Accuracy of LightCycler SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review and meta-analysis

Purpose: There is an urgent need to develop diagnostic tests to improve the detection of pathogens causing life-threatening infection (sepsis). SeptiFast is a CE-marked multi-pathogen real-time PCR system capable of detecting DNA sequences of bacteria and fungi present in blood samples within a few hours. We report here a systematic review and meta-analysis of diagnostic accuracy studies of SeptiFast in the setting of suspected sepsis.

Methods: A comprehensive search strategy was developed to identify studies that compared SeptiFast with blood culture in suspected sepsis. Methodological quality was assessed using QUADAS. Heterogeneity of studies was investigated using a coupled forest plot of sensitivity and specificity and a scatter plot in receiver operator characteristic space. Bivariate model method was used to estimate summary sensitivity and specificity.

Results: From 41 phase III diagnostic accuracy studies, summary sensitivity and specificity for SeptiFast compared with blood culture were 0.68 (95 % CI 0.63–0.73) and 0.86 (95 % CI 0.84–0.89) respectively. Study quality was judged to be variable with important deficiencies overall in design and reporting that could impact on derived diagnostic accuracy metrics.

Conclusions: SeptiFast appears to have higher specificity than sensitivity, but deficiencies in study quality are likely to render this body of work unreliable. Based on the evidence presented here, it remains difficult to make firm recommendations about the likely clinical utility of SeptiFast in the setting of suspected sepsis.

Combined effect of high pressure processing and antimicrobial packaging to control the growth of Listeria monocytogenes on ready-to-eat chicken breast

In the European Union, food is considered safe with regard to Listeria monocytogenes if its numbers do not exceed 100 cfu/g throughout the shelf-life of the food. Therefore, it is important to determine if a food supports growth of L. monocytogenes. Challenge tests are laboratory-based studies that measure the growth of L. monocytogenes on artificially contaminated food stored under foreseeable conditions of transportation, distribution and storage. The aim of this study was to elaborate and optimize a user-friendly protocol to perform challenge tests on food and to apply it to determine whether growth of L. monocytogenes is supported during the production and distribution of a potentially risky food i.e. mushrooms. A three-strain mixture of L. monocytogenes was inoculated onto three independent batches of whole mushrooms, sliced mushrooms, mushroom casing and mushroom substrate at a concentration of about 100 -1000 cfu/g. The batches were incubated at potential abuse temperatures, as a worst case scenario, and at intervals during storage L. monocytogenes numbers, % moisture and pH were determined. The results showed that the sliced and whole mushrooms supported growth of L. monocytogenes while mushroom casing allowed survival but did not support growth. Mushroom substrate showed a rich background microflora able of growing in Listeria selective media which hindered enumeration of L. monocytogenes. Combase predictions were not always accurate, indicating that challenge tests are a necessary part of growth determination of L. monocytogenes.

A techno-economic evaluation of changing from conventional vehicles to range extended electric vehicles

Transportation accounts for 22% of greenhouse gas emissions in the UK, and increases to 25% in Northern Ireland. Surface transport carbon dioxide emissions, consisting of road and rail, are dominated by cars. Demand for mobility is rising rapidly and vehicle numbers are expected to more than double by 2050. Car manufacturers are working towards reducing their carbon footprint through improving fuel efficiency and controlling exhaust emissions. Fuel efficiency is now a key consideration of consumers purchasing a new vehicle. While measures have been taken to help to reduce pollutants, in the future, alternative technologies will have to be used in the transportation industry to achieve sustainability. There are currently many alternatives to the market leader, the internal combustion engine. These alternatives include hydrogen fuel cell vehicles and electric vehicles, a term which is widely used to cover battery electric vehicles, plug-in hybrid electric vehicles and extended-range electric vehicles. This study draws direct comparisons measuring the differing performance in terms of fuel consumption, carbon emissions and range of a typical family saloon car using different fuel types. These comparisons will then be analysed to see what effect switching from a conventionally fuelled vehicle to a range extended electric vehicle would have not only on the end user, but also the UK government.

Northern Ireland and ‘The Troubles’, outlining an innovative approach to nursing/midwifery student teaching and module evaluation

This discussion paper outlines an approach to developing and evaluating an educative programme primarily delivered by lay `citizen trainers’ in educating student nurses, and student midwives to the impact of and experience of extended and extensive civil unrest within their communities (`the Troubles’ ). This is drawn from experience within the Northern Ireland `Troubles’ and all of the citizen trainers were directly affected physically/psychologically. The programme was intended to both educate but primarily to help facilitate student nurses and student midwives to better understanding to experience and context and to more effective care delivery to those affected by/damaged by `the Troubles’. Evaluation of the teaching and learning by the students was significantly positive.

