Eradication of endotracheal tube biofilm by nebulised gentamicin.

Objective: To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.

Setting: General intensive care units in two university teaching hospitals.

Design: The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.

Patients: Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.

Measurements and results: Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23–1.31) mg/l and 0.28 (<0.23–0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34–0.83) mg/l, with trough concentrations of 0.35 (<0.22–0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352–>1250) mg/l and then, before the next dose, were 436 (250–1000) mg/l.

Conclusion: Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

La ruptura de una economía moral y las deslegitimación de las deudas hipotecarias

In Spain, during the recent housing bubble, purchasing a home seemed the most advantageous strategy to access housing, and there was a wide social consensus about the unavoidability of mortgage indebtedness. However, such consensus has been challenged by the financial and real-estate crisis. The victims of home repossessions have been affected by the transgression of several principles, such as the fair compensation for effort and sacrifice, the prioritisation of basic needs over financial commitments, the possibility of a second chance for over-indebted people, or the State's responsibility to guarantee its citizens' livelihood. Such principles may be understood as part of a moral economy, and their transgression has resulted in the emergence of a social movement, the Plataforma de Afectados por la Hipoteca (PAH), that is questioning the legitimacy of mortgage debts. The article reflects on the extent to which the perception of over-indebtedness and evictions as unfair situations can have an effect on the reproduction of the political-economic system, insofar the latter is perceived as able or unable to repair injustice.

Process Modelling for Control of Product Wall Thickness in Thermoforming

The present paper describes the results of an investigation into the modelling of plug assisted thermoforming. The objective of this work was to improve the finite element modelling of thermoforming through an enhanced understanding of the physical elements underlying the process. Experiments were carried out to measure the effects on output of changes in major parameters and simultaneously simple finite element models were constructed. The experimental results show that the process creates conflicting and interrelated contact friction and heat transfer effects that largely dictate the final wall thickness distribution. From the simulation work it was demonstrated that a high coefficient of friction and no heat transfer can give a good approximation of the actual wall thickness distribution. However, when conduction was added to the model the results for lower friction values were greatly improved. It was concluded that further work is necessary to provide realistic measurements and models for contact effects in thermoforming.

Spectroscopy and metastability of CO22+ molecular ions

The spectroscopy and metastability of the carbon dioxide doubly charged ion, the CO22+ dication, have been studied with photoionization experiments: time-of-flight photoelectron photoelectron coincidence (TOF-PEPECO), threshold photoelectrons coincidence (TPEsCO), and threshold photoelectrons and ion coincidence (TPEsCO ion coincidence) spectroscopies. Vibrational structure is observed in TOF-PEPECO and TPEsCO spectra of the ground and first two excited states. The vibrational structure is dominated by the symmetric stretch except in the TPEsCO spectrum of the ground state where an antisymmetric stretch progression is observed. All three vibrational frequencies are deduced for the ground state and symmetric stretch and bending frequencies are deduced for the first two excited states. Some vibrational structure of higher electronic states is also observed. The threshold for double ionization of carbon dioxide is reported as 37.340+/-0.010 eV. The fragmentation of energy selected CO22+ ions has been investigated with TPEsCO ion coincidence spectroscopy. A band of metastable states from similar to38.7 to similar to41 eV above the ground state of neutral CO2 has been observed in the experimental time window of similar to0.1-2.3 mus with a tendency towards shorter lifetimes at higher energies. It is proposed that the metastability is due to slow spin forbidden conversion from bound excited singlet states to unbound continuum states of the triplet ground state. Another result of this investigation is the observation of CO++O+ formation in indirect dissociative double photoionization below the threshold for formation of CO22+. The threshold for CO++O+ formation is found to be 35.56+/-0.10 eV or lower, which is more than 2 eV lower than previous measurements. (C) 2005 American Institute of Physics.

Welfare Effort and Poverty from the Monetary and Capabilities Approach: A Cross-Country Analysis in Latin American and the Caribbean (1990-2010)

There is abundant empirical evidence on the negative relationship between welfare effort and poverty. However, poverty indicators traditionally used have been representative of the monetary approach, excluding its multidimensional reality from the analysis. Using three regression techniques for the period 1990-2010 and controlling for demographic and cyclical factors, this paper examines the relationship between social spending per capita —as the indicator of welfare effort— and poverty in up to 21 countries of the region. The proportion of the population with an income below its national basic basket of goods and services (PM1) and the proportion of population with an income below 50% of the median income per capita (PM2) were the two poverty indicators considered from the monetarist approach to measure poverty. From the capability approach the proportion of the population with food inadequacy (PC1) and the proportion of the population without access to improved water sources or sanitation facilities (PC2) were used. The fi ndings confi rm that social spending is actually useful to explain changes in poverty (PM1, PC1 and PC2), as there is a high negative and signifi cant correlation between the variables before and after controlling for demographic and cyclical factors. In two regression techniques, social spending per capita did not show a negative relationship with the PM2. Countries with greater welfare effort for the period 1990-2010 were not necessarily those with the lowest level of poverty. Ultimately social spending per capita was more useful to explain changes in poverty from the capability approach.

Intrinsic dielectric response in ferroelectric nano-capacitors

Measurements on 'free-standing' single-crystal barium titanate capacitors with thickness down to 75 nm show a dielectric response typical of large single crystals, rather than conventional thin films. There is a notable absence of any broadening or temperature shift of the dielectric peak or loss tangent. Peak dielectric constants of similar to25 000 are observed, and Curie-Weiss analysis demonstrates first order transformation behaviour. This is in dramatic contrast to results on conventionally deposited thin film capacitor heterostructures, which show large dielectric peak broadening and temperature shifts (e.g. Parker et al 2002 Appl. Phys. Lett. 81 340), as well as an apparent change in the nature-of the paraelectric-ferroelectric transition from first to second order. Our data are compatible with a recent model by Bratkovsky and Levanyuk (2004 Preprint cond-mat/0402100), which attributes dielectric peak broadening to gradient terms that will exist in any thin film capacitor heterostructure. The observed recovery of first order transformation behaviour is consistent with the absence of significant substrate clamping in our experiment, as modelled by Pertsev et al (1998,Phys. Rev. Lett. 80 1988), and illustrates that the second order behaviour seen in conventionally deposited thin films cannot be attributed to the effects of reduced dimensionality in the system, nor to the influence of an intrinsic universal interfacial capacitance associated with the electrode- ferroelectric interface.

Laser technology - Measuring huge magnetic fields

Huge magnetic fields are predicted1–4 to exist in the high-density region of plasmas produced during intense laser–matter interaction, near the criticaldensity surface where most laser absorption occurs, but until now these fields have never been measured. By using pulses focused to extreme intensities to investigate laser–plasma interactions5, we have been able to record the highest magnetic fields ever produced in a laboratory – over 340 megagauss – by polarimetry measurements of self-generated laser harmonics.

How teachers of Geography and History of Secondary Education assess?

The purpose of this article is to analyse the assessment procedures and instruments used by teachers of Geography and History of Compulsory Secondary School (ESO) in the Region of Murcia (Spain). The data have been extracted implementing a survey technique proceeded by a descriptive analysis. The results show that teachers generally have a traditional conception of assessment, reflected in the fact that they think that assessment should not change when teaching strategies are changed or when they innovate. On the other hand, although they consider that is necessary to employ a variety of instruments to assess well and to prevent school failure, they still use exams as the most objective and essential instrument in the assessment, while they don’t apply continuous assessment, only tests in a continuous way. The implementation of similar research in other areas or in other subjects shows the existence of contrasts in teacher assessment practices.