Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Linear programming for large-scale Markov decision problems

We consider the problem of controlling a Markov decision process (MDP) with a large state space, so as to minimize average cost. Since it is intractable to compete with the optimal policy for large scale problems, we pursue the more modest goal of competing with a low-dimensional family of policies. We use the dual linear programming formulation of the MDP average cost problem, in which the variable is a stationary distribution over state-action pairs, and we consider a neighborhood of a low-dimensional subset of the set of stationary distributions (defined in terms of state-action features) as the comparison class. We propose a technique based on stochastic convex optimization and give bounds that show that the performance of our algorithm approaches the best achievable by any policy in the comparison class. Most importantly, this result depends on the size of the comparison class, but not on the size of the state space. Preliminary experiments show the effectiveness of the proposed algorithm in a queuing application.

We know this: How to apply what you already know to treat alcohol and other drug problems

Background Implementing effective AOD supports and treatments into our daily practice can occur via a range of strategies. While specialist treatments exclusively targeting pathways toward substance reduction are an option, it is often not within the scope of many psychologists working in generalist or tertiary mental health settings. Regardless of the perceived barriers for integrating AOD practice into our work, there are key principles and approaches that can be adopted to improve the outcomes for many clients. Aim Irrespective of the client’s perceived need to address AOD issues, significant substance use will impact on the development, prognosis and treatment of most mental health conditions. Embedding AOD practice across our clinical work requires an openness to consider evidence-based approaches for all levels of substance use. Method This presentation will outline a series of approaches that all practitioners can adopt, based on the principles of harm reduction and empowerment of client’s choice. An emphasis will be made toward outlining approaches that are consistent with best practice, easily accessible and do not require extensive resources to embed. Conclusion Applying effective AOD treatments as a standard treatment component is achievable for all practitioners and is essential for achieving better outcomes for a high proportion of the community accessing treatment from psychologists.

Exploring the role of energy, trade and financial development in explaining economic growth in South Africa: A revisit

South Africa is an emerging and industrializing economy which is experiencing remarkable progress. We contend that amidst the developments in the economy, the role of energy, trade openness and financial development are critical. In this article, we revisit the pivotal role of these factors. We use the ARDL bounds [72], the Bayer and Hanck [11] cointegration techniques, and an extended Cobb–Douglas framework, to examine the long-run association with output per worker over the sample period 1971–2011. The results support long-run association between output per worker, capital per worker and the shift parameters. The short-run elasticity coefficients are as follows: energy (0.24), trade (0.07), financial development (−0.03). In the long-run, the elasticity coefficients are: trade openness (0.05), energy (0.29), and financial development (−0.04). In both the short-run and the long-run, we note the post-2000 period has a marginal positive effect on the economy. The Toda and Yamamoto [91] Granger causality results show that a unidirectional causality from capital stock and energy consumption to output; and from capital stock to trade openness; a bidirectional causality between trade openness and output; and absence (neutrality) of any causality between financial development and output thus indicating that these two variables evolve independent of each other.

How Australian construction contractors responded to the economic downturn

The Global Financial Crisis (GFC) in 2008 had a significant impact on the world economy and the construction industry was no exception. This study investigates the major impacts of the 2008 GFC on the Australian construction industry and, in particular how the Australian construction contractors responded to the economic downturn. A total of 35 senior managers from the Top 100 Australian construction companies were interviewed. The findings indicate that construction companies, particularly the large ones were not affected in any significant way but are expecting some difficult financial times over the next few years and are taking actions to minimize the upcoming adverse impacts. The most common strategy adopted by Australian construction contractors is to concentrate on core business while avoiding aimless bidding. Similarly, great focus is placed on retaining human resources in order to maintain the skill set so that the company can respond quickly when market conditions improves. The research findings will provide construction contractors with insights on how to establish and sustain competitive advantages during economic slowdown and become more resilient in the future.

Enhancing information about sustainability features for sustainable housing delivery

Sustainability practices in government regulations and within the society influence the delivery of sustainable housing. The actual delivery rate of Australian sustain-able housing is not as high as other countries. There is an absence of engagement by stakeholders in adopting sustainable housing practices. This may be due, in the current Australian property market, to confusion as to what sustainability features should be considered, given the large range of environmental, economic and social sustainability options possible. One of the main problems appears to be that information demanders, especially real estate agents, valuers, insurance agents and mortgage lenders do not include sustainability perspectives in their advice or in their decision processes. Information distribution in the Australian property market is flawed, resulting in a lack of return-on-investment value of ‘green’ features implemented by some stakeholders. This paper reviewed the global sustainable development concept and Australian sustainable assessment methods. This review identified the possibility of a research project which aimed at identifying and integrating different perceptions and priority needs of the information demanders, for developing a model for the potential implementation of sustainability features distribution in the property industry. This research will reduce confusion on the sustainability-related information which can influence the decision making of stakeholders in the supply and demand of sustainable housing.

Cycling for transport and recreation: Associations with the socio-economic, natural and built environment

This study examined associations between objective environmental attributes and, separately, transport (TC) and recreational cycling (RC). Environmental attributes were more strongly associated with TC than RC. Distances to areas with the best bicycle infrastructure and urban amenities may be key environmental factors influencing TC but not RC. Government investments in bicycle infrastructure within inner Brisbane appear to have resulted in more TC than in outer areas and to appeal to residents of both the most and least disadvantaged neighbourhoods. Extending this infrastructure to residents living in disadvantaged and advantaged neighbourhoods outside the CBD could expand TC participation.

