Comparing the cost-effectiveness of MRSA control strategies between ICU and non-ICU settings

Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

The relationship between abdominal obesity and depression in the general population : a systematic review and meta-analysis

Obesity has been widely regarded as a public health concern because of its adverse impact on individuals’ health. Systematic reviews have been published in examining the effect of obesity on depression, but with major emphasis on general obesity as measured by the body mass index. Despite a stronger effect of abdominal obesity on individuals’ physical health outcomes, to our best knowledge, no systematic review was undertaken with regard to the relationship between abdominal obesity and depression. This paper reports the results of a systematic review and meta-analysis of cross-sectional studies examining the relationship between abdominal obesity and depression in a general population. Multiple electronic databases were searched until the end of September 2009. 15 articles were systematically reviewed and meta-analyzed. The analysis showed that the odds ratio of having depression for individuals with abdominal obesity was 1.38 (95% CI, 1.22–1.57) as compared to those who are not obese. Furthermore, it was found that this relationship did not vary with potential confounders including gender, age, measurement of depression and abdominal obesity, and study quality.

Train control to reduce delays upon service disturbances at railway junctions

Train delay is one of the most important indexes to evaluate the service quality of the railway. Because of the interactions of movement among trains, a delayed train may conflict with trains scheduled on other lines at junction area. Train that loses conflict may be forced to stop or slow down because of restrictive signals, which consequently leads to the loss of run-time and probably enlarges more delays. This paper proposes a time-saving train control method to recover delays as soon as possible. In the proposed method, golden section search is adopted to identify the optimal train speed at the expected time of restrictive signal aspect upgrades, which enables the train to depart from the conflicting area as soon as possible. A heuristic method is then developed to attain the advisory train speed profile assisting drivers in train control. Simulation study indicates that the proposed method enables the train to recover delays as soon as possible in case of disturbances at railway junctions, in comparison with the traditional maximum traction strategy and the green wave strategy.

Free software as a democratic principle

Software forms an important part of the interface between citizens and their government. An increasing amount of government functions are being performed, controlled, or delivered electronically. This software, like all language, is never value-neutral, but must, to some extent, reflect the values of the coder and proprietor. The move that many governments are making towards e-governance, and the increasing reliance that is being placed upon software in government, necessitates a rethinking of the relationships of power and control that are embodied in software.

Sulfated fibrous ZrO2/Al2O3 core and shell nanocomposites : a novel strong acid catalyst with hierarchically macro-mesoporous nanostructure

A series of solid strong acid catalysts were synthesised from fibrous ZrO2/Al2O3 core and shell nanocomposites. In this series, the zirconium molar percentage was varied from 2 % to 50 %. The ZrO2/Al2O3 nanocomposites and their solid strong acid counterparts were characterised by a variety of techniques including 27Al magic angle spinning nuclear magnetic resonance (MAS-NMR), scanned electronic microscopy (SEM), transmission electron microscope (TEM), X-ray photoelectron spectroscopy (XPS), Nitrogen adsorption and infrared emission spectroscopy (IES). NMR results show that the interaction between zirconia species and alumina strongly correlates with pentacoordinated aluminium sites. This can also be detected by the change in binding energy of the 3d electrons of the zirconium. The acidity of the obtained solid acids was tested by using them as catalysts for the benzolyation of toluene. It was found that a sample with a 50 % zirconium molar percentage possessed the highest surface acidity equalling that of pristine sulfated zirconia despite the reduced mass of zirconia.

Event-related brain potentials dissociate the developmental time-course of automatic numerical magnitude analysis and cognitive control functions during the first three years of primary school

In this study we set out to dissociate the developmental time course of automatic symbolic number processing and cognitive control functions in grade 1-3 British primary school children. Event-related potential (ERP) and behavioral data were collected in a physical size discrimination numerical Stroop task. Task-irrelevant numerical information was processed automatically already in grade 1. Weakening interference and strengthening facilitation indicated the parallel development of general cognitive control and automatic number processing. Relationships among ERP and behavioral effects suggest that control functions play a larger role in younger children and that automaticity of number processing increases from grade 1 to 3.

