Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

<p>Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to &lt;3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3��7%, compared to 9��5% during the baseline period (P &lt; 0��001) with an estimated potential annual cost savings of about ��250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.</p>

Inappropriate prescribing of combination inhalers in Northern Ireland: retrospective cross-sectional cohort study of prescribing practice in primary care

<p>BACKGROUND: Asthma management guidelines advocate a stepwise approach to asthma therapy, including the addition of a long-acting bronchodilator to inhaled steroid therapy at step 3. This is almost exclusively prescribed as inhaled combination therapy.</p><p>AIMS: To examine whether asthma prescribing practice for inhaled combination therapy (inhaled corticosteroid/long-acting ��2-agonist (ICS/LABA)) in primary care in Northern Ireland is in line with national asthma management guidelines.</p><p>METHODS: Using data from the Northern Ireland Enhanced Prescribing Database, we examined initiation of ICS/LABA in subjects aged 5-35 years in 2010.</p><p>RESULTS: A total of 2,640 subjects (67%) had no inhaled corticosteroid monotherapy (ICS) in the study year or six months of the preceding year (lead-in period) and, extending this to a 12-month lead-in period, 52% had no prior ICS. 41% of first prescriptions for ICS/LABA were dispensed in January to March. Prior to ICS/LABA prescription, in the previous six months only 17% had a short-acting ��2-agonist (SABA) dispensed, 5% received oral steroids, and 17% received an antibiotic.</p><p>CONCLUSIONS: ICS/LABA therapy was initiated in the majority of young subjects with asthma without prior inhaled steroid therapy. Most prescriptions were initiated in the January to March period. However, the prescribing of ICS/LABA did not appear to be driven by asthma symptoms (17% received SABA in the previous 6 months) or severe asthma exacerbation (only 5% received oral steroids). Significant reductions in ICS/LABA, with associated cost savings, would occur if the asthma prescribing guidelines were followed in primary care.</p>

Gas Hydrate Inhibition: A Review of the Role of Ionic Liquids

<p>Ionic liquids (ILs) are popular designer green chemicals with great potential for use in diverse energy-related applications. Apart from the well-known low vapor pressure, the physical properties of ILs, such as hydrogen-bond-forming capacity, physical state, shape, and size, can be fine-tuned for specific applications. Natural gas hydrates are easily formed in gas pipelines and pose potential problems to the oil and natural gas industry, particularly during deep-sea exploration and production. This review summarizes the recent advances in IL research as dual-function gas hydrate inhibitors. Almost all of the available thermodynamic and kinetic inhibition data in the presence of ILs have been systematically reviewed to evaluate the efficiency of ILs in gas hydrate inhibition, compared to other conventional thermodynamic and kinetic gas hydrate inhibitors. The principles of natural gas hydrate formation, types of gas hydrates and their inhibitors, apparatuses and methods used, reported experimental data, and theoretical methods are thoroughly and critically discussed. The studies in this field will facilitate the design of advanced ILs for energy savings through the development of efficient low-dosage gas hydrate inhibitors.</p>

Wing Panel Design with Novel Skin-Buckling Containment Features

The impact of buckling containment features on the stability of thin-gauge fuselage, metallic stiffened panels has previously been demonstrated. With the continuing developments in manufacturing technology, such as welding, extrusion, machining, and additive layer manufacture, understanding the benefits of additional panel design features on heavier applications, such as wing panels, is timely. This compression testing of thick-gauge panels with and without buckling containment features has been undertaken to verify buckling and collapse behaviors and validate sizing methods. The experimental results demonstrated individual panel mass savings on the order of 9%, and wing cover design studies demonstrated mass savings on the order of 4 to 13%, dependent on aircraft size and material choice.

Energy and environmental forensic analysis for public buildings.

