Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325​505

IMPOSE (IMProving Outcomes after Sepsis)—the effect of a multidisciplinary follow-up service on health-related quality of life in patients postsepsis syndromes—a double-blinded randomised controlled trial: protocol

Introduction Patients post sepsis syndromes have a poor quality of life and a high rate of recurring illness or mortality. Follow-up clinics have been instituted for patients postgeneral intensive care but evidence is sparse, and there has been no clinic specifically for survivors of sepsis. The aim of this trial is to investigate if targeted screening and appropriate intervention to these patients can result in an improved quality of life (Short Form 36 health survey (SF36V.2)), decreased mortality in the first 12 months, decreased readmission to hospital and/or decreased use of health resources. Methods and analysis 204 patients postsepsis syndromes will be randomised to one of the two groups. The intervention group will attend an outpatient clinic two monthly for 6 months and receive screening and targeted intervention. The usual care group will remain under the care of their physician. To analyse the results, a baseline comparison will be carried out between each group. Generalised estimating equations will compare the SF36 domain scores between groups and across time points. Mortality will be compared between groups using a Cox proportional hazards (time until death) analysis. Time to first readmission will be compared between groups by a survival analysis. Healthcare costs will be compared between groups using a generalised linear model. Economic (health resource) evaluation will be a within-trial incremental cost utility analysis with a societal perspective. Ethics and dissemination Ethical approval has been granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC; HREC/13/QRBW/17), The University of Queensland HREC (2013000543), Griffith University (RHS/08/14/HREC) and the Australian Government Department of Health (26/2013). The results of this study will be submitted to peer-reviewed intensive care journals and presented at national and international intensive care and/or rehabilitation conferences.

Use of climate information for farm-level decision making: rainfed groundnut in southern India

The production of rainfed crops in semi-arid tropics exhibits large variation in response to the variation in seasonal rainfall. There are several farm-level decisions such as the choice of cropping pattern, whether to invest in fertilizers, pesticides etc., the choice of the period for planting, plant population density etc. for which the appropriate choice (associated with maximum production or minimum risk) depends upon the nature of the rainfall variability or the prediction for a specific year. In this paper, we have addressed the problem of identifying the appropriate strategies for cultivation of rainfed groundnut in the Anantapur region in a semi-arid part of the Indian peninsula. The approach developed involves participatory research with active collaboration with farmers, so that the problems with perceived need are addressed with the modern tools and data sets available. Given the large spatial variation of climate and soil, the appropriate strategies are necessarily location specific. With the approach adopted, it is possible to tap the detailed location specific knowledge of the complex rainfed ecosystem and gain an insight into the variety of options of land use and management practices available to each category of stakeholders. We believe such a participatory approach is essential for identifying strategies that have a favourable cost-benefit ratio over the region considered and hence are associated with a high chance of acceptance by the stakeholders. (C) 2002 Elsevier Science Ltd. All rights reserved.

Rural electrification: Optimising the choice between decentralised renewable energy sources and grid extension

The study presents an analysis aimed at choosing between off-grid solar photovoltaic, biomass gasifier based power generation and conventional grid extension for remote village electrification. The model provides a relation between renewable energy systems and the economical distance limit (EDL) from the existing grid point, based on life cycle cost (LCC) analysis, where the LCC of energy for renewable energy systems and grid extension will match. The LCC of energy feed to the village is arrived at by considering grid availability and operating hours of the renewable energy systems. The EDL for the biomass gasifier system of 25 kW capacities is 10.5 km with 6 h of daily operation and grid availability. However, the EDL for a similar 25 kW capacity photovoltaic system is 35 km for the same number of hours of operation and grid availability. The analysis shows that for villages having low load demand situated far away from the existing grid line, biomass gasification based systems are more cost competitive than photovoltaic systems or even compared to grid extension. (C) 2012 Elsevier Inc. All rights reserved.

Social Housing under Oligopoly

In this paper it is shown that the setting up of a social housing system may decrease the total number of houses built in the market, induce a price of non-social houses greater than the price of houses without that system and increase the profits of housing developers even in situations where they have to sell social houses at a price below production cost. The analysis considers a situation with imperfect competition in the housing market and with a social housing system where housing developers must provide some social houses when they obtain a permit to build non-social houses.

