Nosocomial infections and their relationship to non-traditional risk factors in a medical intensive care unit

Background. Nosocomial infections are a source of concern for many hospitals in the United States and worldwide. These infections are associated with increased morbidity, mortality and hospital costs. Nosocomial infections occur in ICUs at a rate which is five times greater than those in general wards. Understanding the reasons for the higher rates can ultimately help reduce these infections. The literature has been weak in documenting a direct relationship between nosocomial infections and non-traditional risk factors, such as unit staffing or patient acuity.^ Objective. To examine the relationship, if any, between nosocomial infections and non-traditional risk factors. The potential non-traditional risk factors we studied were the patient acuity (which comprised of the mortality and illness rating of the patient), patient days for patients hospitalized in the ICU, and the patient to nurse ratio.^ Method. We conducted a secondary data analysis on patients hospitalized in the Medical Intensive Care Unit (MICU) of the Memorial Hermann- Texas Medical Center in Houston during the months of March 2008- May 2009. The average monthly values for the patient acuity (mortality and illness Diagnostic Related Group (DRG) scores), patient days for patients hospitalized in the ICU and average patient to nurse ratio were calculated during this time period. Active surveillance of Bloodstream Infections (BSIs), Urinary Tract Infections (UTIs) and Ventilator Associated Pneumonias (VAPs) was performed by Infection Control practitioners, who visited the MICU and performed a personal infection record for each patient. Spearman's rank correlation was performed to determine the relationship between these nosocomial infections and the non-traditional risk factors.^ Results. We found weak negative correlations between BSIs and two measures (illness and mortality DRG). We also found a weak negative correlation between UTI and unit staffing (patient to nurse ratio). The strongest positive correlation was found between illness DRG and mortality DRG, validating our methodology.^ Conclusion. From this analysis, we were able to infer that non-traditional risk factors do not appear to play a significant role in transmission of infection in the units we evaluated.^

The impact of traditional psychiatric services and case management services on the functioning of people with schizophrenia: A cross-national study in Nova Scotia and Texas

The purpose of this study was to determine the impact of traditional psychiatric services with case management services on the functioning of people with schizophrenia. Traditional services were defined as routine clinic services consisting of medication follow-along, psychotherapy, and support services. Case management consisted of activities involved in linking, planning, and monitoring services for the outpatient client who has schizophrenia. The target population was adult schizophrenics who had been receiving outpatient clinic services for a minimum of six months. Structured interviews were conducted using standardized scales (e.g., Quality of Life, Self-Efficacy, and Brief Symptom Inventory) with 78 outpatient client volunteers from two sites: Nova Scotia (Canada) and Texas (USA). The researcher tested for differences in psychiatric symptomatology, recidivism, and quality of life for persons with schizophrenia receiving traditional psychiatric services in Nova Scotia and traditional plus case management services in Texas. Data were collected from the structured interviews and medical records review forms. Types of services were blocked into low and high levels of Intensity (frequency x minutes) and compared to determine the relative contribution of each. Finally, the role of clients' self-efficacy was tested as an intervening variable. Although the findings did not support the hypotheses in the direction anticipated, there were some interesting and useful results. From the Nova Scotia site, clients who received low levels of services were hospitalized less compared to the Texas site. The more psychotic a patient was the higher their involvement in medication follow-along and the more monitoring they received. The more psychotherapy received, the lower the reported satisfaction with social relationships. Of particular interest is the role that self-efficacy played in improved client outcomes. Although self-efficacy scores were related to improved functioning, the mechanism for this still needs to be clarified through subsequent research. ^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial

Gynuity

Farming strategy of African smallholder farmers in transition from traditional to alternative agriculture : the case of the Nupe in central Nigeria

It is worthwhile to understand farming strategies of smallholder farmers in sub-Saharan Africa, especially those of farmers who are in transition from traditional to alternative agriculture in terms of adoption of innovative technologies. In a case study of inland valleys in central Nigeria, we investigated the farming strategy of Nupe farmers who have a long-term tradition of wet rice cultivation and indigenous methods of land preparation for soil, water and weed management. In this region, a new method of land preparation has recently been introduced along with a recommendation to use improved seeds and chemical fertilizers. Our findings reveal that Nupe farmers directly sow traditional seeds and apply a marginal amount of fertilizer to paddy plots prepared by labor-saving methods on drought-prone hydromorphic valley fringes and flood-susceptible valley bottoms, whereas they preferentially transplanted improved seedlings and applied a relatively large quantity of fertilizer to paddy fields prepared by a labor-intensive and mechanized method on a valley position where they can access to optimum water condition (less risky against the drought and flood).

Traditional Building Adaptation to New Requirements: Historic Center of Arequipa, Perú

The traditional buildings in the historic center of the city of Arequipa, Perú, recently declared of human heritage, are of volcanic tuff both in walls and in vaulted roofs on the ground floor. Having been built in the 18th century and up to the beginning of the 20th century, they have suffered many damages from the seismic movements registered in this region. Due to this, many of them have had to be rebuilt. In this presentation, the different changes to adapt the city of Spanish colonial origin to the present tertiary use are analyzed.

