Butler County Solid Waste Commission, June 30, 2001 & June 30, 2002

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Jones County Solid Waste Management Commission, June 30, 2002 & June 30, 2003

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Hardin County Sanitary Solid Waste Disposal Commission, June 30, 2003

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Shelby County Area Solid Waste Agency, June 30, 2002 & June 30, 2003

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Butler County Solid Waste Commission, June 30, 2002 & June 30, 2003

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Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation.

Cytomegalovirus (CMV) continues to be one of the most common infections after solid-organ transplantation, resulting in significant morbidity, graft loss, and adverse outcomes. Management of CMV varies considerably among transplant centers but has been become more standardized by publication of consensus guidelines by the Infectious Diseases Section of The Transplantation Society. An international panel of experts was reconvened in October 2012 to revise and expand evidence and expert opinion-based consensus guidelines on CMV management, including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues. The following report summarizes the recommendations.

Pocahontas County Solid Waste Commission, June 30, 2003

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Wayne-Ringgold-Decatur County Solid Waste Management Commission, June 30, 2002 & June 30, 2003

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Prairie Solid Waste Agency, June 30, 2003 and 2002

Audit report on the Prairie Solid Waste Agency, fiscal years ending June 30, 2003 and 2002.

Crawford County Area Solid Waste Agency Commission, June 30, 2003 and 2002

Audit report on the Crawford County Area Solid Waste Agency Commission, fiscal year ending June 30, 2003 and 2002.

Delaware County Solid Waste Disposal Commission, June 30, 2003 & 2002

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Neurally Adjusted Ventilatory Assist (NAVA) improves the matching of diaphragmatic electrical activity and tidal volume in comparison to pressure support (PS) under non invasive ventilation

INTRODUCTION. Patient-ventilator asynchrony is a frequent issue in non invasivemechanical ventilation (NIV) and leaks at the patient-mask interface play a major role in itspathogenesis. NIV algorithms alleviate the deleterious impact of leaks and improve patient-ventilator interaction. Neurally adusted ventilatory assist (NAVA), a neurally triggered modethat avoids interferences between leaks and the usual pneumatic trigger, could further improvepatient-ventilator interaction in NIV patients.OBJECTIVES. To evaluate the feasibility ofNAVAin patients receiving a prophylactic postextubationNIV and to compare the respective impact ofPSVandNAVAwith and withoutNIValgorithm on patient-ventilator interaction.METHODS. Prospective study conducted in 16 beds adult critical care unit (ICU) in a tertiaryuniversity hospital. Over a 2 months period, were included 17 adult medical ICU patientsextubated for less than 2 h and in whom a prophylactic post-extubation NIV was indicated.Patients were randomly mechanically ventilated for 10 min with: PSV without NIV algorithm(PSV-NIV-), PSV with NIV algorithm (PSV-NIV+),NAVAwithout NIV algorithm (NAVANIV-)and NAVA with NIV algorithm (NAVA-NIV+). Breathing pattern descriptors, diaphragmelectrical activity, leaks volume, inspiratory trigger delay (Tdinsp), inspiratory time inexcess (Tiexcess) and the five main asynchronies were quantified. Asynchrony index (AI) andasynchrony index influenced by leaks (AIleaks) were computed.RESULTS. Peak inspiratory pressure and diaphragm electrical activity were similar in thefour conditions. With both PSV and NAVA, NIV algorithm significantly reduced the level ofleak (p\0.01). Tdinsp was not affected by NIV algorithm but was shorter in NAVA than inPSV (p\0.01). Tiexcess was shorter in NAVA and PSV-NIV+ than in PSV-NIV- (p\0.05).The prevalence of double triggering was significantly lower in PSV-NIV+ than in NAVANIV+.As compared to PSV,NAVAsignificantly reduced the prevalence of premature cyclingand late cycling while NIV algorithm did not influenced premature cycling. AI was not affectedby NIV algorithm but was significantly lower in NAVA than in PSV (p\0.05). AIleaks wasquasi null with NAVA and significantly lower than in PSV (p\0.05).CONCLUSIONS. NAVA is feasible in patients receiving a post-extubation prophylacticNIV. NAVA and NIV improve patient-ventilator synchrony in different manners. NAVANIV+offers the best patient-ventilator interaction. Clinical studies are required to assess thepotential clinical benefit of NAVA in patients receiving NIV.