Comportamiento de las empresas respecto a la formación contínua de sus directivos

Este trabajo ha sido previamente presentado en las XVII Jornadas Luso-Espanholas de Gestao Científica, celebradas en Evora (Portugal) en febrero de 2006.

Uma contribuição para a melhoria da disponibilidade da infraestrutura de armazenamento consolidado de dados na Câmara Dos Deputados

Apresenta uma proposta de contribuição para a melhoria de disponibilidade do armazenamento de dados, baseado no estudo de caso da Câmara dos Deputados. Inclui a caracterização do ambiente existente, do ponto de vista da disponibilidade e o entendimento dos requisitos das efetivas necessidades do negócio, balanceadas pela relação custo/benefício. São avaliados os assuntos da alta disponibilidade e do gerenciamento de projetos relativos ao caso. São analisadas as práticas de Gerenciamento de Disponibilidade à luz de guias amplamente reconhecidos como o ITIL. A aplicação deste conhecimento, adequado ao cenário em estudo, permite a consolidação de um Plano de Projeto de implantação de melhorias.

Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV

No mundo, as hepatites decorrentes de infecções virais têm sido uma das grandes preocupações em saúde pública devido a seu caráter crônico, curso assintomático e pela sua capacidade de determinar a perda da função hepática. Com o uso em larga escala de medicamentos antirretrovirais, a doença hepática relacionada à infecção pelo vírus da hepatite C (VHC) contribuiu para uma mudança radical na história natural da infecção pelo vírus da imunodeficiência humana (HIV). Não se sabe ao certo o peso da coinfecção VHC/HIV no Brasil, mas evidências apontam que independentemente da região geográfica, esses indivíduos apresentam maiores dificuldades em eliminar o VHC após o tratamento farmacológico, quando comparados a monoinfectados. No âmbito do SUS, o tratamento antiviral padrão para portadores do genótipo 1 do VHC e do HIV é a administração de peguinterferon associado à Ribavirina. Quanto ao período de tratamento e aos indivíduos que devem ser incluídos, os dois protocolos terapêuticos mais recentes possuem divergências. A diretriz mais atual preconiza o tratamento de indivíduos respondedores precoces somados a respondedores virológicos lentos, enquanto a diretriz imediatamente anterior exclui na 12 semana indivíduos que não respondem completamente. Com base nessa divergência, esse estudo objetivou avaliar o custo-efetividade do tratamento contra o VHC em indivíduos portadores do genótipo 1, coinfectados com o HIV, virgens de tratamento antiviral, não cirróticos e imunologicamente estabilizados, submetidos às regras de tratamento antiviral estabelecidos pelas duas mais recentes diretrizes terapêuticas direcionadas ao atendimento pelo SUS. Para tal, foi elaborado um modelo matemático de decisão, baseado em cadeias de Markov, que simulou a progressão da doença hepática mediante o tratamento e não tratamento. Foi acompanhada uma coorte hipotética de mil indivíduos homens, maiores de 40 anos. Adotou-se a perspectiva do Sistema Único de Saúde, horizonte temporal de 30 anos e taxa de desconto de 5% para os custos e consequências clínicas. A extensão do tratamento para respondedores lentos proporcionou incremento de 0,28 anos de vida ajustados por qualidade (QALY), de 7% de sobrevida e aumento de 60% no número de indivíduos que eliminaram o VHC. Além dos esperados benefícios em eficácia, a inclusão de respondedores virológicos lentos mostrou-se uma estratégia custo-efetiva ao alcançar um incremental de custo efetividade de R$ 44.171/QALY, valor abaixo do limiar de aceitabilidade proposto pela Organização Mundial da Saúde OMS - (R$ 63.756,00/QALY). A análise de sensibilidade demonstrou que as possíveis incertezas contidas no modelo são incapazes de alterar o resultado final, evidenciando, assim, a robustez da análise. A inclusão de indivíduos coinfectados VHC/HIV respondedores virológicos lentos no protocolo de tratamento apresenta-se, do ponto de vista fármaco-econômico, como uma estratégia com relação de custoefetividade favorável para o Sistema Único de Saúde. Sua adoção é perfeitamente compatível com a perspectiva do sistema, ao retornar melhores resultados em saúdeassociados a custos abaixo de um teto orçamentário aceitável, e com o da sociedade, ao evitar em maior grau, complicações e internações quando comparado à não inclusão.

