An evaluation of the effectiveness of an algorithm intervention in reducing inappropriate faecal samples sent for Clostridium difficile testing.

Background: Clostridium difficile (C. difficile) is a leading cause of infectious diarrhoea in hospitals. Sending faecal samples for testing expedites diagnosis and appropriate treatment. Clinical suspicion of C. difficile based on patient history, signs and symptoms is the basis for sampling. Sending faecal samples from patients with diarrhoea ‘just in case’ the patient has C. difficile may be an indication of poor clinical management.

Aim: To evaluate the effectiveness of an intervention by an Infection Prevention and Control Team (IPCT) in reducing inappropriate faecal samples sent for C. difficile testing.

Method: An audit of numbers of faecal samples sent before and after a decision-making algorithm was introduced. The number of samples received in the laboratory was retrospectively counted for 12-week periods before and after an algorithm was introduced.
Findings: There was a statistically significant reduction in the mean number of faecal samples sent post the algorithm. Results were compared to a similar intervention carried out in 2009 in which the same message was delivered by a memorandum. In 2009 the memorandum had no effect on the overall number of weekly samples being sent.

Conclusion: An algorithm intervention had an effect on the number of faecal samples being sent for C. difficile testing and thus contributed to the effective use of the laboratory service.

A primer for use of genetic tools in selecting and testing the suitability of set-aside sites protected from deep-sea seafloor massive sulfide mining activities

Seafloor massive sulfide (SMS) mining will likely occur at hydrothermal systems in the near future. Alongside their mineral wealth, SMS deposits also have considerable biological value. Active SMS deposits host endemic hydrothermal vent communities, whilst inactive deposits support communities of deep water corals and other suspension feeders. Mining activities are expected to remove all large organisms and suitable habitat in the immediate area, making vent endemic organisms particularly at risk from habitat loss and localised extinction. As part of environmental management strategies designed to mitigate the effects of mining, areas of seabed need to be protected to preserve biodiversity that is lost at the mine site and to preserve communities that support connectivity among populations of vent animals in the surrounding region. These "set-aside" areas need to be biologically similar to the mine site and be suitably connected, mostly by transport of larvae, to neighbouring sites to ensure exchange of genetic material among remaining populations. Establishing suitable set-asides can be a formidable task for environmental managers, however the application of genetic approaches can aid set-aside identification, suitability assessment and monitoring. There are many genetic tools available, including analysis of mitochondrial DNA (mtDNA) sequences (e.g. COI or other suitable mtDNA genes) and appropriate nuclear DNA markers (e.g. microsatellites, single nucleotide polymorphisms), environmental DNA (eDNA) techniques and microbial metagenomics. When used in concert with traditional biological survey techniques, these tools can help to identify species, assess the genetic connectivity among populations and assess the diversity of communities. How these techniques can be applied to set-aside decision making is discussed and recommendations are made for the genetic characteristics of set-aside sites. A checklist for environmental regulators forms a guide to aid decision making on the suitability of set-aside design and assessment using genetic tools. This non-technical primer document represents the views of participants in the VentBase 2014 workshop.

Sustained release of the candidate antiretroviral peptides T-1249 and JNJ54310516-AFP from a rod insert vaginal ring

Administration of biomacromolecular drugs in effective quantities from conventional vaginal rings is hampered by poor drug permeability in the polymers from which rings are commonly constructed. Here, we report the formulation development and testing of rod insert rings for sustained release of the candidate antiretroviral peptides T-1249 and JNJ54310516-AFP (JNJ peptide), both of which have potential as HIV microbicides. Rod inserts were prepared comprising antiviral peptides T-1249 or JNJ peptide in combination with a hydrophilic excipient (sodium chloride, sodium glutamate, lactose or zinc acetate) dispersed at different loadings within a medical grade silicone elastomer. The inserts were tested for weight change and swelling when immersed in simulated vaginal fluid (SVF). Dye migration into the inserts was also assessed visually over 28 days. In vitro release of T-1249 and JNJ peptide from rings containing various insert types was tested. Weight change and degree of swelling of rods immersed in SVF was dependent on the type and concentration of excipient present. The rods displayed the following rank order in terms of weight change: sodium glutamate > zinc acetate ≈ sodium chloride > lactose. The weight change and degree of swelling of the inserts did not correlate with the level of dye uptake observed. In vitro release of T-1249 was improved through addition of lactose, sodium chloride and sodium glutamate, while release of JNJ peptide was improved through addition of sodium chloride or sodium glutamate. Sustained release of hydrophobic peptides can be achieved using a rod insert ring design formulated to include a hydrophilic excipient. Release rates were dependent upon the type of excipient used. The degree of release improvement with different inserts partially reflects their ability to imbibe surrounding fluid and swell in aqueous environments.

