Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae

Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%), fortified breast milk (28%), ready to feed formula (20%), reconstituted powdered infant formula (PIF, 6%), or a mixture of these (21%). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41%), Serratia marcescens (36%), E. hormaechei (33%), Escherichia coli (29%), Klebsiella pneumoniae (25%), Raoultella terrigena (10%), and S. liquefaciens (12%). Other organisms isolated included C. sakazakii (2%),Yersinia enterocolitica (1%),Citrobacter freundii (1%), E. vulneris (1%), Pseudomonas fluorescens (1%), and P. luteola (1%). The enteral feeding tubes were in place between < 6 h (22%) to > 48 h (13%). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.

Creation of relational assets through the 'library of equipment' model:an industrial modernization approach of Japan's local technology centres

SMEs with a weak internal R&D capacity show the tendency to shy away from using external sources of technical expertise. The tendency deters providers of industrial modernization services from supporting such structurally weak SMEs. This paper examines how Japan's local technology centres - kosetsushi - remove the bottleneck and reach out to a significant proportion of SMEs with a weak R&D capacity in their localities. Kosetsushi centres sustain habitual interactions with client firms through 'low information gap' services solving immediate needs and lead the clients to a riskier and longer path toward innovation capacity building. This gives kosetsushi centres a position distinct from universities and consultancies in the regional innovation system. While long-term relationships between kosetsushi centres and their client firms can increase switching costs and produce lock-in effects, a case study of two kosetsushi centres illustrates the importance of 'low-information gap' services and relational assets created thereby to the modernization of SMEs with a weak internal R&D capacity. The paper calls for long-term commitment by the public sector if it addresses the issue through modernization services.

Maintenance strategies affecting equipment performance

Proper maintenance of plant items is crucial for the safe and profitable operation of process plants, The relevant maintenance policies fall into the following four categories: (i) preventivejopportunistic/breakdown replacement policies, (ii) inspection/inspection-repair-replacernent policies, (iii) restorative maintenance policies, and (iv) condition based maintenance policies, For correlating failure times of component equipnent and complete systems, the Weibull failure distribution has been used, A new powerful method, SEQLIM, has been proposed for the estimation of the Weibull parameters; particularly, when maintenance records contain very few failures and many successful operation times. When a system consists of a number of replaceable, ageing components, an opporturistic replacernent policy has been found to be cost-effective, A simple opportunistic rrodel has been developed. Inspection models with various objective functions have been investigated, It was found that, on the assumption of a negative exponential failure distribution, all models converge to the same optimal inspection interval; provided the safety components are very reliable and the demand rate is low, When deterioration becomes a contributory factor to same failures, periodic inspections, calculated from above models, are too frequent, A case of safety trip systems has been studied, A highly effective restorative maintenance policy can be developed if the performance of the equipment under this category can be related to some predictive modelling. A novel fouling model has been proposed to determine cleaning strategies of condensers, Condition-based maintenance policies have been investigated. A simple gauge has been designed for condition monitoring of relief valve springs. A typical case of an exothermic inert gas generation plant has been studied, to demonstrate how various policies can be applied to devise overall maintenance actions.

Improving returnable transport equipment management with an autonomous approach

Challenges of returnable transport equipment (RTE) management continue to heighten as the popularity of their usage magnifies. Logistics companies are investigating the implementation of radio-frequency identification (RFID) technology to alleviate problems such as loss prevention and stock reduction. However, the research within this field is limited and fails to fully explore with depth, the wider network improvements that can be made to optimize the supply chain through efficient RTE management. This paper, investigates the nature of RTE network management building on current research and practices, filling a gap in the literature, through the investigation of a product-centric approach where the paradigms of “intelligent products” and “autonomous objects” are explored. A network optimizing approach with RTE management is explored, encouraging advanced research development of the RTE paradigm to align academic research with problematic areas in industry. Further research continues with the development of an agent-based software system, ready for application to a real-case study distribution network, producing quantitative results for further analysis. This is pivotal on the endeavor to developing agile support systems, fully utilizing an information-centric environment and encouraging RTE to be viewed as critical network optimizing tools rather than costly waste.

Simulation of power station protection equipment

Computer programs have been developed to enable the coordination of fuses and overcurrent relays for radial power systems under estimated fault current conditions. The grading curves for these protection devices can be produced on a graphics terminal and a hard copy can be obtained. Additional programs have also been developed which could be used to assess the validity of relay settings (obtained under the above conditions) when the transient effect is included. Modelling of a current transformer is included because transformer saturation may occur if the fault current is high, and hence the secondary current is distorted. Experiments were carried out to confirm that distorted currents will affect the relay operating time, and it is shown that if the relay current contains only a small percentage of harmonic distortion, the relay operating time is increased. System equations were arranged to enable the model to predict fault currents with a generator transformer incorporated in the system, and also to include the effect of circuit breaker opening, arcing resistance, and earthing resistance. A fictitious field winding was included to enable more accurate prediction of fault currents when the system is operating at both lagging and leading power factors prior to the occurrence of the fault.

Perceptions of technological change : the attitude of managers towards group technology in the United States food equipment industry

In the center of today's continued and rapid technological change and ever competitive environment of the next millennium, manufacturers must realize that unless they are ready to consider and evaluate new technologies brought onto them, they may fail to adequately respond to the challenges that lie ahead of them. This research was designed to determine the consistency of the perceptions of technical and non-technical administrators, in manufacturing environment, towards technological change and group technology as an advanced manufacturing system. This research has included a review of literature with references to technological change, justification and implementation processes, and various manufacturing systems including group technology and its benefits. This research has used the research method of empirical analysis (quantitative) and case studies (qualitative) to research perceptions of technical and non-technical administrators towards technological change and group technology. Sixty-four (64) technical and fifty-one (51) nontechnical administrators from fifty (50) manufacturing organizations in the United States of America responded to the mail survey questionnaire used in this research. Responses were analyzed using the Repeated Measures ANOVA procedure to compare mean responses of each group. Two correlation analyses, Cronback Coefficient Alpha and Pearson Correlation Coefficient, were also performed to determine the reliability of the questionnaire as well as the degree of correlation of perceptions between these two groups. This research, through the empirical analysis, has found that perceptions of the technical and non-technical administrators towards group technology were not consistent. In other words, they did not perceive the benefits of group technology in the same manner to the overall organizational performance. This finding was significant since it provided the first clear and comprehensive view of the technical and non-technical administrators' perception towards group technology and technological change, in Food Equipment Manufacturer Industry, in United States of America. In addition, a number of cases were analyzed and the results have supported those of the quantitative analysis. Therefore, this research not only has provided basic data, which was unavailable prior to this investigation, but it also provided a basis for future studies.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.