This paper outlines a forensic method for analysing the energy, environmental and comfort performance of a building. The method has been applied to a recently developed event space in an Irish public building, which was evaluated using on-site field studies, data analysis, building simulation and occupant surveying. The method allows for consideration of both the technological and anthropological aspects of the building in use and for the identification of unsustainable operational practice and emerging problems. The forensic analysis identified energy savings of up to 50%, enabling a more sustainable, lower-energy operational future for the building. The building forensic analysis method presented in this paper is now planned for use in other public and commercial buildings.

An aggregated fridge-freezer peak shaving and valley filling control strategy for enhanced grid operations

The need for fast response demand side participation (DSP) has never been greater due to increased wind power penetration. White domestic goods suppliers are currently developing a `smart' chip for a range of domestic appliances (e.g. refrigeration units, tumble dryers and storage heaters) to support the home as a DSP unit in future power systems. This paper presents an aggregated population-based model of a single compressor fridge-freezer. Two scenarios (i.e. energy efficiency class and size) for valley filling and peak shaving are examined to quantify and value DSP savings in 2020. The analysis shows potential peak reductions of 40 MW to 55 MW are achievable in the Single wholesale Electricity Market of Ireland (i.e. the test system), and valley demand increases of up to 30 MW. The study also shows the importance of the control strategy start time and the staggering of the devices to obtain the desired filling or shaving effect.

Energy versus data integrity trade-offs in embedded high-density logic compatible dynamic memories

<p>Current variation aware design methodologies, tuned for worst-case scenarios, are becoming increasingly pessimistic from the perspective of power and performance. A good example of such pessimism is setting the refresh rate of DRAMs according to the worst-case access statistics, thereby resulting in very frequent refresh cycles, which are responsible for the majority of the standby power consumption of these memories. However, such a high refresh rate may not be required, either due to extremely low probability of the actual occurrence of such a worst-case, or due to the inherent error resilient nature of many applications that can tolerate a certain number of potential failures. In this paper, we exploit and quantify the possibilities that exist in dynamic memory design by shifting to the so-called approximate computing paradigm in order to save power and enhance yield at no cost. The statistical characteristics of the retention time in dynamic memories were revealed by studying a fabricated 2kb CMOS compatible embedded DRAM (eDRAM) memory array based on gain-cells. Measurements show that up to 73% of the retention power can be saved by altering the refresh time and setting it such that a small number of failures is allowed. We show that these savings can be further increased by utilizing known circuit techniques, such as body biasing, which can help, not only in extending, but also in preferably shaping the retention time distribution. Our approach is one of the first attempts to access the data integrity and energy tradeoffs achieved in eDRAMs for utilizing them in error resilient applications and can prove helpful in the anticipated shift to approximate computing.</p>

Social housing tenants, Climate Change and sustainable living: A study of awareness, behaviours and willingness to adapt

<p>Despite a focus in the UK on providing sustainable housing in recent years, it is unlikely that targets set to reduce resource consumption in housing will be achieved without a greater focus on human behaviour. It is necessary to understand the actions of people occupying dwellings, as it is invariably the occupants rather than the buildings that decided whether or not to consume resources. In this paper the authors present a pilot study where 53 social housing tenant households in Northern Ireland were interviewed to ascertain their perceptions of Climate Change, their current behaviours and their willingness to reduce energy and water consumption in the home. The intention was to explore links between perceptions and reported behaviour as well as perceptions and willingness to reduce resource consumption. Results show that 77% of tenants believed Climate Change to be an important issue; 57% accepted that it is up to the individual to take responsibility for tackling Climate Change; and demonstrated a strong desire to make a difference to reduce their impact. The researchers identified both passive (devices) and active (behaviours) resource savings currently in place and established where further resource reduction was feasible based on tenants' willingness to alter their behaviours.</p>

Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma

AIM: To investigate the safety and potential savings of decreasing medication use in low-risk patients with ocular hypertension (OH).<br/>METHODS: Patients with OH receiving pressure-lowering medication identified by medical record review at a university hospital underwent examination by a glaucoma specialist with assessment of visual field (VF), vertical cup-to-disc ratio (vCDR), central corneal thickness and intraocular pressure (IOP). Subjects with estimated 5-year risk of glaucoma conversion &lt;15% were asked to discontinue ���1 medication, IOP was remeasured 1���month later and risk was re-evaluated at 1 year.<br/>RESULTS: Among 212 eyes of 126 patients, 44 (20.8%) had 5-year risk &gt;15% and 14 (6.6%) had unreliable baseline VF. At 1 month, 15 patients (29 eyes, 13.7%) defaulted follow-up or refused to discontinue medication and 11 eyes (5.2%) had risk &gt;15%. The remaining 69 patients (107 eyes, 50.7%) successfully discontinued 141 medications and completed 1-year follow-up. Mean IOP (20.5��2.65���mm���Hg vs 20.3��3.40, p=0.397) did not change, though mean VF pattern SD (1.58��0.41���dB vs 1.75��0.56���dB, p=0.001) and glaucoma conversion risk (7.31��3.74% vs 8.76��6.28%, p=0.001) increased at 1���year. Mean defect decreased (-1.42��1.60 vs -1.07��1.52, p=0.022). One eye (0.47%) developed a repeatable VF defect and 13 eyes (6.1%) had 5-year risk &gt;15% at 1���year. The total 1-year cost of medications saved was US$4596.<br/>CONCLUSIONS: Nearly half (43.9%) of low-risk OH eyes in this setting could safely reduce medications over 1���year, realising substantial savings.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Waiting time for cataract surgery and its influence on patient attitudes.

PURPOSE: <br/><br/>To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong.<br/><br/>METHODS: <br/><br/>This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status.<br/><br/>RESULTS: <br/><br/>Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more.<br/><br/>CONCLUSIONS: <br/><br/>Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.<br/>

Heterogeneous error-resilient scheme for spectral analysis in ultra-low power wearable electrocardiogram devices

<p>Wearable devices performing advanced bio-signal analysis algorithms are aimed to foster a revolution in healthcare provision of chronic cardiac diseases. In this context, energy efficiency is of paramount importance, as long-term monitoring must be ensured while relying on a tiny power source. Operating at a scaled supply voltage, just above the threshold voltage, effectively helps in saving substantial energy, but it makes circuits, and especially memories, more prone to errors, threatening the correct execution of algorithms. The use of error detection and correction codes may help to protect the entire memory content, however it incurs in large area and energy overheads which may not be compatible with the tight energy budgets of wearable systems. To cope with this challenge, in this paper we propose to limit the overhead of traditional schemes by selectively detecting and correcting errors only in data highly impacting the end-to-end quality of service of ultra-low power wearable electrocardiogram (ECG) devices. This partition adopts the protection of either significant words or significant bits of each data element, according to the application characteristics (statistical properties of the data in the application buffers), and its impact in determining the output. The proposed heterogeneous error protection scheme in real ECG signals allows substantial energy savings (11% in wearable devices) compared to state-of-the-art approaches, like ECC, in which the whole memory is protected against errors. At the same time, it also results in negligible output quality degradation in the evaluated power spectrum analysis application of ECG signals.</p>

Lattice-based Encryption Over Standard Lattices in Hardware

Lattice-based cryptography has gained credence recently as a replacement for current public-key cryptosystems, due to its quantum-resilience, versatility, and relatively low key sizes. To date, encryption based on the learning with errors (LWE) problem has only been investigated from an ideal lattice standpoint, due to its computation and size efficiencies. However, a thorough investigation of standard lattices in practice has yet to be considered. Standard lattices may be preferred to ideal lattices due to their stronger security assumptions and less restrictive parameter selection process. In this paper, an area-optimised hardware architecture of a standard lattice-based cryptographic scheme is proposed. The design is implemented on a FPGA and it is found that both encryption and decryption fit comfortably on a Spartan-6 FPGA. This is the first hardware architecture for standard lattice-based cryptography reported in the literature to date, and thus is a benchmark for future implementations.<br/>Additionally, a revised discrete Gaussian sampler is proposed which is the fastest of its type to date, and also is the first to investigate the cost savings of implementing with lamda_2-bits of precision. Performance results are promising in comparison to the hardware designs of the equivalent ring-LWE scheme, which in addition to providing a stronger security proof; generate 1272 encryptions per second and 4395 decryptions per second.