Stocking, Enhancement, and Mariculture of Penaeus orientalis and Other Species in Shanghai and Zhejiang Provinces, China

China's marine aquaculture landings provide only 18% of its combined freshwater and amrine capture and culture landings, at a per-capita consumption of only 3.2 kg/yr out of a total of 18.1 kg/yr. We described development and some of the results of long-term mariculture and stocking/enhancement projects that have been underway for up to 20 years in the Hangzhou Bay area. Penaeus orientalis (also referred to as P. chinensis) stocking provided up to 400 t/yr, at a total cost-benefit ratio of up to 8 Yuan of landed shrimp per Yuan invested in shrimp stocking. Over 40 t of Penaeus orientalis were produced commercially in 1993, with proceeds being used to fund mariculture and fisheries research. Large scale edible jellyfish restocking is also underway, while semicommercial culture of abalone, Haliotis diversicolor, has been successful. Technical problems limitig mariculture have been solved successfully for some species.

克隆植物对异质性生境的适应对策研究

植物的生境在时间和空间上都是异质性的，即使在很小的尺度上这种异质性也是存在的。克隆生长使得克隆植物在理论上更适应利用异质性环境，本文以几种克隆植物为对象，采用实验生态学方法，着重从生理生态特性、信号物质传导方面探讨克隆植物对异质性环境的适应对策。 以匍匐茎克隆植物野草莓(Fragaria vesca)为对象，研究了不同海拔梯度种群(1800m和3900m)对光照和养分资源斑块性分布生境的响应。研究结果显示：与资源的空间同质性处理(I) 和(II) 相比, 资源的空间异质性处理(III) 和(IV) 两个种群野草莓的近端、远端和整个克隆片段的生物量和分株数均获得显著增加。经历低光高养近端分株与经历高光低养的远段分株相连时，相比与低光高养的同质生境，来自两个海拔的种群分配更多的生物量到根；经历高光低养近端分株与经历低光高养远端分株相连时，相比于高光低养的同质生境，来自两个海拔的种群分配更少的生物量到根，类似的生物量分配格局在远端分株也被观察到。相比于高光低养同质性生境，当与低光高养远端分株相连时经历高光低养近端分株有更大的叶面积；相比于高光低养同质性生境，当与低光高养近端分株相连时经历高光低养远端分株有更大叶面积。实验结果表明, 资源交互斑块性生境中野草莓发生了克隆内分工。通过克隆内分工, 克隆植物能有效的利用异质性分布的资源, 缓解资源交互斑块性分布对克隆植物生长的不利影响。 以匍匐茎克隆植物蛇莓(Duchesnea indica)为对象, 研究其在高光照低水分斑块和低光照高水分斑块组成的资源交互斑块性生境中的克隆内分工。结果显示，当生长于高光照低水分(HL)条件下近端分株(basal ramets)与生长于低光照高水分(LH)条件下的远端分株(apical ramets)之间的匍匐茎连接时，近端分株根冠比显著下降，而远端分株根冠比显著增加，近端分株叶面积和远端分株总根长显著增加；当与低光照高水分条件下的远端分株相连时，近端分株叶片光合速率和叶绿素含量也相应增加。此外，克隆分株间资源交互传输显著提高蛇莓的生长表现（生物量和分株数）。因此，在光、水资源交互斑块性环境中克隆植物蛇莓分株在生物量分配、资源获取器官形态和生理特性方面发生了环境诱导的功能特化。这种对局部丰富资源的趋富特化在一定的程度上增强了克隆分株对资源的吸收利用能力，克隆内资源共享有助于缓解资源交互性斑块生境对克隆植物生长的不利影响，有效地提高克隆植物在其生境中存活与定居能力。 一个盆栽实验被采用以便调查克隆整合对经受局部沙埋的根状茎克隆植物沙生苔草(Carex praeclara)的影响，结果显示随着沙埋深度的增加，切断分株间的根状茎连接将显著降低经受沙埋处理分株的存活。当克隆植物经历局部沙埋时，切断分株间根状茎连接对其克隆生长（生物量、分株数和叶片数量）有显著负影响。耗-益(cost-benefit)分析显示，当与经历沙埋处理的远端分株相连时，近端分株的生长表现没有遭受任何负面影响。与经历沙埋处理远端分株相连时，近端分株的光合能力随沙埋深度的增加而增加。分株间的源-汇反馈调节机制所导致的补偿性反应减缓了局部沙埋对克隆植物生长的负效应。因此，克隆整合有助于提高经历局部沙埋克隆植物的存活，克隆植物在沙化地区植被恢复与重建方面具有重要意义。 克隆植物分株间的匍匐茎或根状茎连接不仅可以传输水分、矿质养分、光合产物，而且还可以传输信号物质。以根状茎克隆植物黑褐苔草(Carex alrofusca)为对象，采用盆栽实验研究外源茉莉酸诱导克隆片段相连分株间信号物质传导。结果显示，相比中龄和老龄分株，幼年分株对1mM茉莉酸诱导有显著反应。茉莉酸引起幼年分株叶片浓缩单宁含量显著增加，同时其叶片可溶性碳水化合物和氮含量降低。茉莉酸诱导后，幼年分株被昆虫咬食叶面积比率显著下降。因此匍匐茎或根状茎传也是克隆植物分株间信号物质传导重要通道，克隆植物通过分株间的风险扩散策略增强了对幼嫩植物组织器官的保护，这对克隆植物的存活或生长具有重要意义。

