Nosocomial outbreak by imipenem-resistant metallo-beta-lactamase-producing Pseudomonas aeruginosa in an adult intensive care unit in a Brazilian teaching hospital

Objective: To describe an outbreak of imipenem-resistant metallo-beta-lactamase-producing Pseudomonas aeruginosa, enzyme type bla, by horizontal transmission in patients admitted to a mixed adult ICU. Methods: A case-control study was carried out, including 47 patients (cases) and 122 patients (control) admitted to the mixed ICU of a university hospital in Minas Gerais. Brazil from November 2003 to July 2005. The infection site, risk factors, mortality, antibiotic susceptibility, metallo-beta-lactamase (MBL) production, enzyme type, and clonal diversity were analyzed, Results: A temporal/spatial relationship was detected in most patients (94%), overall mortality was 55.3%, and pneumonia was the predominant infection (85%). The majority of isolates (95%) were resistant to imipenem and other antibiotics, except for polymyxin, and showed MBL production (76.7%). Only bla SPM-1 (33%) was identified in the 15 specimens analyzed. In addition, 4 clones were identified, with a predominance of clone A (61.5%) and B (23.1%). On multivariate analysis, advanced age, mechanical ventilation, tracheostomy, and previous imipenem use were significant risk factors for imipenem-resistant P. aeruginosa infection. Conclusions: Clonal dissemination of MBL-producing P. aeruginosa strains with a spatial/temporal relationship disclosed problems in the practice of hospital infection control, low adherence to hand hygiene, and empirical antibiotic use. (C) 2008 Elsevier Espana, S.L. All rights reserved.

Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients

Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value < 0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. Conclusion: These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.

The Ethics and Citizenship Program: a Brazilian experience in moral education

This article describes the Ethics and Citizenship Program, a moral education project developed by the Brazilian government to promote education in ethics and citizenship in Brazilian fundamental and middle schools through four key themes: ethics, democratic coexistence, human rights and social inclusion. Some findings from a research project that investigated whether such a program did in fact promote the ethical and citizenship awareness of participating students are outlined. As an introduction to the paper`s main concerns, the Brazilian socioeconomic context is characterised, followed by a description of the historical background of moral education in Brazil.

Modulational Instability in Periodic Quadratic Nonlinear Materials

We investigate the modulational instability of plane waves in quadratic nonlinear materials with linear and nonlinear quasi-phase-matching gratings. Exact Floquet calculations, confirmed by numerical simulations, show that the periodicity can drastically alter the gain spectrum but never completely removes the instability. The low-frequency part of the gain spectrum is accurately predicted by an averaged theory and disappears for certain gratings. The high-frequency part is related to the inherent gain of the homogeneous non-phase-matched material and is a consistent spectral feature.

On the nonlinear Neumann problem with critical and supercritical nonlinearities

We investigate the solvability of the Neumann problem (1.1) involving a critical Sobolev exponent. In the first part of this work it is assumed that the coeffcients Q and h are at least continuous. Moreover Q is positive on overline Omega and lambda > 0 is a parameter. We examine the common effect of the mean curvature and the shape of the graphs of the coeffcients Q and h on the existence of low energy solutions. In the second part of this work we consider the same problem with Q replaced by - Q. In this case the problem can be supercritical and the existence results depend on integrability conditions on Q and h.

Bellerophon: a program to detect chimeric sequences in multiple sequence alignments

Bellerophon is a program for detecting chimeric sequences in multiple sequence datasets by an adaption of partial treeing analysis. Bellerophon was specifically developed to detect 16S rRNA gene chimeras in PCR-clone libraries of environmental samples but can be applied to other nucleotide sequence alignments.

Nodal solutions for nonlinear eigenvalue problems

We are concerned with determining values of, for which there exist nodal solutions of the boundary value problems u" + ra(t) f(u) = 0, 0 < t < 1, u(O) = u(1) = 0. The proof of our main result is based upon bifurcation techniques.

An improved novel method for solving nonlinear boundary value problems

A modified formula for the integral transform of a nonlinear function is proposed for a class of nonlinear boundary value problems. The technique presented in this paper results in analytical solutions. Iterations and initial guess, which are needed in other techniques, are not required in this novel technique. The analytical solutions are found to agree surprisingly well with the numerically exact solutions for two examples of power law reaction and Langmuir-Hinshelwood reaction in a catalyst pellet.

