃ ^- additions showed that the NO₃ ^--evoked depolarizations were the consequence of an inward-directed current that appeared in parallel with the depolarizations across the entire range of accessible voltages -400 to +100 mV). Measurements of NO₃ ^- uptake using NO₃ ^--selective macroelectrodes indicated a charge stoichiometry for NO₃ ^- transport of 1(+):1(NO₃ ^-) with common K(m) and J(max) values around 25 μM and 75 pmol NO₃ ^- cm^-2sec^-1, respectively, and combined measurements of pH(o) and [NO₃ ^-](o) showed a net uptake of approx. 1 H⁺ with each NO₃ ^- anion. Analysis of the NO₃ ^- current demonstrated a pronounced voltage sensitivity within the normal physiological range between -300 and -100 mV as well as interactions between the kinetic parameters of membrane voltage, pH(o) and [NO₃ ^-](o). Increasing the bathing pH from 5.5 to 8.0 reduced the current and the associated membrane depolarizations 2- to 4-fold. At a constant pH(o) of 6.1, driving the membrane voltage from -350 to -150 mV resulted in an approx. 3-fold reduction in the maximum current and a 5-fold rise in the apparent affinity for NO₃ ^-. By contrast, the same depolarization effected an approx. 20% fall in the K(m) for transport as a function in [H⁺](o). These, and additional results are consistent with a charge-coupling stoichiometry of 2(H⁺) per NO anion transported across the membrane, and implicate a carrier cycle in which NO binding is kinetically adjacent to the rate-limiting step of membrane charge transit. The data concur with previous studies demonstrating a pronounced voltage-dependence to high-affinity NO₃ ^- transport system in Arabidopsis, and underline the importance of voltage as a kinetic factor controlling NO₃ ^- transport; finally, they distinguish metabolite repression of NO₃ ^- transport induction from its sensitivity to metabolic blockade and competition with the uptake of other substrates that draw on membrane voltage as a kinetic substrate.

What is being taught in Religious Education classes in Northern Ireland and to what extent should states be concerned about regulation, quality and control of the subject?

This paper reports on a research project designed to discover what schools are teaching in Religious Education in Northern Ireland and what procedures are in place to maintain standards in the delivery of the subject. A search through literature shows that little research has been carried out to determine what is being taught in Religious Education in Northern Ireland. It also indicates that there are very weak systems of control to measure the effectiveness or quality of what is delivered. A survey of the websites of all Post-Primary schools in the region was used to provide some answers to the basic question of what is being taught in RE. Using content and discourse analysis of these alongside supporting documentary sources (textbooks and exam specifications), it is possible to get a clearer picture of how the Northern Ireland Core Syllabus for Religious Education and any additional curricular elements are delivered in schools. The findings show that a significant minority of schools do not publicly articulate what pupils do in religious education. In situations where the content of religious education is made clear, some definite trends are evident. Despite the existence of a statutory core syllabus, there is significant variation in what is taught in schools. The content is most divergent from the syllabus in relation to the teaching of World Religions at Key Stage 3 and at Key Stage 4 whole elements of the syllabus are neglected due to limited conformity between the syllabus and exam specifications. These results raise important questions about the systems of regulation and control of the subject in the region. In law the subject is exempt from formal inspection by the local inspection authority; instead, a form of inspection is allowed for by the Christian churches who design the syllabus, but it is a process that is either entirely neglected or entirely unreported in situations where it does occur. It is argued that these findings raise questions of more general concern for this and other regions in Europe where the teaching of religious education is largely unregulated. For example, to what extent should states take an interest in what is taught in religious education, how it is delivered, what values it promotes and how standards of teaching and learning in the subject are upheld?

The planning and control of operations involving the use of lethal force

This is an analysis of the case law of the European Court of Human Rights on the obligation on States to plan and control the use of potentially lethal force by their police and military personnel. It illustrates the Court's attachment to the strict or careful scrutiny test and suggests how the Court might want to develop its jurisprudence in the future.

Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research

Background: Critically ill patients have an increased risk of developing delirium during their intensive care stay.To date, pharmacological interventions have not been shown to be effective for delirium management but non-pharmacological interventions have shown some promise. The aim of this systematic review is to identify effective non-pharmacological interventions for reducing the incidence or the duration of delirium in critically ill patients.

Methods: We will search MEDLINE, EMBASE, CINAHL, Web of Science, AMED, psycINFO and the Cochrane Library.We will include studies of critically ill adults and children. We will include randomised trials and controlled trials which measure the effectiveness of one or more non-pharmacological interventions in reducing incidence or duration ofdelirium in critically ill patients. We will also include qualitative studies that provide an insight into patients and their families’ experiences of delirium and non-pharmacological interventions. Two independent reviewers will assess studies for eligibility, extract data and appraise quality. We will conduct meta-analyses if possible or present results narratively.Qualitative studies will also be reviewed by two independent reviewers, and a specially designed quality assessment tool incorporating the CASP framework and the POPAY framework will be used to assess quality.

