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

A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

Selecting rainfall events for effective Water Sensitive Urban Design: A case study in Gold Coast City, Australia

The current approach for protecting the receiving water environment from urban stormwater pollution is the adoption of structural measures commonly referred to as Water Sensitive Urban Design (WSUD). The treatment efficiency of WSUD measures closely depends on the design of the specific treatment units. As stormwater quality is influenced by rainfall characteristics, the selection of appropriate rainfall events for treatment design is essential to ensure the effectiveness of WSUD systems. Based on extensive field investigations in four urban residential catchments based at Gold Coast, Australia, and computer modelling, this paper details a technically robust approach for the selection of rainfall events for stormwater treatment design using a three-component model. The modelling results confirmed that high intensity-short duration events produce 58.0% of TS load while they only generated 29.1% of total runoff volume. Additionally, rainfall events smaller than 6-month average recurrence interval (ARI) generates a greater cumulative runoff volume (68.4% of the total annual runoff volume) and TS load (68.6% of the TS load exported) than the rainfall events larger than 6-month ARI. The results suggest that for the study catchments, stormwater treatment design could be based on the rainfall which had a mean value of 31 mm/h average intensity and 0.4 h duration. These outcomes also confirmed that selecting smaller ARI rainfall events with high intensity-short duration as the threshold for treatment system design is the most feasible approach since these events cumulatively generate a major portion of the annual pollutant load compared to the other types of events, despite producing a relatively smaller runoff volume. This implies that designs based on small and more frequent rainfall events rather than larger rainfall events would be appropriate in the context of efficiency in treatment performance, cost-effectiveness and possible savings in land area needed.

Psykoterapian vaikutusten arvioiminen : Keskustelunanalyttinen tutkimus arviointihaastattelun käytänteistä

In the field of psychiatry semi-structured interview is one of the central tools in assessing the psychiatric state of a patient. In semi-structured interview the interviewer participates in the interaction both by the prepared interview questions and by his or her own, unstructured turns. It has been stated that in the context of psychiatric assessment interviewers' unstructured turns help to get focused information but simultaneously may weaken the reliability of the data. This study examines the practices by which semi-structured psychiatric interviews are conducted. The method for the study is conversation analysis, which is both a theory of interaction and a methodology for its empirical, detailed analysis. Using data from 80 video-recorded psychiatric interviews with 16 patients and five interviewers it describes in detail both the structured and unstructured interviewing practices. In the analysis also psychotherapeutic concepts are used to describe phenomena that are characteristic for therapeutic discourse. The data was received from the Helsinki Psychotherapy Study (HPS). HPS is a randomized clinical trial comparing the effectiveness of four forms of psychotherapy in the treatment of depressive and anxiety disorders. A total of 326 patients were randomly assigned to one of three treatment groups: solution-focused therapy, short-term psychodynamic psychotherapy, and long-term psychodynamic psychotherapy. The patients assigned to the long-term psychodynamic psychotherapy group and 41 patients self-selected for psychoanalysis were included in a quasi-experimental design. The primary outcome measures were depressive and anxiety symptoms, while secondary measures included work ability, need for treatment, personality functions, social functioning, and life style. Cost-effectiveness was determined. The data were collected from interviews, questionnaires, psychological tests, and public health registers. The follow-up interviews were conducted five times during a 5-year follow-up. The study shows that interviewers pose elaborated questions that are formulated in a friendly and sensitive way and that make relevant patients' long and story-like responses. When receiving patients' answers interviewers use a wide variety of different interviewing practices by which they direct patients' talk or offer an understanding of the meaning of patients' response. The results of the study are two-fold. Firstly, the study shows that understanding the meaning of mental experiences requires interaction between interviewer and patient. It is stated that therefore semi-structured interview is both relevant and necessary method for collecting data in psychotherapy outcome study. Secondly, the study suggests that conversation analysis, enriched with psychotherapeutic concepts, offers methodological possibilities for psychotherapy process research, especially for process-outcome paradigm.

Parallel circuit partitioning on a reduced array architecture

The physical design of a VLSI circuit involves circuit partitioning as a subtask. Typically, it is necessary to partition a large electrical circuit into several smaller circuits such that the total cross-wiring is minimized. This problem is a variant of the more general graph partitioning problem, and it is known that there does not exist a polynomial time algorithm to obtain an optimal partition. The heuristic procedure proposed by Kernighan and Lin1,2 requires O(n2 log2n) time to obtain a near-optimal two-way partition of a circuit with n modules. In the VLSI context, due to the large problem size involved, this computational requirement is unacceptably high. This paper is concerned with the hardware acceleration of the Kernighan-Lin procedure on an SIMD architecture. The proposed parallel partitioning algorithm requires O(n) processors, and has a time complexity of O(n log2n). In the proposed scheme, the reduced array architecture is employed with due considerations towards cost effectiveness and VLSI realizability of the architecture.The authors are not aware of any earlier attempts to parallelize a circuit partitioning algorithm in general or the Kernighan-Lin algorithm in particular. The use of the reduced array architecture is novel and opens up the possibilities of using this computing structure for several other applications in electronic design automation.

