Hospital outbreak of methicillin-resistant Staphylococcus aureus caused by a new, possibly hyperepidemic variant from a previously sporadic strain.

Objective: To describe an ongoing outbreak that tripled the annual detection of methicillin-resistant Staphylococcus aureus (MRSA) carriage in a tertiary care hospital. Methods: Active surveillance of MRSA is performed since 20 years in our hospital. Our protocol includes screening of patients transferred from high-incidence health-care institutions or countries, roommates of new MRSA cases, and wards where _2 patients acquired MRSA during the same week. Contact precautions are used for known carriers. PFGE was used for molecular typing until 2004, and was then replaced by Double-Locus Sequence Typing (DLST). Results: A median yearly incidence of 173 new carriers of MRSA was observed from 2002 to 2007. Since September 2008, an increasing number of new cases were observed, mainly as successive clusters limited to distinct wards, reaching a total of 398 until October 2009. The yearly incidence of new cases rose to 275 in 2008 and 613 in 2009. 60% of the cases were due to one strain: DLST 4−4, ST 228, SCCmecI. The incidence of new cases due to the previously predominant strains remained unchanged. The epidemic strain corresponded to a new variant of a clone responsible for a previous outbreak in 2001, and only sporadically isolated (mean of 20 cases/year) since then. A case- control study documented a significant association between acquisition of the epidemic strain and a stay in intensive and intermediary care units, a highest number of internal transfers, but did not identify a point source of transmission. Infection control practices and antibiotic policy had remained unchanged for several years. Compliance with handhygiene as monitored yearly was on the rise. Screening of 313 healthcare workers only found one carrier of the epidemic strain lately in the outbreak. Additional infection control measures were enforced, including screening at ICU admission and discharge with PCR-based rapid test, routine screening for all patients leaving epidemic wards, introduction of PCR-based rapid test for contact tracing, additional working forces for environmental disinfection, and hospital-wide education of healthcare workers. However, the outbreak was still ongoing after 5 months. Conclusions: Factors linked to the dissemination of this new variant in our institution remain undetermined. This unresolved outbreak suggests that this new variant acquired hyperepidemic properties, which calls for further investigations.

Sieve Analysis of Combined Aggregate Samples by Different Test Methods, MLR-84-05, 1982

This past winter the sieve analysis of combined aggregate was investigated. This study was given No. 26 by the Central Laboratory. The purpose of this work was to try and develop a sieve analysis procedure for combined aggregate which is less time consuming and has the same accuracy as the method described in I.M. 304. In an attempt to use a variety of aggregates for this investigation, a request was made to each District Materials Office to obtain at least 3 different combined aggregate samples in their respective districts. At the same time it was also requested that the field technician test these samples, prior to submitting them to the Central Laboratory. The field technician was instructed to test each sample as described in method I.M. 304 and also by a modified AASHTO T27 method which will be identified in the report as Method A. The modified AASHTO Method A was identical to T27 with the exception that a smaller sample is used for testing. The field technicians submitted the samples, test results and also comments regarding the modified AASHTO procedure. The general comments of the modified AASHTO procedure were: The method was much simpler to follow; however, it took about the same amount of time so there was no real advantage. After reviewing AASHTO T27, T164, I.M. 304 and Report No. FHWA-RD-77-53 another test method was purposed. Report No. FHWA-RD-77-53 is a report prepared by FHWA from data they gathered concerning control practices and shortcut or alternative test methods for aggregate gradation. A second test method was developed which also was very similar to AASHTO T27, The test procedure for this method is attached and is identified as Method B. The following is a summary of test results submitted by the Field Technicians and obtained by the aggregate section of the Central Laboratory.

1016-010 Iowa Great Lakes Watershed Final Report

Part of a phased approach, an intensive information and education program, construction of erosion control practices, and sediment control on construction sites is proposed. These proposed practices will manage sediment runoff and nutrient runoff on agricultural and urban areas. Sediment control “structures” such as waterways, wetlands, modified terraces, grade stabilization structures, sediment basins, and rain gardens is proposed and will be combined with nutrient and pesticide management and reduced tillage to reduce non-point source pollution. A reduction of 15% of the sediment and phosphorus delivered to a water body from priority areas will be looked at as a success in this short-term project focused primarily at education within the project area which is also, for the most part, the top 25% sediment load producing sub-watersheds. In addition, four urban areas have been identified as part of this project as needing immediate assistance. A combination of urban and agricultural conservation practices, shoreline revegetation, and education of landowners will be used to achieve these results on both the urban and the agricultural arena.