Discussion: Although non-pharmacological interventions have been studied in populations outside of intensive care units and multicomponent interventions have successfully reduced incidence and duration of delirium, no systematic review of non-pharmacological interventions specifically targeting delirium in critically ill patients have been undertaken to date. This systematic review will provide evidence for the development of a multicomponent intervention for delirium management of critically ill patients that can be tested in a subsequent multicentre randomised trial.

Retinopathy of prematurity: Causes, prevention and treatment

Advances in neonatal intensive care have improved survival rates in extremely premature an infant, which has led to an increase of Retinopathy of Prematurity (ROP) in the developed world. Left untreated, infants are at risk of developing strabismus, myopia, vitreous haemorrhage, vitreo-retinal fibrosis, retinal detachment, secondary angle closure glaucoma and ultimately complete loss of vision. The improvements in the understanding and treatment of ROP have been supported by seminal research, and its complexity is still being explored. However the importance of early screening and treatment is essential in the prevention and treatment of this disease. The following paper will examine the causes and treatments of ROP, as well as implications for future neonatal practice.

Management and Control of Water Supply Systems

The fast increase in the energy’s price has brought a growing concern about the highly expensive task of transporting water. By creating an hydraulic model of the Water Supply System’s (WSS) network and predicting its behaviour, it is possible to take advantage of the energy’s tariffs, reducing the total cost on pumping activities. This thesis was developed, in association with a technology transfer project called the E-Pumping. It focuses on finding a flexible supervision and control strategy, adaptable to any existent Water Supply System (WSS), as well as forecasting the water demand on a time period chosen by the end user, so that the pumping actions could be planned to an optimum schedule, that minimizes the total operational cost. The OPC protocol, associated to a MySQL database were used to develop a flexible tool of supervision and control, due to their adaptability to function with equipments from various manufacturers, being another integrated modular part of the E-Pumping project. Furthermore, in this thesis, through the study and performance tests of several statistical models based on time series, specifically applied to this problem, a forecasting tool adaptable to any station, and whose model parameters are automatically refreshed at runtime, was developed and added to the project as another module. Both the aforementioned modules were later integrated with an Graphical User Interface (GUI) and installed in a pilot application at the ADDP’s network. The implementation of this software on WSSs across the country will reduce the water supply companies’ running costs, improving their market competition and, ultimately, lowering the water price to the end costumer.

An overview of nonlinear identification and control with neural networks.

The aim of this chapter is to introduce background concepts in nonlinear systems identification and control with artificial neural networks. As this chapter is just an overview, with a limited page space, only the basic ideas will be explained here. The reader is encouraged, for a more detailed explanation of a specific topic of interest, to consult the references given throughout the text. Additionally, as general books in the field of neural networks, the books by Haykin [1] and Principe et al. [2] are suggested. Regarding nonlinear systems identification, covering both classical and neural and neuro-fuzzy methodologies, Reference 3 is recommended. References 4 and 5 should be used in the context of B-spline networks.

Searching biocompounds in marine natural extracts with potential use in tumor prevention and treatment

Cancer is a multistage process characterized by three stages: initiation, promotion and progression; and is one of the major killers worldwide. Oxidative stress acts as initiator in tumorigenesis; chronic inflammation promotes cancer; and apoptosis inactivation is an issue in cancer progression. In this study, it was investigated the antioxidant, antiinflammatory and antitumor properties of hexane, ether, chloroform, methanol and water extracts of five species of halophytes: A. macrostachyum, P. coronopus, J. acutus, C. edulis and A. halimus. Antioxidant activity was assessed by DPPH• and ABTS•+ methods, and the total phenolics content (TPC) was evaluated by the Folin-Ciocalteau method. The anti-inflammatory activity of the extracts was determined by the Griess method, and by evaluating the inhibition of NO production in LPS-stimulated RAW- 264.7 macrophages. The cytotoxic activity of the extracts against HepG2 and THP1 cell lines was estimated by the MTT assay, and the results obtained were further compared with the S17 non-tumor cell line. The induction of apoptosis of J. acutus ether extract was assessed by DAPI staining. The highest antioxidant activities was observed in C. edulis methanol and the J. acutus ether extracts against the DPPH• radical; and J. acutus ether and A. halimus ether extracts against the ABTS•+ radical. The methanol extracts of C. edulis and P. coronopus, and the ether extract of J. acutus revealed a high TPC. Generally the antioxidant activity had no correlation with the TPC. The A. halimus chloroform and P. coronopus hexane extracts demonstrated ability to reduce NO production in macrophages (> 50%), revealing their anti-inflammatory capacity. The ether extract of J. acutus showed high cytotoxicity against HepG2 cancer cells, with reduced cellular viability even at the lowest concentrations. This outcome was significantly lower than the obtained with the non-tumor cells (S17). This result was complemented by the induction of apoptosis.