Using FCD Mapper Software and Landsat Images to Assess Forest Canopy Density in Landscapes in Australia and the Philippines

Using Landsat imagery, forest canopy density (FCD) estimated with the FCD Mapper®, was correlated with predominant height (PDH, measured as the average height of the tallest 50 trees per hectare) for 20 field plots measured in native forest at Noosa Heads, south-east Queensland, Australia. A corresponding image was used to calculate FCD in Leyte Island, the Philippines and was validated on the ground for accuracy. The FCD Mapper was produced for the International Tropical Timber Organisation and estimates FCD as an index of canopy density using reflectance characteristics of Landsat Enhanced Thematic (ETM) Mapper images. The FCD Mapper is a ‘semi-expert’ computer program which uses interactive screens to allow the operator to make decisions concerning the classification of land into bare soil, grass and forest. At Noosa, a positive strong nonlinear relationship (r2 = 0.86) was found between FCD and PDH for 15 field plots with variable PDH but complete canopy closure. An additional five field plots were measured in forest with a broken canopy and the software assessed these plots as having a much lower FCD than forest with canopy closure. FCD estimates for forest and agricultural land in the island of Leyte and subsequent field validation showed that at appropriate settings, the FCD Mapper differentiated between tropical rainforest and banana or coconut plantation. These findings suggest that in forests with a closed canopy this remote sensing technique has promise for forest inventory and productivity assessment. The findings also suggest that the software has promise for discriminating between native forest with a complete canopy and forest which has a broken canopy, such as coconut or banana plantation.

Combining GIS and Expert Opinion to Model Landscapes for a Smallholder Forest Extension Program in Leyte, the Philippines

A Geographic Information System (GIS) was used to model datasets of Leyte Island, the Philippines, to identify land which was suitable for a forest extension program on the island. The datasets were modelled to provide maps of the distance of land from cities and towns, land which was a suitable elevation and slope for smallholder forestry and land of various soil types. An expert group was used to assign numeric site suitabilities to the soil types and maps of site suitability were used to assist the selection of municipalities for the provision of extension assistance to smallholders. Modelling of the datasets was facilitated by recent developments of the ArcGIS® suite of computer programs and derivation of elevation and slope was assisted by the availability of digital elevation models (DEM) produced by the Shuttle Radar Topography (SRTM) mission. The usefulness of GIS software as a decision support tool for small-scale forestry extension programs is discussed.

Highs and lows

The past year has been a mixed one for research in the addictions. The Global Burden of Disease study confirmed that alcohol was a major contributor to the burden of disease in developed countries, as a risk factor for injury and alcohol dependence (Murray). A 10-year study of 65 171 Kaiser Permanente Medical Care Program members found that regular marijuana use had little impact on mortality (Sidney). Its association with increased AIDS mortality in men, probably suggests that it is a marker for male homosexual behaviour. Reassurance about the mortality risks of marijuana is premature because the mean age at follow-up was only 43 years: cigarette smoking and alcohol use were only modestly associated with premature mortality.

An evaluation of the Keep on Talking program for maintaining communication skills into old

Communication skills change with age as a result of sensory deficits, memory loss, and increasing word finding difficulties The Keep on Talking program (L. Hickson, H. Barnett, L. Worrall, & E. Yiu, 1994) was developed to assist older people to develop their own strategies for maintaining communication skills into old age. Two hundred and fifty-two healthy older people were recruited from the community and were assessed on a battery of communication assessments on entry to the study and at 1 year after entry. The experimental group (n = 120) participated in the 5-week group Keep on Talking program run by volunteers A further 130 control subjects were assessed only. The short-term effectiveness of the program was evaluated using a short knowledge based and attitudinal questionnaire and qualitative written feedback. At the I-year follow up, subjects were also asked whether they had taken any action as a result of the project. Results concluded that there was a significant difference between the number of correct questionnaire responses on the knowledge based items and the ratings on the attitudinal items pre- and postprogram questionnaire for the experimental subjects. Qualitative written feedback was positive with many participants remarking on the amount of information that they had acquired. Forty-eight experimental and 69 control subjects (n = 117) were assessed I year later, and there was a significant difference between the groups in terms of the number of subjects who reported having taken action as a result of the program. The Keep on Talking program increased knowledge about communication, produced a positive change in attitude toward the importance of communication, and encouraged participants to take action to maintain their communication skills. Maintaining communication skills may prevent social isolation. This simple 5-hour group program has been effective in empowering participants to maintain. their communication skills as they age.