Variability in ribosomal DNA genic and spacer regions in Verticillium dahliae isolates from different hosts

Using PCR-based assays with specific primers for amplification of the ribosomal DNA intergenic spacer region (IGS) and a portion of the mitochondrial DNA small subunit ribosomal RNA gene (mtDNA SSU rRNA), the genetic variability among Verticillium dahliae isolates from olive (Olea europaea) and other host species from Argentina and Brazil was estimated. The derived UPGMA-generated phenograms based upon the restriction fingerprinting data of rDNA IGS products revealed genetic differences, correlating with the host of origin. Isolates infecting olive genetically distinct from those from cocoa (Theobroma cacao) and sunflower (Helianthus annuus). Digestion of mitochondrial DNA SSU rRNA PCR products revealed less variability, distinguishing only one isolate from sunflower. Ribosomal DNA ITS restriction patterns were identical for all isolates of V. dahliae, irrespective of host of origin. These preliminary results may have relevance for Verticillium wilt control practices, possibly reflecting a different evolutionary origin, or reproductive isolation of the pathogen in olive, distinct from populations of other hosts.

Germination and emergence of Stachytarpheta cayennensis and Ipomoea asarifolia

Understanding how weed seed germination and emergence respond to environmental factors is critical to determining their adaptive capabilities and potential for infestations, and could also aid in the development of effective control practices. Germination of Ipomoea asarifolia (Desr.) Roem. & Schultz and Stachytarpheta cayennensis (Rich) Vahl. decreased linearly with decreasing osmotic potentials. Also, increasing osmotic stress delayed germination of Ipomoea more than that of Stachytarpheta. Ipomoea germination was insensitive to light, while Stachytarpheta showed a positive photoblastic behavior. Nitrate had a negative effect on germination of Ipomoea seed under both light and dark conditions but stimulated dark germination of Stachytarpheta. Ipomoea emergence was not significantly affected by planting depth. However, for Stachytarpheta emergence was restrited to seeds planted at the soil surface. Emergence of Ipomoea seedlings from greater than 6cm significantly decreased the amount of biomass allocated to roots, while biomass allocated to leaves was decreased for seedlings that emerged from depths greater than 2cm. These germination and emergence responses are discussed in relation to their ecological implications and to weed control strategies.

Competition periods of crabgrass with rice and soybean crops

Determining the periods of weed competition with crops helps the producer to choose the most appropriate time to use weed control practices. This strategy allows for the reduction of the number of herbicide applications, reducing costs and the environmental impact of pesticides. The objectives were to determine the period before the interference (PBI) of crabgrass (Digitaria ciliaris) competing with flooded rice, the critical period of interference prevention (CPIP) of crabgrass with soybean and the effects of competition on the grains yield and their components. Experiments were conducted with the coexistence of BRS Querência rice cultivar with crabgrass, for periods of 0, 7, 14, 21, 28, 35, and 110 days after emergency (DAE) and Fundacep 53RR soybean cultivar, whose periods of coexistence and control of crabgrass were 0, 7, 14, 21, 28, 35, and 156 DAE. Rice can grow with crabgrass infestation until 18 DAE, while soybean should remain free from the presence of crabgrass in the period between 23 and 50 DAE. The grain yield and its components, in the crops studied, are affected when grown with crabgrass.

Étude transversale sur l’asepsie des articles transférés entre la clinique et le laboratoire dentaire et de l’instrumentation de laboratoire