Influence of testing on permeability of compacted fine soils

The British standard constant-head triaxial test for measuring the permeability of fine-grained soils takes a relatively long time. A quicker test could provide savings to the construction industry, particularly for checking the quality of landfill clay liners. An accelerated permeability test has been developed, but the method often underestimates the permeability values compared owing to structural changes in the soil sample. This paper reports on an investigation<br/>into the accelerated test to discover if the changes can be limited by using a revised procedure. The accelerated test is assessed and compared with the standard test and a ramp-accelerated permeability test. Four different finegrained materials are compacted at various water contents to produce analogous samples for testing using the three different methods. Fabric analysis is carried out on specimens derived from post-test samples using mercury intrusion porosimetry and scanning electron microscopy to assess the effects of testing on soil structure. The results show that accelerated testing in general underestimates permeability compared with values derived from the standard test, owing to changes in soil structure caused by testing. The ramp-accelerated test is shown to provide an improvement in terms of these structural changes.

Perce����es e cren��as dos consumidores portugueses acerca dos medicamentos gen��ricos

Disserta����o, Mestrado, Marketing, Instituto Polit��cnico de Santar��m, Escola Superior de Gest��o e Tecnologia, 2014

Algoritmos inteligentes de baixa complexidade

A dom��tica �� uma ��rea com grande interesse e margem de explora����o, que pretende alcan��ar a gest��o autom��tica e aut��noma de recursos habitacionais, proporcionando um maior conforto aos utilizadores. Para al��m disso, cada vez mais se procuram incluir benef��cios econ��micos e ambientais neste conceito, por forma a garantir um futuro sustent��vel. O aquecimento de ��gua (por meios el��tricos) �� um dos fatores que mais contribui para o consumo de energia total de uma resid��ncia. Neste enquadramento surge o tema ���algoritmos inteligentes de baixa complexidade���, com origem numa parceria entre o Departamento de Eletr��nica, Telecomunica����es e Inform��tica (DETI) da Universidade de Aveiro e a Bosch Termotecnologia SA, que visa o desenvolvimento de algoritmos ditos ���inteligentes���, isto ��, com alguma capacidade de aprendizagem e funcionamento aut��nomo. Os algoritmos devem ser adaptados a unidades de processamento de 8 bits para equipar pequenos aparelhos dom��sticos, mais propriamente tanques de aquecimento el��trico de ��gua. Uma por����o do desafio est��, por isso, relacionada com as restri����es computacionais de microcontroladores de 8 bits. No caso espec��fico deste trabalho, foi determinada a exist��ncia de sensores de temperatura da ��gua no tanque como a ��nica fonte de informa����o externa aos algoritmos, juntamente com par��metros pr��-definidos pelo utilizador que estabelecem os limiares de temperatura m��xima e m��nima da ��gua. Partindo deste princ��pio, os algoritmos desenvolvidos baseiam-se no perfil de consumo de ��gua quente, observado ao longo de cada semana, para tentar prever futuras tiragens de ��gua e, consequentemente, agir de forma adequada, adiantando ou adiando o aquecimento da ��gua do tanque. O objetivo �� alcan��ar uma gest��o vantajosa entre a economia de energia e o conforto do utilizador (��gua quente), isto sem que exista necessidade de interven����o direta por parte do utilizador final. A solu����o prevista inclui tamb��m o desenvolvimento de um simulador que permite observar, avaliar e comparar o desempenho dos algoritmos desenvolvidos.