Comparative study of power converter topologies and control strategies for the harmonic performance of variable-speed wind turbine generator systems

Power converters play a vital role in the integration of wind power into the electrical grid. Variable-speed wind turbine generator systems have a considerable interest of application for grid connection at constant frequency. In this paper, comprehensive simulation studies are carried out with three power converter topologies: matrix, two-level and multilevel. A fractional-order control strategy is studied for the variable-speed operation of wind turbine generator systems. The studies are in order to compare power converter topologies and control strategies. The studies reveal that the multilevel converter and the proposed fractional-order control strategy enable an improvement in the power quality, in comparison with the other power converters using a classical integer-order control strategy. (C) 2010 Elsevier Ltd. All rights reserved.

Subepithelial collagen content in the peripheral airways of heaves-affected and control horses

Chez les patients asthmatiques, on retrouve un remodelage de la matrice extracellulaire des poumons, caractérisé par une augmentation du collagène ou fibrose de la couche sous-épithéliale des voies respiratoires. Le souffle, maladie inflammatoire chronique des voies respiratoires inférieures des chevaux matures, présente des similarités physiopathologiques avec l’asthme humain, incluant le remodelage. Ceci nous conduit à l’hypothèse que la fibrose de la couche sous-épithéliale pourrait être une composante des lésions pulmonaires chez les chevaux affectés, ce que notre étude avait pour objectif d’évaluer. Des biopsies pulmonaires périphériques réalisées par voie thoracoscopique ont été obtenues chez 5 chevaux témoins et 6 chevaux atteints du souffle, avant (T0) et après une stimulation antigénique de 30 jours avec du foin moisi et de la paille. Avant le début de l’étude, les sujets étaient en rémission clinique et ne démontraient aucun signe clinique de maladie. Un examen microscopique des échantillons prélevés a été réalisé après traitement au picrosirius-rouge, colorant spécifique des fibres de collagène. La surface du collagène de la couche sous-épithéliale a été mesurée et corrigée en fonction de la taille de la voie respiratoire en utilisant des techniques morphométriques standards. Les chevaux atteints de souffle ont une surface de collagène plus grande dans la couche sous-épithéliale (p<0.1) en comparaison avec les chevaux témoins. La fibrose de la couche sous-épithéliale demeure inchangée chez les chevaux malades après la stimulation antigénique de 30 jours. À T0, la fibrose de la couche sous-épithéliale est associée positivement aux variations maximales de pression pleurale et à la résistance pulmonaire chez les chevaux atteints de souffle. Les résultats de cette étude suggèrent qu’une fibrose de la couche sous-épithéliale est présente dans les voies respiratoires périphériques des chevaux atteints de souffle et contribue au déficit de fonction résiduel pulmonaire observé lors de rémission clinique.

Studies on the Development and Control of Desiccation cracks in compacted clay liner soils

The present study aimed at critically looking at the current practice of the installation of compacted clay liner using bentonite enhanced sand (BES). The application of bentonite is currently the most accepted practice for lining purposes. The ideal bentonite sand combination, which satisfies the liner requirements is 20% bentonite and 80% sand, was selected as one of the liner materials for the investigation of development of desiccation cracks. Locally available sundried marine clay and its combination with bentonite were also included in the study. The desiccation tests on liner materials were conducted for wet/dry cycles to simulate the seasonal variations. Digital image processing techniques were used to measure the crack intensity factor (CIF), a useful and effective parameter for quantification of desiccation cracking. The repeatability of the tests could be well established, as the variation in CIF values of identical samples had a very narrow range of 0 to 2%. The studies on the development of desiccation cracks showed that the CIF of bentonite enhanced sand mixture (BES) was 18.09%, 39.75% and 21.22% for the first, second and third cycles respectively, while it was only 9.83%, 7.52% and 4.58% respectively for sun dried marine clay (SMC). Thus the locally available, alternate liner material suggested, viz SMC, is far superior to BES, when subjected to alternate wet/dry cycles. Further, the improvement of these liner materials when amended with randomly distributed fibre reinforcements was also investigated. Three types of fibres ,namely nylon fibre, polypropylene monofilament and polypropylene fibre mesh were used for the study of fibre amended BES and SMC.The influence of these amendments on the properties of the above liner materials is also studied. The results showed that there is definite improvement in the properties of the liner materials when it is reinforced with discrete random fibres. The study also proved that the desiccation cracks could be controlled with the help of fibre reinforcement.