Les mesures de contrôle de la contamination croisée sont principalement concentrées dans la salle opératoire dentaire alors que les articles transférés entre la clinique et le laboratoire dentaire et les instruments de laboratoire ont reçu peu d’attention. Cette étude vise à documenter l’application des mesures d’asepsie sur ces articles par les professionnels du domaine dentaire ainsi que leurs perceptions entourant ces mesures. Un questionnaire autoadministré et anonyme a été envoyé à un échantillon aléatoire des dentistes, denturologistes et directeurs de laboratoire dentaire qui étaient inscrits aux listes des ordres professionnels en juin 2008 dans la province de Québec. Des 1100 questionnaires envoyés, 376 ont été retournés remplis. Presque trois quarts (72,1 %) des répondants affirment faire l’asepsie des instruments de laboratoire et 74,9 %, la désinfection des articles transférés mais avec des pourcentages variables selon le groupe d’articles (empreintes, prothèses, etc.). Seulement 9,1 % de professionnels identifient de façon générale les articles désinfectés avant l’envoi. Plus de la moitié des professionnels (51,4 %) trouvent qu’ils n’ont pas assez d’information sur l’asepsie des articles transférés et 62,4 %, qu’elle est difficile à appliquer. Cette étude est la première réalisée auprès des trois groupes de professionnels et la première à étudier leurs perceptions entourant l’asepsie des articles transférés et de l’instrumentation de laboratoire. Nous avons démontré que l’application des mesures d’asepsie à ces articles par les professionnels du domaine dentaire n’est pas toujours conforme aux normes proposées et qu’il existe un besoin de renforcer leur application, surtout en ce qui a trait aux articles transférés.

De l'organisation au déroulement d'événements rave à Montréal : étude des mécanismes de régulation sociale

Les raves sont des événements festifs dédiés à la musique techno et à la danse qui se distinguent des autres lieux de rassemblement tels que les bars et les discothèques notamment par le fait qu’ils se déroulent toute la nuit dans un lieu aménagé pour l’occasion et qu’il n’y a généralement pas de vente d’alcool. La consommation de drogues de synthèse telles que l’ecstasy et les speeds y est toutefois largement répandue. La tenue de ces rassemblements pose une série de problèmes du point de vue des autorités policières, tels que la présence de trafiquants de drogues ainsi que la sécurité des lieux où se déroulent les raves. Dans le contexte particulier de ces événements, les pratiques de contrôle social sont soumises à un certain nombre d’ambiguïtés. Le but général de l’étude est de permettre une compréhension de la façon dont se déterminent et s’appliquent les règles qui visent à encadrer la tenue de ce type de rassemblements. Trois objectifs spécifiques sont poursuivis, soit 1) de comprendre comment on a tenté de réguler ce type d’événements à Montréal, 2) de comprendre comment les différents acteurs responsables de l’organisation et du bon déroulement des événements établissent une série de règles, aussi bien formelles qu’informelles, et négocient leur application dans le cadre de leur pratique, et 3) de comprendre comment ces acteurs identifient certaines situations comme constituant un problème et éventuellement, y réagissent. La principale méthode de recueil des données a consisté à réaliser des entretiens semi-dirigés avec des promoteurs d’événements rave, des agents de sécurité ainsi que d’autres personnes impliquées dans le milieu telles que policier, pompier, artistes de la scène rave et intervenants. L’observation participante lors d’événements rave fut utilisée comme méthode complémentaire. L’étude démontre comment le service de police s’est vu confronté avec les raves à un vide juridique et comment l’encadrement de ce type d’événements s’est plutôt exercé par le service de prévention des incendies. Les autorités ont également tenté d’encadrer le phénomène par des modifications à certaines règlementations, dont celles sur les permis d’alcool. L’étude démontre également de quelle manière et en fonction de quoi les différents acteurs du milieu négocient les règles en cours d’action dans un contexte où la frontière entre le licite et l’illicite est floue.

Représentations sociales de la dangerosité psychiatrique chez les intervenants en santé mentale : une anthropologie du risque

