Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN:Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING:A 950-bed teaching hospital in Seville, Spain. PATIENTS:All patients admitted to the hospital during the period from 1995 through 2008. METHODS:Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS:Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION:Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers

Background: Despite the fact that labour market flexibility has resulted in an expansion of precarious employment in industrialized countries, to date there is limited empirical evidence about its health consequences. The Employment Precariousness Scale (EPRES) is a newly developed, theory-based, multidimensional questionnaire specifically devised for epidemiological studies among waged and salaried workers. Objective: To assess acceptability, reliability and construct validity of EPRES in a sample of waged and salaried workers in Spain. Methods: Cross-sectional study, using a sub-sample of 6.968 temporary and permanent workers from a population-based survey carried out in 2004-2005. The survey questionnaire was interviewer administered and included the six EPRES subscales, measures of the psychosocial work environment (COPSOQ ISTAS21), and perceived general and mental health (SF-36). Results: A high response rate to all EPRES items indicated good acceptability; Cronbach’s alpha coefficients, over 0.70 for all subscales and the global score, demonstrated good internal consistency reliability; exploratory factor analysis using principal axis analysis and varimax rotation confirmed the six-subscale structure and the theoretical allocation of all items. Patterns across known groups and correlation coefficients with psychosocial work environment measures and perceived health demonstrated the expected relations, providing evidence of construct validity. Conclusions: Our results provide evidence in support of the psychometric properties of EPRES, which appears to be a promising tool for the measurement of employment precariousness in public health research.

Focused time-lapse inversion of radio and audio magnetotelluric data

Geoelectrical techniques are widely used to monitor groundwater processes, while surprisingly few studies have considered audio (AMT) and radio (RMT) magnetotellurics for such purposes. In this numerical investigation, we analyze to what extent inversion results based on AMT and RMT monitoring data can be improved by (1) time-lapse difference inversion; (2) incorporation of statistical information about the expected model update (i.e., the model regularization is based on a geostatistical model); (3) using alternative model norms to quantify temporal changes (i.e., approximations of l(1) and Cauchy norms using iteratively reweighted least-squares), (4) constraining model updates to predefined ranges (i.e., using Lagrange Multipliers to only allow either increases or decreases of electrical resistivity with respect to background conditions). To do so, we consider a simple illustrative model and a more realistic test case related to seawater intrusion. The results are encouraging and show significant improvements when using time-lapse difference inversion with non l(2) model norms. Artifacts that may arise when imposing compactness of regions with temporal changes can be suppressed through inequality constraints to yield models without oscillations outside the true region of temporal changes. Based on these results, we recommend approximate l(1)-norm solutions as they can resolve both sharp and smooth interfaces within the same model. (C) 2012 Elsevier B.V. All rights reserved.

Emergency Management in the United States of America

Core capabilities are under the above mission areas as outlined in the National Preparedness Goal. Planning, Public Information and Warning, and Operational Coordination cut across all five mission areas. Without these three cross-cutting capabilities, the other capabilities might not be achieved or could be weakened. Other core capabilities are aligned under a specific mission area, based on where it had the most relevance. Core capabilities alignment: Prevention capabilities focus on things related to preventing an imminent terrorist attack; by imminent, we mean an attack that is about to happen ; Protection capabilities focus on security— making sure things, systems, and people are protected ; Mitigation capabilities focus on risk, resilience and building a culture of preparedness; Response capabilities focus on meeting a community’s immediate needs when disaster strikes and finally, recovery capabilities focus on getting communities back on their feet.

Cross Listing of a Finnish Company on an Exchange in the United States of America

Finnish companies cross listing in the United States is an exceptional phenomenon. This study examines the cross listing decision, cross listing choice and cross listing process with associated challenges and critical factors. The aim is to create an in-depth understanding of the cross listing process and the required financial information. Based on that, the aim is to establish the process phases with the challenges and the critical factors that ought to be considered be- fore establishing the process plus re-evaluated and further considered at points in time during the process. The empirical part of this study is conducted as a qualitative study. The research data was collected through the adoption of two approaches, which are the interview approach and the textual data approach. The interviews were conducted with Finnish practitioners in the field of accounting and finance. The textual data was from publicly available publications of this phenomenon by the two BIG5 accounting companies worldwide. The results of this study demonstrate the benefits of cross listing in the U.S. are the better growth opportunities, the reduction of cost of capital and the production of higher quality financial information. In the decision making process companies should assess whether the benefits exceed the increased costs, the pressure for performance, the uncertainty of market recognition and the requirements of management. The exchange listing is seen as the most favourable cross listing choice for Finnish companies. The establishment of the processes for producing reliable, transparent and timely financial information was seen as both highly critical and very challenging. The critical success factors relating to the cross listing phases are the assessment and planning as well as the right mix of experiences and expertise. The timing plays important role in the process. The results mainly corroborate the literature concerning cross listing decision and choice. This study contributes to the literature on the cross listing process offering a useful model for the phases of the cross listing process.