Expression of VP1 protein of serotype A and O of foot-and-mouth disease virus in transgenic sunnhemp plants and its immunogenicity for guinea pigs

Recently, transgenic plants expressing immunogenic proteins of foot-and-mouth disease virus (FMDV) have been used as oral or parenteral vaccines against foot-and-mouth disease (FMD). They exhibit advantages like cost effectiveness, absence of processing, thermostability, and easy oral application. FMDV VP1 protein of single serotype has been mostly used as immunogen. Here we report the development of a bivalent vaccine with tandem-linked VP1 proteins of two serotypes, A and O, present in transgenic forage crop Crotalaria juncea. The expression of the bivalent protein in the transgenic plants was confirmed by Western blot analysis. Guinea pig reacted to orally or parenterally applied vaccine by humoral as well as cell-mediated immune responses including serum antibodies and stimulated lymphocytes, respectively. The vaccine protected the animals against a challenge with the virus of serotype A as well as O. This is the first report on the development of a bivalent FMD vaccine using a forage crop.

Perspectives on Titanium Science and Technology

The basic framework and - conceptual understanding of the metallurgy of Ti alloys is strong and this has enabled the use of titanium and its alloys in safety-critical structures such as those in aircraft and aircraft engines. Nevertheless, a focus on cost-effectiveness and the compression of product development time by effectively integrating design with manufacturing in these applications, as well as those emerging in bioengineering, has driven research in recent decades towards a greater predictive capability through the use of computational materials engineering tools. Therefore this paper focuses on the complexity and variety of fundamental phenomena in this material system with a focus on phase transformations and mechanical behaviour in order to delineate the challenges that lie ahead in achieving these goals. (C) 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Science of geoengineering

Carbon dioxide emissions from the burning of coal, oil, and gas are increasing atmospheric carbon dioxide concentrations. These increased concentrations cause additional energy to be retained in Earth's climate system, thus increasing Earth's temperature. Various methods have been proposed to prevent this temperature increase either by reflecting to space sunlight that would otherwise warm Earth or by removing carbon dioxide from the atmosphere. Such intentional alteration of planetary-scale processes has been termed geoengineering. The first category of geoengineering method, solar geoengineering (also known as solar radiation management, or SRM), raises novel global-scale governance and environmental issues. Some SRM approaches are thought to be low in cost, so the scale of SRM deployment will likely depend primarily on considerations of risk. The second category of geoengineering method, carbon dioxide removal (CDR), raises issues related primarily to scale, cost, effectiveness, and local environmental consequences. The scale of CDR deployment will likely depend primarily on cost.

Near infrared detectors based on HgSe and HgCdSe quantum dots generated at the liquid-liquid interface

HgSe and Hg0.5Cd0.5Se quantum dos (QDs) are synthesized at room temperature by a novel liquid-liquid interface method and their photodetection properties in the near-IR region are investigated. The photodetection properties of our Te-free systems are found to be comparable to those of the previously reported high performance QD vis-IR detectors including HgTe. The present synthesis indicates the cost-effectiveness of selenium based IR detectors owing to the abundance and lower toxicity of selenium compared to tellurium.

Nanostructured electrode materials for electrochemical energy storage and conversion

Manipulation of matter at the nanoscale is a way forward to move beyond our current choices in electrochemical energy storage and conversion technologies with promise of higher efficiency, environmental benignity, and cost-effectiveness. Electrochemical processes being basically surface phenomena, tailored multifunctional nanoarchitecturing can lead to improvements in terms of electronic and ionic conductivities, diffusion and mass transport, and electron transfer and electrocatalysis. The nanoscale is also a domain in which queer properties surface: those associated with conversion electrodes, ceramic particles enhancing the conductivity of polymer electrolytes, and transition metal oxide powders catalyzing fuel cell reactions, to cite a few. Although this review attempts to present a bird's eye view of the vast literature that has accumulated in this rather infant field, it also lists a few representative studies that establish the beneficial effects of going `nano'. Investigations on nanostructuring and use of nanoparticles and nanoarchitectures related to lithium-ion batteries (active materials and electrolytes), supercapacitors (electrical double-layer capacitors, supercapacitors based on pseudo-capacitance, and hybrid supercapacitors), and fuel cells (electrocatalysts, membranes and hydrogen storage materials) are highlighted. (C) 2012 John Wiley & Sons, Ltd.