Crowdfunding and independent screen content production in Australia: A direct economic relationship between producer and audience

This thesis examines the significance of crowdfunding for Australian filmmakers and provides an empirical basis to current claims about the role of crowdfunding in the film production and policy sectors. It has found that crowdfunding is a small but growing source of supplementary finance which is opening up new possibilities for Australian independent screen content producers. This project also highlights the discussion within Australian film policy circles that is opening the way for crowdfunding to potentially become a larger and more formalised component of current and emerging policy initiatives.

The effect of surface tension in porous wave maker problems

Using a mixed-type Fourier transform of a general form in the case of water of infinite depth and the method of eigenfunction expansion in the case of water of finite depth, several boundary-value problems involving the propagation and scattering of time harmonic surface water waves by vertical porous walls have been fully investigated, taking into account the effect of surface tension also. Known results are recovered either directly or as particular cases of the general problems under consideration.

Problems with geoengineering schemes to combat climate change

The accelerated rate of increase in atmospheric CO2 concentration in recent years has revived the idea of stabilizing the global climate through geoengineering schemes. Majority of the proposed geoengineering schemes will attempt to reduce the amount of solar radiation absorbed by our planet. Climate modelling studies of these so called 'sunshade geoengineering schemes' show that global warming from increasing concentrations of CO2 can be mitigated by intentionally manipulating the amount of sunlight absorbed by the climate system. These studies also suggest that the residual changes could be large on regional scales, so that climate change may not be mitigated on a local basis. More recent modelling studies have shown that these schemes could lead to a slow-down in the global hydrological cycle. Other problems such as changes in the terrestrial carbon cycle and ocean acidification remain unsolved by sunshade geoengineering schemes. In this article, I review the proposed geoengineering schemes, results from climate models and discuss why geoengineering is not the best option to deal with climate change.

Implementation mechanism: Protection against harassment of women at workplace

Pakistan is widely known and appreciated in the world for its history, Islamic culture and norms. Since the creation of Pakistan, it inherited poverty in its roots. There are many reasons for poverty but one lies on the shoulder of women who are 50% of the total population of Pakistan. On the apex of it, women do not take part in the development of Pakistan because when they step out of their homes, they suffer a lot of problems. These problems are a hurdle in their active participation in development .Government has tried to create an environment for those women, who suffer different problems. Harassment of women at work place is one of those problems which discourage women in taking active part in economic and social development of society. Women Activists, from the last decade, were working for the protection of woman’s right at workplace and they succeeded in formulation of Harassment Act 2010. Since law is ineffective without its proper mechanism of implementation, steps should be taken for its proper implementation mechanism. This article aims to provide information about the provisions of law, related to the harassment of women at workplace with an attempt to explore the effectiveness of its implementation. The study was conducted in twin cities of Pakistan, Islamabad and Rawalpindi. Interviews were conducted with the employees and employers of organizations, educational institutions, women activists, NGOs workers, lawyers, judges and some law enforcement officers. Group discussions were also held with teachers, students of Human rights and religious personalities. This report focuses on the implementation mechanism of new legislation in Pakistan. It also highlights some important facts related to its enforcement.

Estimation of mineral-adhered biomass of Thiobacillusferrooxidans by protein assay-some problems and remedies

Enumeration of adhered cells of Thiobacillus ferrooxidans on sulphide minerals through protein assay poses problems due to interference from dissolved mineral constituents. The manner in which sulphide minerals such as pyrite, chalcopyrite, sphalerite, arsenopyrite and pyrrhotite interfere with bacterial protein estimation is demonstrated. Such interferences can be minimised either through dilution or addition of H2O2 to the filtrate after hot alkaline digestion of the biotreated mineral samples.

Maximal regularity for second order non-autonomous Cauchy problems

We consider some non-autonomous second order Cauchy problems of the form u + B(t)(u) over dot + A(t)u = f (t is an element of [0, T]), u(0) = (u) over dot(0) = 0. We assume that the first order problem (u) over dot + B(t)u = f (t is an element of [0, T]), u(0) = 0, has L-p-maximal regularity. Then we establish L-p-maximal regularity of the second order problem in situations when the domains of B(t(1)) and A(t(2)) always coincide, or when A(t) = kappa B(t).

A three-dimensional hybrid smoothed finite element method (H-SFEM) for nonlinear solid mechanics problems

This paper presents a novel three-dimensional hybrid smoothed finite element method (H-SFEM) for solid mechanics problems. In 3D H-SFEM, the strain field is assumed to be the weighted average between compatible strains from the finite element method (FEM) and smoothed strains from the node-based smoothed FEM with a parameter α equipped into H-SFEM. By adjusting α, the upper and lower bound solutions in the strain energy norm and eigenfrequencies can always be obtained. The optimized α value in 3D H-SFEM using a tetrahedron mesh possesses a close-to-exact stiffness of the continuous system, and produces ultra-accurate solutions in terms of displacement, strain energy and eigenfrequencies in the linear and nonlinear problems. The novel domain-based selective scheme is proposed leading to a combined selective H-SFEM model that is immune from volumetric locking and hence works well for nearly incompressible materials. The proposed 3D H-SFEM is an innovative and unique numerical method with its distinct features, which has great potential in the successful application for solid mechanics problems.

A pseudo-dynamical systems approach to a class of inverse problems in engineering

A pseudo-dynamical approach for a class of inverse problems involving static measurements is proposed and explored. Following linearization of the minimizing functional associated with the underlying optimization problem, the new strategy results in a system of linearized ordinary differential equations (ODEs) whose steady-state solutions yield the desired reconstruction. We consider some explicit and implicit schemes for integrating the ODEs and thus establish a deterministic reconstruction strategy without an explicit use of regularization. A stochastic reconstruction strategy is then developed making use of an ensemble Kalman filter wherein these ODEs serve as the measurement model. Finally, we assess the numerical efficacy of the developed tools against a few linear and nonlinear inverse problems of engineering interest.