Recovery of traditional mortars in the laboratory of materials at the school of architectura of Madrid

The Laboratory of Materials seminar is an optional course offered to students in the School of Architecture in Madrid. It is taught during 35 class hours in the laboratory of materials distributed in two hours and forty minutes weekly. One of the working lines is the preparation of traditional mortars made by students groups, each one of 4 or 5 members. It is basically a practical course, and students have to prepare a group of tests pieces in order to confirm the initial hypothesis, or when needed, make innovations. The test pieces are of 150mmx150mmx10mm and applied to big size hollow bricks, prismatic test pieces of 40mmx40mmx160mm to apply physical and mechanical tests and brick wallings of varied dimensions.

Similarities and Differences in Barrel Vaults of Traditional and Stately Houses in the Historic Centre of Arequipa, Perú

The traditional architecture of the centre of the city of Arequipa has been analyzed by comparing floor-plans of houses from the eighteenth and nineteenth centuries in order to explain the reasons behind the arrangement of their constructional elements and the evolution of said elements and floor-plans. The historic centre of Arequipa, a city located in the South of Perú, South America (Latitude 16°23' South, Longitude 71 °31' West), is based on a ground plan from 1540 that was set during the city's Spanish foundation. It was declared Patrimony of the Humanity by UNESCO. The manorial architecture is widely known for its decorated fronts and one-of-a-kind designs, but its differences with respect to the popular architecture are not based exclusively on decorative aspects. Peru's colonial period finished around 1825, but the barrel-vault, construction style continued in Arequipa through 1868, when an earthquake destroyed the city. Thereafter, the vaults were replaced by roofs made of rails, with cinders made out of the lava stone. The stately houses belonged to the founding families who settled around the main square on forty nine blocks that formed a square-grid, street layout. Also belonging to this category are the houses of landlords and traders from post-colonial times.

The introduction of teaching innovations into the traditional teaching of construction and building materials

The traditional teaching methods used for training civil engineers are currently being called into question as a result of the new knowledge and skills now required by the labor market. In addition, the European Higher Education Area is requesting that students be given a greater say in their learning. In the subject called Construction and Building Materials at the Civil Engineering School of the Universidad Politécnica de Madrid, a path was set three academic years ago to lead to an improvement in traditional teaching by introducing active methodologies. The innovations are based on cooperative learning, new technologies, and continuous assessment. The writers’ proposal is to offer their experience as a contribution to the debate on how students can be encouraged to acquire the skills currently demanded from a civil engineer, though not overlooking solid, top-quality training. From the outcomes obtained, it can be concluded that using new teaching techniques to supplement a traditional approach provides more opportunities for students to learn while boosting their motivation. In our case, the introduction of these changes has resulted in an increased pass rate of 29% on average, when such a figure is considered in the light of the mean value of passes during the last decade.

Study of the damage evolution of the concrete under freeze-thaw cycles using traditional and non-traditional techniques

Some experiments have been performed to investigate the cyclic freeze-thaw deterioration of concrete, using traditional and non-traditional techniques. Two concrete mixes, with different pore structure, were tested in order to compare the behavior of a freeze-thaw resistant concrete from one that is not. One of the concretes was air entrained, high content of cement and low w/c ratio, and the other one was a lower cement content and higher w/c ratio, without air-entraining agent. Concrete specimens were studied under cyclic freeze-thaw conditions according to UNE-CENT/TS 12390-9 test, using 3% NaCl solution as freezing medium (CDF test: Capillary Suction, De-icing agent and Freeze-thaw Test). The temperature and relative humidity were measured during the cycles inside the specimens using embedded sensors placed at different heights from the surface in contact with the de-icing agent solution. Strain gauges were used to measure the strain variations at the surface of the specimens. Also, measurements of ultrasonic pulse velocity through the concrete specimens were taken before, during, and after the freeze-thaw cycles. According to the CDF test, the failure of the non-air-entraining agent concrete was observed before 28 freeze-thaw cycles; contrariwise, the scaling of the air-entraining agent concrete was only 0.10 kg/m 2 after 28 cycles, versus 3.23 kg/m 2 in the deteriorated concrete, after 28 cycles. Similar behavior was observed on the strain measurements. The residual strain in the deteriorated concrete after 28 cycles was 1150 m versus 65 m, in the air-entraining agent concrete. By means of monitoring the changes of ultrasonic pulse velocity during the freeze-thaw cycles, the deterioration of the tested specimens were assessed

Applying Problem-Based Project-Organized Learning in a traditional system

Nowadays, PBL is considered a suitable methodology for engineering education. But making the most of this methodology requires some features, such as multidisciplinary, illstructured teamwork and autonomous research that sometimes are not easy to achieve. In fact, traditional university systems, including curricula, teaching methodologies, assessment and regulation, do not help the implementation of these features. Firstly, we look through the main differences found between a traditional system and the Aalborg model, considered a reference point in PBL. Then, this work is aimed at detecting the main obstacles that a standing traditional system presents to PBL implementation. A multifaceted PBL experience, covering three different disciplines, brings us to analyse these difficulties, order them according to its importance and decide which should be the first changes. Finally, we propose a straightforward introduction of generic competences in the curricula aimed at supporting the use of Problem-Based Project-Organized Learning

Contributions to traditional electronic voting systems in order to reinforce citizen confidence

This document provides a general description of the telematic voting scenario designed by the author?s research group. This scenario reinforces verification procedures as key elements to achieve full acceptance of the system on the part of voters. To frame this work, a general overview of electronic voting is given and the conditions entailed by these systems are specified.