Suitability of rich-fish culture under mono and polyculture systems in the boro rice ecosystem

An experiment was conducted in farmers’ fields under Paikgacha thana, Khulna to study the suitability of integrated rice-cum-fish culture. Three treatments namely T1 (Puntius gonionotus), T2 (Puntius gonionotus and Cyprinus carpio) and T3 ( Cyprinus carpio) were included for the study each having three replicates. The fish were stocked at a density of 3750/ha in all the rice plots. The physicochemical parameters of water viz., water depth, temperature, dissolved oxygen, pH, salinity, nitrate and phosphate etc. recorded during the study period were found within optimum range. Of the two cultured species C. carpio attained the highest average individual weight (160g) and survival (81.06%). With respect to biomass and income, highest average fish production and net profit per hectare (306.74kg and Tk. 8177.91) were obtained in T2 and the lowest (184.17kg and Tk. 2049.41) obtained in T1 and a significant variation (p<0.05) in fish production was observed among the treatments while for rice production, it was insignificant. The cost benefit ratio of fish production found were 1:1.29, 1:2.14 and 1:1.90 for T1, T2 and T3, respectively.

Observation on the production performance of Penaeus monodon with Liza parsia under different cropping system

Study was conducted in six ponds each with an area of 0.1 ha in the pond complex of Brackishwater Station, Paikgacha, Khulna from February to October '96, to find out the variation of production rate in two culture system viz., single and double crop of P. monodon with L. parsia. In treatment T1 wild fry of P. monodon (0.006g) and L. parsia (0.20g) collected from nearby river were stocked at a rate of 40,000 and 10,000/ha, respectively, for a culture period of 120 days. In treatment T2, the rate was 20,000/ha for bagda fry in 1st and 2nd crop each and 10,000 for parsia fry/ha for an extended period of 225 days. The highest survivability and growth of P. monodon and L. parsia were 57.08% (1st crop of T2) and 75.26% (T2), and 27.08g (1st crop of T2) and 47.78g (T2), respectively with a significant variations (P>0.05) with other treatment. The net profit (Tk. 93,134) and cost benefit ratio of 1:1.76 were also found higher in T2.

Marketing of value-added products from silver carp and involvement of rural people in the production and marketing chain

Cost-profit analysis and market testing of some value-added products from silver carp such as fish mince block, fish sausage, fish ball, fish stick and fish burger were analyzed during April 2001 to March 2002. The study also explored the possibility to involve rural low-income people in the production and marketing of such products. The production of silver carp was higher in greater Jessore and Mymensingh districts but the price remained low during the peak-harvesting season in October to November. The price varied with size of the fish, season, market characteristics and effective demand of the buyers. Price of about 500 g size fish was found to be Tk. 20-25/kg in the rural markets. The average size of fish in the rural markets was 3S0-550 g while that in the urban markets it was 700-1,200 g. The cost of production of the value added products and profit margin were assessed on the basis of market price of the raw material as well as that of the finished products, transportation, storage and marketing costs. The profit margins of 34%, 39%, 81% and 31% of their sales price were obtained for fish sausage, fish ball, fish stick and fish burger, respectively. Actual production cost could be minimized if the fish is purchased directly from the farmers. Consumer's acceptance and marketability tests showed that both rural and urban people preferred fish ball than fish sausage. However, response towards the taste, flavor and color of fish ball and fish sausage was found to vary with occupations and age of the consumers. A correlation was observed between age group and acceptance of new products. Fish ball, fish stick and fish burger were found to be the most preferable items to the farmers because of easy formulation process with common utensils. Good marketing linkage and requirement of capital had been identified as the prerequisites for operating small-scale business on value-added fish products.