Design and Material Selection of High-Speed Rotating Electrical Machines

The increasing emphasis on energy efficiency is starting to yield results in the reduction in greenhouse gas emissions; however, the effort is still far from sufficient. Therefore, new technical solutions that will enhance the efficiency of power generation systems are required to maintain the sustainable growth rate, without spoiling the environment. A reduction in greenhouse gas emissions is only possible with new low-carbon technologies, which enable high efficiencies. The role of the rotating electrical machine development is significant in the reduction of global emissions. A high proportion of the produced and consumed electrical energy is related to electrical machines. One of the technical solutions that enables high system efficiency on both the energy production and consumption sides is high-speed electrical machines. This type of electrical machines has a high system overall efficiency, a small footprint, and a high power density compared with conventional machines. Therefore, high-speed electrical machines are favoured by the manufacturers producing, for example, microturbines, compressors, gas compression applications, and air blowers. High-speed machine technology is challenging from the design point of view, and a lot of research is in progress both in academia and industry regarding the solution development. The solid technical basis is of importance in order to make an impact in the industry considering the climate change. This work describes the multidisciplinary design principles and material development in high-speed electrical machines. First, high-speed permanent magnet synchronous machines with six slots, two poles, and tooth-coil windings are discussed in this doctoral dissertation. These machines have unique features, which help in solving rotordynamic problems and reducing the manufacturing costs. Second, the materials for the high-speed machines are discussed in this work. The materials are among the key limiting factors in electrical machines, and to overcome this limit, an in-depth analysis of the material properties and behavior is required. Moreover, high-speed machines are sometimes operating in a harsh environment because they need to be as close as possible to the rotating tool and fully exploit their advantages. This sets extra requirements for the materials applied.

The law of the sea: the United States, Canada and the deep seabed

The Falkland Islands War of 1982 was fought over competing claims to sovereignty over a group of islands off the east coast of South America. The dispute was between Argentina and the United Kingdom. Argentina claims the islands under rights to Spanish succession, the fact that they lie off the Argentine coast line and that in 1833 Great Britain took the islands illegally and by force. The United Kingdom claims the islands primarily through prescription--the fact that they have governed the islands in a peaceful, continuous and public manner since 1833. The British also hold that the population living on the islands, roughly eighteen hundred British descendants, should be able to decide their own future. The United Kingdom also lays claim to the islands through rights of discovery and settlement, although this claim has always been challenged by Spain who until 1811 governed the islands. Both claims have legal support, and the final decision if there will ever be one is difficult to predict. Sadly today the ultimate test of sovereignty does not come through international law but remains in the idea that "He is sovereign who can defend his sovereignty." The years preceding the Argentine invasion of 1982 witnessed many diplomatic exchanges between The United Kingdom and Argentina over the future of the islands. During this time the British sent signals to Argentina that ii implied a decline in British resolve to hold the islands and demonstrated that military action did more to further the talks along than did actual negotiations. The Argentine military junta read these signals and decided that they could take the islands in a quick military invasion and that the United Kingdom would consider the act as a fait accompli and would not protest the invasion. The British in response to this claimed that they never signaled to Argentina that a military solution was acceptable to them and launched a Royal Navy task force to liberate the islands. Both governments responded to an international crisis with means that were designed both to resolve the international crisis and increase the domestic popularity of the government. British Prime Minister Margaret Thatcher was facing an all-time low in popularity for post-War Prime Ministers while Argentine President General Galtieri needed to gain mass popular support so he could remain a viable President after he was scheduled to lose command of the army and a seat on the military junta that ran the country. The military war for the Falklands is indicative of the nature of modern warfare between Third World countries. It shows that the gap in military capabilities between Third and First World countries is narrowing significantly. Modern warfare between a First and Third World country is no longer a 'walk over' for the First World country.

Agricultural Policy and Nest Success of Prairie Ducks in Canada and the United States