Le présent mémoire porte sur les représentations sociales de la dangerosité en psychiatrie chez les intervenants de proximité (infirmières, préposés, et agent de sécurité), d’un milieu de soins psychiatriques. Nous cherchons à explorer comment ces intervenants perçoivent et interprètent les risques inhérents à leur métier et comment ils y réagissent en situation d’incertitude. Les concepts de dangerosité, d’ « individu dangereux » et de risque en psychiatrie sont abordés dans le présent mémoire, à travers un angle historique, social et anthropologique, suivant les lectures de Michel Foucault; de Robert Castel; de Ian Hacking; et de Mary Douglas. De l’observation participante dans une unité de soins psychiatriques aigus et des entrevues semi-structurées ont été réalisées auprès d’une dizaine d’intervenants en santé mentale. Une approche ethnographique et interprétative nous a permis de dégager les principales récurrences, divergences et contradictions intra et inter intervenants sur la question de la dangerosité et du risque en psychiatrie. Les résultats sont séparés en fonction de trois grands thèmes : 1) représentations sociales de la dangerosité 2) perceptions du risque au travail 3) réactions face au risque perçu. L’analyse de nos résultats montre que les connaissances qu’ont les intervenants sur la dangerosité ne se limitent pas à celles produites par le savoir expert, elles s’ouvrent aussi sur leur propre réalité clinique. De plus, contrairement aux prédictions du savoir expert, la différence observée entre les pratiques de contrôle des intervenants n’est pas la conséquence d’une surestimation du risque ni d’un manque d’information « objective » sur les facteurs de risque du comportement agressif, mais s’explique davantage en fonction de la présence ou de l’absence d’un lien thérapeutique et du degré de reconnaissance sociale dans les interactions entre les soignants et les soignés. Les éléments qui renforcent ou limitent l’établissement d’un lien de confiance sont explicités dans le présent mémoire.

Eficacia de la limpieza corporal con clorhexidina en prevenir la sepsis neonatal en cuidado intensivo revisión sistemática

ANTECEDENTES. La mortalidad neonatal se debe principalmente a procesos infecciosos y a prematurez. Se ha sugerido que el lavado corporal total con clorhexidina podría reducir la mortalidad neonatal relacionada con infección. No existen revisiones sistemáticas que exploren la eficacia de esta intervención. Objetivo. Evaluar la eficacia y seguridad de la limpieza corporal total con clorhexidina en la prevención de las infecciones asociadas al cuidado de la salud en neonatos de alto riesgo hospitalizados en cuidado intensivo neonatal. Metodología. Se realizó una revisión sistemática de la literatura. La búsqueda se hizo a través de las bases de datos Medline, Embase, LilaCS, Cochrane library y el registro de ensayos clínicos del Instituto Nacional de Salud de Estados Unidos. Se incluyeron ensayos clínicos publicados en los últimos 15 años hasta el 30 de enero del 2015. Las variables cualitativas se estimaron mediante OR o RR con sus IC95%. Las variables cuantitativas mediante diferencias de promedios o diferencias estandarizadas de promedios con sus IC95%. Resultados: Se incluyeron 3 estudios en el análisis cualitativo y cuantitativo. No se encontró evidencia concluyente que permita recomendar el uso de la limpieza corporal total con clorhexidina en los recién nacidos hospitalizados en cuidado intensivo neonatal. Conclusión: No existe evidencia que permita concluir que la limpieza corporal total con clorhexidina al 0.25% es mejor respecto a otras intervenciones en la prevención de sepsis neonatal asociada al cuidado de la salud . Es una intervención segura sin efectos adversos significativos.

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.

Planejamento estratégico e o controle da gestão pública: Desenvolvimento da ação de controle da gestão dos recursos públicos

Esta dissertação procura analisar o planejamento estratégico e a evolução do pensamento estratégico, objetivando identificar a possibilidade de adequação da utilização de suas técnicas, para contribuir no desenvolvimento da metodologia empregada no controle da gestão dos recursos públicos. Com esse propósito, a pesquisa bibliográfica é centrada no estudo do referencial teórico, e enfatiza a investigação das práticas e dos fenômenos organizadonais à luz da teoria da gestão estratégica. Nesse sentido, também é apresentada a análise dos resultados da pesquisa de campo, onde fica caracterizado a carência de estudo, pesquisa e desenvolvimento das práticas de controle; retratando a ausência de um pensamento estratégico voltado para o desenvolvimento dessa poUtica pública. As reflexões sobre as observaçôes colhidas no estudo, levaram à conclusão da necessidade fundamental da utilização do pensamento estratégico e da gestão estratégica, como um exercfcio contínuo de aperfeiçoamento da metodologia de ação de controle da gestão dos recursos públicos, voltada ao melhor cumprimento da missão institucional.