Immigració i desafecció política a l'espai local: la instrumentalització política de la immigració a Catalunya i Gran Bretanya

El projecte ha tingut com a objectiu principal abordar la instrumentalització política de la immigració per part de partits polítics de nova extrema dreta. Aquest fenomen, que ha adquirit una gran rellevància a gran part dels països europeus, està adquirint una creixent rellevància en els casos britànic i català a partir de, entre altres coses, l'emergència electoral dels partits Plataforma per Catalunya i British National Party. En aquest sentit, el projecte ha tractat de desenvolupar una recerca que produís un conjunt de dades i coneixements que permetessin abordar de forma fonamentada un fenomen “nou” en el context català i que, fins al moment, ha rebut escassa atenció per part del món acadèmic. Dins d’aquest objectiu cal destacar el fet que la àmplia experiència de l’equip investigador britànic en l’anàlisi de la nova extrema dreta ha permès que els investigadors catalans poguessin desenvolupar la seva recerca recolzant-se i dialogant en la seva contrapart britànica. Els resultats de la recerca són certament novedosos i representaran una important contribució al coneixement d’aquest fenomen. Així, en el marc de la recerca s’han desenvolupat una sèrie d’entrevistes a membres i a votants de PxC, així com una enquesta a votants i una anàlisi agregada sobre el vot al partit. En aquest sentit, cal destacar que és la primera vegada que s’aconsegueixen aquest tipus de dades. Un fet que està fent, i farà, que la seva explotació i divulgació adquireixi una gran rellevància tant en el món acadèmic com en el de les administracions públiques. Finalment, convé ressaltar que el projecte també ha servit per consolidar la relació entre els equips d’investigació britànic i català i per impulsar la inserció de l’equip català en les xarxes europees d’investigació sobre aquesta matèria.

Decision-support tools to manage drug incompatibilities: evaluation by nurses

Introduction Preventing drug incompatibilities has a high impact onthe safety of drug therapy. Although there are no internationalguidelines to manage drug incompatibilities, different decision-supporttools such as handbooks, cross-tables and databases are available.In a previous study, two decision-support tools have been pre-selectedby pharmacists as fitting nurses' needs on the wards1. The objective ofthis study was to have these both tools evaluated by nurses todetermine which would be the most suitable for their daily practice.Materials & Methods Evaluated tools were:1. Cross-table of drug pairs (http://files.chuv.ch/internet-docs/pha/medicaments/pha_phatab_compatibilitessip.pdf)2. Colour-table (a colour for each drug according to the pH: red =acid; blue = basic; yellow = neutral; black = to be infused alone)2Tools were assessed by 48 nurses in 5 units (PICU, adult andgeriatric intensive care, surgery, onco-hematology) using a standardizedform1. The scientific accuracy of the tools was evaluated bydetermining the compatibility of five drugs pairs (rate of correctanswers according to the Trissel's Handbook on Injectable Drugs,chi-square test). Their ergonomics, design, reliability and applicabilitywere estimated using visual analogue scales (VAS 0-10; 0 =null, 10 = excellent). Results are expressed as the median and interquartilerange (IQR) for 25% and 75% (Wilcoxon rank sum test).Results The rate of correct answers was above 90% for both tools(cross-table 96.2% vs colour-table 92.5%, p[0.05).The ergonomics and the applicability were higher for the crosstable[7.1 (IQR25 4.0, IQR75 8.0) vs 5.0 (IQR25 2.7, IQR75 7.0), p =0.025 resp. 8.3 (IQR25 7.4, IQR75 9.2) vs 7.6 (IQR25 5.9, IQR75 8.8)p = 0.047].The design of the colour-table was judged better [4.6 (IQR25 2.9,IQR75 7.1) vs 7.1 (IQR25 5.4, IQR75 8.4) p = 0.002].No difference was observed in terms of reliability [7.3 (IQR25 6.5,IQR75 8.4) vs 6.7 (IQR25 5.0, IQR758.6) p[0.05].The cross-table was globally preferred by 65% of the nurses (27%colour-table, 8% undetermined) and 68% would like to have thisdecision-support tool available for their daily practice.Discussion & Conclusion Both tools showed the same accuracy toassess drug compatibility. In terms of ergonomics and applicabilitythe cross-table was better than the colour-table, and was preferred bythe nurses for their daily practice. The cross-table will be implementedin our hospital as decision-support tool to help nurses tomanage drug incompatibilities.

Butler County Solid Waste Commission, Independent Auditor's Reports, Financial Statement, Schedule of Findings, June 30, 2004

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