The Prairie Pothole Region of North America has been modified by agriculture during the past 100 yr, resulting in habitat loss, fragmentation, and degradation that have reduced the abundance and productivity of many wildlife species. The 1985 U.S. Farm Bill provided economic incentives to agriculture that are considered by many to be beneficial to nesting waterfowl and other wildlife. Canada has not experienced an equally comprehensive legislative initiative, which would seem to indicate that benefits to waterfowl in Canada should lag behind those in the United States. However, with the removal of some agricultural subsidies in Canada during the 1990s, the amount of perennial cover in the Canadian prairies increased to levels similar to those of the 1970s. Therefore, it is unclear whether and how the U.S. and Canadian prairies might differ with regard to habitat quality for nesting waterfowl. We used historical and contemporary data to compare temporal trends in duck nest success between the United States and Canada and to assess how mean nest success varied with proportion of cropland and wetland density. The data best supported models with nonlinear temporal trends that varied between the two countries and suggested that mean nest success in Canada declined from its high point in 1930s and remained below the long-term value of 0.16 until the end of the time series in 2005. Mean nest success in the United States also declined from its high point in the 1930s, but increased to above the long-term value of 0.25 during the early 2000s. Mean nest success varied negatively with proportion of cropland in both the United States and Canada. Mean nest success was positively correlated with pond density at Canadian sites, but showed only a weak association with pond density at U.S. sites. All models explained the low proportions of the variation in nest success, suggesting that unmeasured factors such as the abundance and identity of nest predators may have strong effects on nest success. Nonetheless, these results support earlier suggestions that agricultural policy that encourages permanent cover positively influences duck reproductive success. We also found that, for reasons that are not entirely clear, nest success for the same intensity of row cropping was generally higher in the United States than in Canada. Further research is required to elucidate the exact nature of the composition, size, and distribution of permanent cover that coincides with greater average nest success by dabbling ducks in the United States. In addition, the data suggest that the benefits that might accrue from increases in the amount of perennial cover in Canada would be better realized if these efforts are accompanied by strong measures to conserve wetlands.

Racial Conflict in the United States of America : A Deconstructive Perspective on Native Speaker by Changrae Lee

Written about the time of the Golden Venture incident, Chang-rae Lee’s Native Speaker makes a particular reference to that incident, whereby implying that particular immigrants, on the grounds of their racial identities, are mistreated and considered as aliens by some Americas. While some whites discriminate against immigrants, there is widespread ethnic tension between Korean Americans and African Americans. Significantly, racial conflict between Koreans and blacks and the racist attitude of some whites toward immigrants are mirrored in the relationship between the Korean-American protagonist Henry and his American wife Lelia. That is, due to their different racial identities they do not understand each other and they always argue. However, toward the end of the novel, Henry and Lelia come to understand each other. While ethnic conflict between Koreans and blacks and certain whites’ discriminatory attitudes toward immigrants is serious one, the novel suggests the unimportance of racial identity. In other words, the novel concludes that there is no discriminatory treatment of immigrants and, in fact, every one is a native Speaker in America. In the novel there is no message of how racial conflict could be resolved. However, this essay suggests that by investigating how the tension between Henry and Lelia is resolved, one could suggest a solution for the ethnicity problem in America and in real life.

Spatial and temporal distribution of the shrimp nematopalaemon schmitti (Decapoda: Caridea: Palaemonidae) at a subtropical enclosed bay in South America

The spatio-temporal distribution of the soft bottom dwelling shrimp Nematopalaemon schmitti and the effect of environmental conditions (sediment characteristics, temperature, salinity and dissolved oxygen) on its abundance were studied at Ubatuba Bay, south-eastern coast of Brazil. Surveys were conducted monthly from September 1995 to August 1996. Each sampling set comprised eight different transects distributed within the bay. Comparisons of CPUE of shrimp among sampling stations demonstrated that the abundance of N. schmitti was the greatest during winter, when average water temperature within the bay was considerably lower than during the rest of the year. Most shrimps (more than 95%) were collected at a single transect located at the northernmost side of the bay, demonstrating the extremely patchy distribution of this species. A multiple regression analysis using data only from this northernmost transect indicated that temperature was the most relevant factor affecting the abundance of N. schmitti during the year. Copyright © 2009 Marine Biological Association of the United Kingdom.

No more!: the right of women to live a life free of violence in Latin America and the Caribbean

Includes bibliography

Toxicological and histopathological effects of boric acid on atta sexdens rubropilosa (Hymenoptera: Formicidae) workers

The current study compared the toxicity of different concentrations of boric acid in adult workers of Atta sexdens rubropilosa Forel (Hymenoptera: Formicidae), with toxicological bioassays, and examining the dose-dependent and time-dependent histopathological changes, of the midgut, Malpighian tubules, and postpharyngeal glands. Our results revealed the importance of conducting toxicological bioassays combined with morphological analyses of the organs of ants chronically exposed to insecticides used in commercial ant baits. In vitro bioassays showed that boric acid significantly decreases the survivorship of workers regardless of concentration, whereas the morphological data suggested progressive dose-dependent and time-dependent changes in the organs examined, which were evident in the midgut. The midgut is the first organ to be affected, followed by the postpharyngeal gland and Malpighian tubules. This sequence is in agreement with the absorption pathway of this chemical compound in the midgut, its transference to the hemolymph, possibly reaching the postpharyngeal glands, and excretion by the Malpighian tubules. These progressive changes might be due to the cumulative and delayed effect of boric acid. Our findings provide important information for the understanding of the action of boric acid in ant baits in direct and indirect target organs. © 2010 Entomological Society of America.

Development, institutional and policy aspects of international migration between Africa, Europe and Latin America and the Caribbean

Incluye bibliografía

Flexible labour markets, workers' protection and the security of the wings": a Danish flexicurity solution to the unemployment and social problems in globalized economies"

Includes bibliography