HACCP based management system for improving quality of freshwater giant prawn, Macrobrachium rosenbergii

The study was conducted on the present status of HACCP based quality management system of golda, Macrobrachium rosenbergii farms in Fulpur region of Mymensingh. Information was collected on general condition of farms, culture systems and post-harvest quality management. In almost all farms, there is no or inadequate infrastructure facilities such as, road access, electric supply, telecommunications, ice, feed storage facility, vehicle for golda transportation, washing and toilet facilities. The problems associated with sanitation and hygiene was: widespread use of cow dung, poultry manure and construction of open toilet within the vicinity of prawn culture pond. Different grades of commercially available and locally prepared feeds were used for golda culture in the pond. Golda post-larvae (PL) of 40-50 days old were stocked with carp species. The price of golda PL ranged from Tk. 1.00 to Tk. 1.25/piece. The pond size varied from 50 decimal (0.2 ha) to 2.5 acre (1.0 ha) with an average depth of 2-2.5 m. The culture period of golda varied from April-May to November-December and survival rate ranged between 75 and 80%. Production of golda varied from 250-500 kg/acre (625-1,250 kg/ha). Harvested golda were transported to city market within 4 h. Two size grading were generally followed during pricing, e.g. Tk. 500 to 550/kg for >100 g size and Tk. 300/kg for <100 g size. The cost-benefit ratio was found to remain around 1:1.25 depending on availability of PL. Water quality parameters such as, water temperature, pH, dissolved oxygen, total alkalinity and chlorophyll a in five golda farms in Fulpur region were monitored. Water temperature ranged from 29°C to 33°C, dissolved oxygen from 2.28 to 4.13 mg/l, pH between 6.65 and 7.94, alkalinity from 44 to 70 mg/l and chlorophyll a concentration from 61.88 to 102.34 µg/l in the five investigated ponds. The Aerobic Plate Count (APC) of the water sample was within the range of 2.0x10^6 - 2.96x10^7 CFU/ml and of soil samples within the range of 6.9x10^6 - 7.73x10^6 CFU/g. Streptococcus sp., Bacillus sp., Escherichia coli, Staphylococcus sp., Pseudomonas sp. and Salmonella sp. were isolated from pond water and sediment. Different feed samples used for golda was analyzed for proximate composition. Moisture content ranged around 14.14-21.22%, crude protein 20.55-44.1%, lipid 4.67-12.54% and ash 9.7-27.69%. The TVB-N values and peroxide values of feeds used as starter, grower and fish meal were found within the acceptable ranges and samples were free from pathogenic organisms. A training was organized for the golda farmers on HACCP, water quality and post-harvest quality management of prawn.

Polymer-based board-level optical interconnects

This paper provides an overview of the rationale behind the significant interest in polymer-based on-board optical links together with a brief review of recently reported work addressing certain challenges in this field. Polymer-based optical links have garnered considerable research attention due to their important functional attributes and compelling cost-benefit advantages in on-board optoelectronic systems as they can be cost-effectively integrated on conventional printed circuit boards. To date, significant work on the polymer materials, their fabrication process and their integration on standard board substrates have enabled the demonstration of numerous high-speed on-board optical links. However, to be deployed in real-world systems, these optoelectronic printed circuit boards (OE PCBs) must also be cost-effective. Here, recent advances in the integration process focusing on simple direct end-fire coupling schemes and the use of low-cost FR4 PCB substrates are presented. Performance of two proof-of-principle 10 Gb/s systems based on this integration method are summarised while work in realising more complex yet compact planar optical components is outlined. © 2011 IEEE.