The Impact of the Recent Economic Recession on the NEC Contract in Northern Ireland: A Preliminary Study

In comparison to the rest of the United Kingdom (UK) the Northern Irish Construction Industry was disproportionately affected by the recent economic recession. During this period, use of the New Engineering Contract (NEC) has proliferated in the public sector, however no study has been undertaken to examine the impact of the recession on this contract in Northern Ireland. The aim of this paper is to explore NEC contract implementation in Northern Ireland and the impact of the recession on its operation. A qualitative methodology is adopted using a literature review and semi structured interviews with six construction professionals. A qualitative analysis identifies themes and issues arising exploring connections and links between them using thematic coding. The initial findings are that the introduction of the NEC contract in Northern Ireland makes demands of contractors and consultants in terms of additional resources and training. Some consultants show a clear lack of understanding of the contract and its provisions. Whilst there is general agreement that the contract does help to stimulate good project management, the interviewees find the contract time consuming and complicated to administer, describing it as “unforgiving for the architect and unforgiving to the contractor.” Due to the impact of the recession, both contractors and consultants are still reporting a drop in income from pre-recession levels. Project resourcing levels have dropped significantly since the onset of the recession. Adversarial and opportunistic behaviour has increased. Many consultants and contractors are struggling to adequately administer the NEC contract at current income levels. The introduction of the NEC contract and the economic recession have exerted opposing forces on the implementation of the contract, hindering its execution. As the pressures exerted by the economic recession abate and a greater understanding of the contract develops, these opposing forces will ease leading to a more consistent implementation of the contract.

This is Abuse… Or is it? Domestic abuse perpetrators’ responses to anti-domestic violence publicity

Social marketing has become a key component of policy initiatives aimed at reducing the incidence of domestic abuse. However, its efficacy remains debated, with most measures of effectiveness being somewhat crude. More subtle effects of social marketing, such as the boomerang effect whereby the message engenders the opposite effect to that intended, have been detected, suggesting a need for modes of analysis sensitive to the multiple ways in which viewers react to social opprobrium. This article attempts to deliver just this. It begins with a short history and critique of the concept of social marketing. It then proceeds to explore the utility of the more complex notion that viewers often identify with the subject positions thrown open by social marketing on a quite temporary basis, before reconfiguring them. Using the responses of domestic abuse perpetrators exposed to the UK Government’s This is Abuse campaign film, the article shows how contradictory identifications with both anti-violence messages and victim-blaming discourses are negotiated by those young men prone to perpetrating domestic abuse. The article concludes by exploring how effectiveness might be better conceptualised and assessed with regard to the impact of anti-violence social marketing that speaks to domestic abuse perpetrators.

Experimental Investigation of the Detection of Bridge Dynamic Parameters using a Moving Vehicle

This paper investigates the feasibility of using an instrumented vehicle to detect bridge dynamic parameters, such as natural frequency and structural damping, in a scaled laboratory experiment. In the experiment, a scaled vehicle model crosses a steel girder which has been adopted as the bridge model. The bridge model also includes a scaled road surface profile. The effects of varying vehicle model mass and speed are investigated. The damping of the girder is also varied. The bridge frequency and changes in damping are detected in the vehicle acceleration response in the presence of a rough road surface profile.

Using Instrumented Vehicles to Detect Damage in Bridges

This paper describes a ‘drive-by’ method of bridge inspection using an instrumented vehicle. Accelerometers on the vehicle are proposed as a means of detecting damage on the bridge in the time it takes for the vehicle to cross the bridge at full highway speed. For a perfectly smooth road profile, the method is shown to be feasible. Changes in bridge damping, which is an indicator of damage, are clearly visible in the acceleration signal of a quarter-car vehicle on a smooth road surface modelled using MatLab. When road profile is considered, the influence of changes in bridge damping on the vehicle acceleration signal is much less clear. However, when a half-car model is used on a road with a rough profile, it is again possible to detect changes in bridge damping, provided the vehicle has two identical axles.

Parametric study to extract bridge frequencies from the dynamic response of passing vehicles

A conventional way to identify bridge frequencies is utilizing vibration data measured directly from the bridge. A drawback with this approach is that the deployment and maintenance of the vibration sensors are generally costly and time-consuming. One way to cope with the drawback is an indirect approach utilizing vehicle vibrations while the vehicle passes over the bridge. In the indirect approach, however, the vehicle vibration includes the effect of road surface roughness, which makes it difficult to extract the bridge modal properties. One solution may be subtracting signals of two trailers towed by a vehicle to reduce the effect of road surface roughness. A simplified vehicle-bridge interaction model is used in the numerical simulation; the vehicle - trailer and bridge system are modeled as a coupled model. In addition, a laboratory experiment is carried out to verify results of the simulation and examine feasibility of the damage detection by the indirect method.

Corneal structure and biomechanics: impact on the diagnosis and management of glaucoma.

PURPOSE OF REVIEW:

Highlights recent studies relating to the impact of corneal structure and biomechanical properties on glaucoma evaluation and management.

RECENT FINDINGS:

Central corneal thickness has been shown to play a role in the interpretation of intraocular pressure. Central corneal thickness has also been suggested as a glaucoma risk factor. The potential role of other corneal factors, such as stromal makeup, in the accurate measurement of intraocular pressure and the assessment of glaucoma risk remains to be determined.