Biodiesel Exhaust Treatment with HFAC Plasma supported by Red Mud: Study on DeNOx and power consumption

The concentration of Nitrogen Oxides (NOx) in engines which use biodiesel as fuel is higher compared to conventional diesel engine exhaust. In this paper, an attempt has been made to treat this exhaust using a combination of High frequency AC (HFAC) plasma and an industrial waste, Red Mud which shows proclivity towards Nitrogen dioxide (NO2) adsorption. The high frequency AC source in combination with the proposed compact double dielectric plasma reactors is relatively more efficient in converting Nitric Oxide (NO) to NO2. It has been shown that the plasma treated gas enhances the activity of red mud as an adsorbent/catalyst and about 60-72% NOx removal efficiency was observed at a specific energy of 250 J/L. The advantage in this method is the cost effectiveness and abundant availability of the waste red mud in the industry. Further, power estimation studies were carried out using Manley's equation for the two reactors employed in the experiment and a close agreement between experimental and predicted powers was observed. (C) 2015 The Authors. Published by Elsevier Ltd.

Synthesis, and crystal and electronic structure of sodium metal phosphate for use as a hybrid capacitor in non-aqueous electrolyte

Energy storage devices based on sodium have been considered as an alternative to traditional lithium based systems because of the natural abundance, cost effectiveness and low environmental impact of sodium. Their synthesis, and crystal and electronic properties have been discussed, because of the importance of electronic conductivity in supercapacitors for high rate applications. The density of states of a mixed sodium transition metal phosphate (maricite, NaMn1/3Co1/3Ni1/3PO4) has been determined with the ab initio generalized gradient approximation (GGA)+Hubbard term (U) method. The computed results for the mixed maricite are compared with the band gap of the parent NaFePO4 and the electrochemical experimental results are in good agreement. A mixed sodium transition metal phosphate served as an active electrode material for a hybrid supercapacitor. The hybrid device (maricite versus carbon) in a nonaqueous electrolyte shows redox peaks in the cyclic voltammograms and asymmetric profiles in the charge-discharge curves while exhibiting a specific capacitance of 40 F g(-1) and these processes are found to be quasi-reversible. After long term cycling, the device exhibits excellent capacity retention (95%) and coulombic efficiency (92%). The presence of carbon and the nanocomposite morphology, identified through X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy (TEM) studies, ensures the high rate capability while offering possibilities to develop new cathode materials for sodium hybrid devices.

Aircraft Composite Structure Preventive Maintenance

In this paper, a methodology to reduce composite structure maintenance operational cost using SHM systems is adressed. Based on SHM real-time data, in-service structure lifetime prognostic and remaining useful lifetime (RUL) can be performed. Maintenance timetable can be therefore predicted by optimizing inspection times. A probabilistic ap-proach is combined with phenomenological fatigue damage models for composite mate-rials to perform maintenance cost-effectiveness of composite structure. A Monte Carlo method is used to estimate the probability of failure of composite structures and com-pute the average number of composite structure components to be replaced over the component lifetime. The replacement frequency of a given structure component over the aircraft lifetime is assessed. A first application of aeronautical composite structure maintenance is considered. Two composite models to predict the fatigue life and several laminates have been used. Our study shows that maintenance cost-effectiveness depends on material and fatigue loading applied.

Relay node placement for wireless sensor networks deployed in tunnels

Node placement plays a significant role in the effective and successful deployment of Wireless Sensor Networks (WSNs), i.e., meeting design goals such as cost effectiveness, coverage, connectivity, lifetime and data latency. In this paper, we propose a new strategy to assist in the placement of Relay Nodes (RNs) for a WSN monitoring underground tunnel infrastructure. By applying for the first time an accurate empirical mean path loss propagation model along with a well fitted fading distribution model specifically defined for the tunnel environment, we address the RN placement problem with guaranteed levels of radio link performance. The simulation results show that the choice of appropriate path loss model and fading distribution model for a typical environment is vital in the determination of the number and the positions of RNs. Furthermore, we adapt a two-tier clustering multi-hop framework in which the first tier of the RN placement is modelled as the minimum set cover problem, and the second tier placement is solved using the search-and-find algorithm. The implementation of the proposed scheme is evaluated by simulation, and it lays the foundations for further work in WSN planning for underground tunnel applications. © 2010 IEEE.

Is the current EU climate instrument mix adequate?

4 p.