Predictive compensation for variable network delays and packet losses in networked control systems

Networked control systems (NCSs) offer many advantages over conventional control; however, they also demonstrate challenging problems such as network-induced delay and packet losses. This paper proposes an approach of predictive compensation for simultaneous network-induced delays and packet losses. Different from the majority of existing NCS control methods, the proposed approach addresses co-design of both network and controller. It also alleviates the requirements of precise process models and full understanding of NCS network dynamics. For a series of possible sensor-to-actuator delays, the controller computes a series of corresponding redundant control values. Then, it sends out those control values in a single packet to the actuator. Once receiving the control packet, the actuator measures the actual sensor-to-actuator delay and computes the control signals from the control packet. When packet dropout occurs, the actuator utilizes past control packets to generate an appropriate control signal. The effectiveness of the approach is demonstrated through examples.

Editorial : Decolonising action research (Electronic Version)

This edition of the ALAR Action learning action research journal aims to capture some of the current dilemmas, solutions and actions researchers experience in the decolonising space. This collection of papers demonstrates that researchers are not only undertaking action research with and within Indigenous and non-Indigenous contexts, but that they are doing so in exciting and dynamic ways across a diversity of situations. First we will address some of the literature on decolonisation. Then we will explain how this specific edition of the Journal came to fruition and aspects of action research.

A descriptive approach for power system stability and security assessment

Power system dynamic analysis and security assessment are becoming more significant today due to increases in size and complexity from restructuring, emerging new uncertainties, integration of renewable energy sources, distributed generation, and micro grids. Precise modelling of all contributed elements/devices, understanding interactions in detail, and observing hidden dynamics using existing analysis tools/theorems are difficult, and even impossible. In this chapter, the power system is considered as a continuum and the propagated electomechanical waves initiated by faults and other random events are studied to provide a new scheme for stability investigation of a large dimensional system. For this purpose, the measured electrical indices (such as rotor angle and bus voltage) following a fault in different points among the network are used, and the behaviour of the propagated waves through the lines, nodes, and buses is analyzed. The impact of weak transmission links on a progressive electromechanical wave using energy function concept is addressed. It is also emphasized that determining severity of a disturbance/contingency accurately, without considering the related electromechanical waves, hidden dynamics, and their properties is not secure enough. Considering these phenomena takes heavy and time consuming calculation, which is not suitable for online stability assessment problems. However, using a continuum model for a power system reduces the burden of complex calculations

Control, performance management systems and identification processes

Is it possible to control identities using performance management systems (PMSs)? This paper explores the theoretical fusion of management accounting and identity studies, providing a synthesised view of control, PMSs and identification processes. It argues that the effective use of PMSs generates a range of obtrusive mechanistic and unobtrusive organic controls that mediate identification processes to achieve a high level of identity congruency between individuals and collectives—groups and organisations. This paper contends that mechanistic control of PMSs provides sensebreaking effects and also creates structural conditions for sensegiving in top-down identification processes. These processes encourage individuals to continue the bottom-up processes of sensemaking, enacting identity and constructing identity narratives. Over time, PMS activities and conversations periodically mediate several episode(s) of identification to connect past, current and future identities. To explore this relationship, the dual locus of control—collectives and individuals—is emphasised to explicate their interplay. This multidisciplinary approach contributes to explaining the multidirectional effects of PMSs in obtrusive as well as unobtrusive ways, in order to control the nature of collectives and individuals in organisations.

Control, performance management system and identification processes

Is it possible to control identities using performance management systems (PMSs)? This paper explores the theoretical fusion of management accounting and identity studies, providing a synthesised view of control, PMSs and identification processes. It argues that the effective use of PMSs generates a range of obtrusive mechanistic and unobtrusive organic controls that mediate identification processes to achieve a high level of identity congruency between individuals and collectives—groups and organisations. This paper contends that mechanistic control of PMSs provides sensebreaking effects and also creates structural conditions for sensegiving in top-down identification processes. These processes encourage individuals to continue the bottom-up processes of sensemaking, enacting identity and constructing identity narratives. Over time, PMS activities and conversations periodically mediate several episode(s) of identification to connect past, current and future identities. To explore this relationship, the dual locus of control—collectives and individuals—is emphasised to explicate their interplay. This multidisciplinary approach contributes to explaining the multidirectional effects of PMSs in obtrusive as well as unobtrusive ways, in order to control the nature of collectives and individuals in organisations.