SUMMARY:

Improved understanding of central corneal thickness and corneal biomechanical properties may someday lead to a better understanding of glaucoma risk and its assessment.

School-based approaches to the correction of refractive error in children.

The World Health Organization estimates that 13 million children aged 5-15 years worldwide are visually impaired from uncorrected refractive error. School vision screening programs can identify and treat or refer children with refractive error. We concentrate on the findings of various screening studies and attempt to identify key factors in the success and sustainability of such programs in the developing world. We reviewed original and review articles describing children's vision and refractive error screening programs published in English and listed in PubMed, Medline OVID, Google Scholar, and Oxford University Electronic Resources databases. Data were abstracted on study objective, design, setting, participants, and outcomes, including accuracy of screening, quality of refractive services, barriers to uptake, impact on quality of life, and cost-effectiveness of programs. Inadequately corrected refractive error is an important global cause of visual impairment in childhood. School-based vision screening carried out by teachers and other ancillary personnel may be an effective means of detecting affected children and improving their visual function with spectacles. The need for services and potential impact of school-based programs varies widely between areas, depending on prevalence of refractive error and competing conditions and rates of school attendance. Barriers to acceptance of services include the cost and quality of available refractive care and mistaken beliefs that glasses will harm children's eyes. Further research is needed in areas such as the cost-effectiveness of different screening approaches and impact of education to promote acceptance of spectacle-wear. School vision programs should be integrated into comprehensive efforts to promote healthy children and their families.

Determining the Presence of Scour around Bridge Foundations Using Vehicle-Induced Vibrations

Bridge scour is the number one cause of failure in bridges located over waterways. Scour leads to rapid losses in foundation stiffness and can cause sudden collapse. Previous research on bridge health monitoring has used changes in natural frequency to identify damage in bridge beams. The possibility of using a similar approach to identifying scour is investigated in this paper. To assess if this approach is feasible, it is necessary to establish how scour affects the natural frequency of a bridge, and if it is possible to measure changes in frequency using the bridge dynamic response to a passing vehicle. To address these questions, a novel vehicle–bridge–soil interaction (VBSI) model was developed. By carrying out a modal study in this model, it is shown that for a wide range of possible soil states, there is a clear reduction in the natural frequency of the first mode of the bridge with scour. Moreover, it is shown that the response signals on the bridge from vehicular loading are sufficient to allow these changes in frequency to be detected.

Modelling antropogenic impact on primary production of sado estuary

The assessment of human impact on complex estuarine systems is a multidisciplinary task that is highly demanding in terms of measurements and fieldwork. Nowadays the use of inexpensive and reliably modeling tools can substantially reduce the amount of measurements needed to characterize a system. These tools are also a convenient way to forecast the future evolution of the system and to study the impact of different scenarios of human influence. In this communication a modeling system composed by hydrodynamic, transport and ecological models is used to assess the current trophic state of Sado Estuary (Portugal) and to predict the future trends of the system based on different scenarios of human intervention. Special care is taken to the impact of changing riverine nutrient loads. Sado estuary is a large European estuary that has been considered until now in good trophic conditions with eutrophication appearing only in some isolated spots. Nevertheless in recent years some studies point out that the situation is changing. Sado estuary is a system with strong environmental opposing interests. It hosts a major industrial and urban center around the city of Setúbal and the upper reaches are used to intensive cultures such as rice. On the other hand the estuary possess an important ecological value since it is used by several important species of fish as a spawning and nursery area and it’s wetlands are used by many species of birds as winter shelters. Due to it’s importance the majority of Sado Estuary is considered as Natural Reserve.

Carers and Co-Production: Enabling Expertise through Experience?

Purpose To provide a brief overview of the literature to date which has focussed on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision-making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research Limitations Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical Implications Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the ‘triangle of care’ with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social Implications The families of people with severe and enduring mental illness (SMI) assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al, 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The ‘co-production of care’ reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the ‘triangle of care’ with carers bringing their own skills, resources and expertise. Originality/Value This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a ‘triangle of care’.

Intelligent electric vehicle heuristic for energy resource management using simulated annealing

The smart grid concept appears as a suitable solution to guarantee the power system operation in the new electricity paradigm with electricity markets and integration of large amounts of Distributed Energy Resources (DERs). Virtual Power Player (VPP) will have a significant importance in the management of a smart grid. In the context of this new paradigm, Electric Vehicles (EVs) rise as a good available resource to be used as a DER by a VPP. This paper presents the application of the Simulated Annealing (SA) technique to solve the Energy Resource Management (ERM) of a VPP. It is also presented a new heuristic approach to intelligently handle the charge and discharge of the EVs. This heuristic process is incorporated in the SA technique, in order to improve the results of the ERM. The case study shows the results of the ERM for a 33-bus distribution network with three different EVs penetration levels, i. e., with 1000, 2000 and 3000 EVs. The results of the proposed adaptation of the SA technique are compared with a previous SA version and a deterministic technique.