O modelo gerencial do controle interno governamental: as melhores práticas de Pernambuco

Diante da importância do tema relacionado à atividade de controle interno governamental, no cenário nacional e internacional, tendo em vista o aumento da corrupção e a ineficiência administrativa no alcance dos resultados voltados para os cidadãos e ainda, da escassez de pesquisas exploratórias acerca da atividade de controle com enfoque na efetividade em busca da melhoria do gasto público, este estudo procurou identificar práticas da gestão do controle interno governamental que repercutem efetivamente na melhoria da qualidade do gasto público. Para isso procurou conceituar a qualidade do gasto relacionada à atuação do controle interno governamental e avaliar o modelo gerencial de controle interno adotado pelo Estado de Pernambuco, diagnosticando as práticas que estão diretamente relacionadas à melhoria da qualidade na aplicação do recurso público. A escolha do órgão de controle interno governamental do Estado de Pernambuco para o objeto deste estudo deve-se ao fato deste órgão ter sido palco de grandes mudanças na sua gestão com vistas à renovação e adaptação à nova demanda da sociedade que clama pela transparência e qualidade na aplicação do recurso público. Dos resultados apresentados foi possível identificar práticas decorrentes da ação do órgão de controle interno na gestão pública que indicaram um ganho financeiro para o Estado, ficando assim o recurso disponível para a ampliação de benefícios destinados à sociedade. Salientou-se, ainda, o custo da estrutura organizacional do órgão de controle, fato que apontou para um resultado econômico positivo decorrente das ações do órgão de controle interno. O estudo concluiu pela existência de alinhamento do órgão de controle de Pernambuco com os princípios mais modernos de gestão a partir do enfoque no resultado das ações. No entanto, apesar de estar na direção certa, ficou evidente a necessidade de grandes avanços com o fim de potencializar as ações de controle na gestão pública estadual.

Spatial Assessment of Indices for Characterizing the Erosive Force of Rainfall in El Salvador Republic

Soil erosion data in El Salvador Republic are scarce and there is no rainfall erosivity map for this region. Considering that rainfall erosivity is an important guide for planning soil erosion control practices, a spatial assessment of indices for characterizing the erosive force of rainfall in El Salvador Republic was carried out. Using pluviometric records from 25 weather stations, we applied two methods: erosivity index equation and the Fournier index. In all study area, the rainiest period is from May to November. Annual values of erosivity index ranged from 7,196 to 17,856 MJ mm ha(-1) h(-1) year(-1) and the Fournier index ranged from 52.9 to 110.0 mm. The erosivity map showed that the study area can be broadly divided into three major erosion risk zones, and the Fournier index map was divided into four zones. Both methods revealed that the erosive force is severe in all study area and presented significant spatial correlation with each other. The erosive force in the country is concentrated mainly from May to November.

Dinâmica da comunidade de macrófitas aquáticas no reservatório de Santana, RJ

Apesar da importância na dinâmica dos ecossistemas aquáticos, as macrófitas podem formar densas e extensas colonizações em corpos hídricos cujos equilíbrios ecológicos foram rompidos. Nessas condições, essas plantas promovem uma série de problemas que as tornam alvos de controle. Para elaboração de planos adequados de manejo dessa vegetação, é fundamental o conhecimento das dinâmicas relativas das populações que a compõem. O objetivo deste trabalho foi realizar levantamentos mensais da composição específica da comunidade de macrófitas que coloniza o reservatório de Santana, localizado no município de Piraí/RJ, monitorando 97 pontos georreferenciados, abrangendo toda a lâmina d'água. Foram identificadas 41 espécies, inseridas em 21 famílias botânicas. As famílias Poaceae, Pontederiaceae e Cyperacae foram as que apresentaram os maiores números de espécies ao longo do ano. Salvinia herzogii e Egeria densa apresentaram as maiores notas anuais de colonização do reservatório. As populações de Eichhornia azurea, Brachiaria arrecta e Paspalum repens completaram o grupo das espécies numericamente mais relevantes. As plantas de hábito flutuante tenderam a apresentar populações com padrão de distribuição geográfica casualizado, enquanto as espécies fixadas no sedimento e as submersas apresentaram populações com padrão agregado. Não houve expressivas variações mensais dos valores dos índices de diversidade (H') e de equitabilidade (E') das comunidades de macrófitas aquáticas ao longo do ano. O dendrograma construído com o coeficiente de Odum mostrou uma seqüência lógica dos meses, evidenciando uma definida sucessão de populações divididas em dois grupos de similaridade separados pelo mês de junho. Nessa época, o nível de água do reservatório foi reduzido e o sedimento ficou exposto, favorecendo as espécies de hábito emergente.