The Value of Full Scale Prototype Data - Testing Oyster 800 at EMEC, Orkney

This paper demonstrates the unparalleled value of full scale data which has been acquired from ocean trials of Aquamarine Power’s Oyster 800 Wave Energy Converter (WEC) at the European Marine Energy Centre (EMEC), Orkney, Scotland.
High quality prototype and wave data were simultaneously recorded in over 750 distinct sea states (comprising different wave height, wave period and tidal height combinations) and include periods of operation where the hydraulic Power Take-Off (PTO) system was both pressurised (damped operation) and de-pressurised (undamped operation).
A detailed model-prototype correlation procedure is presented where the full scale prototype behaviour is compared to predictions from both experimental and numerical modelling techniques via a high temporal resolution wave-by-wave reconstruction. This unquestionably provides the definitive verification of the capabilities of such research techniques and facilitates a robust and meaningful uncertainty analysis to be performed on their outputs.
The importance of a good data capture methodology, both in terms of handling and accuracy is also presented. The techniques and procedures implemented by Aquamarine Power for real-time data management are discussed, including lessons learned on the instrumentation and infrastructure required to collect high-value data.

An overview of seismic hybrid testing of engineering structures

An overview of research on the development of the hybrid test method is presented. The maturity of the hybrid test method is mapped in order to provide context to individual research in the overall development of the test method. In the pseudo dynamic (PsD) test method, the equations of motion are solved using a time stepping numerical integration technique with the inertia and damping being numerically modelled whilst restoring force is physically measured over an extended timescale. Developments in continuous PsD testing led to the real-time hybrid test method and geographically distributed hybrid tests. A key aspect to the efficiency of hybrid testing is the substructuring technique where the critical structural subassemblies that are fundamental to the overall response of the structure are physically tested whilst the remainder of the structure whose response can be more easily predicted is numerically modelled. Much of the early research focused on developing the accuracy and efficiency of the test method, whereas more recently the method has matured to a level where the test method is applied purely as a dynamic testing technique. Developments in numerical integration methods, substructuring, experimental error reduction, delay compensation and speed of testing have led to a test method now in use as full-scale real-time dynamic testing method that is reliable, accurate, efficient and cost effective.

Do Gifts Increase Consent to Home-based HIV Testing? A Difference-in-differences Study in Rural KwaZulu-Natal, South Africa

Background Despite the importance of HIV testing for controlling the HIV epidemic, testing rates remain low. Efforts to scale-up testing coverage and frequency in hard-to-reach and at-risk populations commonly focus on home-based HIV testing. This study evaluates the effect of a gift (a food voucher for families, worth US$ 5) on consent rates for home-based HIV testing.
Methods We use data on 18,478 men and women who participated in the 2009 and 2010 population-based HIV surveillance carried out by the Wellcome Trust Africa Centre for Health and Population Studies in rural KwaZulu-Natal, South Africa. Our quasi-experimental difference-in-differences approach controls for unobserved confounding in estimating the causal effect of the intervention on HIV testing consent rates.
Results Allocation of the gift to a family in 2010 increased the probability of family members consenting to test in 2010 by 25 percentage points (95% CI 21-30; p<0.001). The intervention effect persisted, slightly attenuated, in the year following the intervention (2011), further increasing intervention value for money.
Conclusions In HIV hyperendemic settings a gift can be highly effective at increasing consent rates for home-based HIV testing. Given the importance of HIV testing for treatment uptake and individual health, as well as for HIV treatment-and-prevention strategies and for monitoring the population impact of the HIV response, gifts should be considered as a supportive intervention for HIV testing initiatives where consent rates have been low.

Assessing the evidence: Student response system versus computer based testing for undertaking multiple choice question assessment in undergraduate nursing education

There is a dearth of evidence focusing on student preferences for computer-based testing versus
testing via student response systems for summative assessment in undergraduate education.
This quantitative study compared the preference and acceptability of computer-based testing
and a student response system for completing multiple choice questions in undergraduate
nursing education. After using both computer-based testing and a student response system to
complete multiple choice questions, 192 first year undergraduate nursing students rated their
preferences and attitudes towards using computer-based testing and a student response system.
Results indicated that seventy four percent felt the student response system was easy to use.
Fifty six percent felt the student response system took more time than the computer-based testing
to become familiar with. Sixty Percent felt computer-based testing was more users friendly.
Seventy Percent of students would prefer to take a multiple choice question summative exam
via computer-based testing, although Fifty percent would be happy to take using student response
system. Results are useful for undergraduate educators in relation to student’s preference
for using computer-based testing or student response system to undertake a summative
multiple choice question exam

The Adaptiveness in Stock Markets: Testing the Stylized Facts in the DAX 30

By testing a simple asset pricing model of heterogeneous agents to characterize the power-law behavior of the DAX 30 from 1975 to 2007, we provide supporting evidence on empirical findings that investors and fund managers use combinations of fixed and switching strategies based on fundamental and technical analysis when making investment decisions. By conducting econometric analysis via Monte Carlo simulations, we show that the autocorrelation patterns, the estimates of the power-law decay indices, (FI)GARCH parameters, and tail index of the model match closely the corresponding estimates for the DAX 30. A mechanism analysis based on the calibrated model provides further insights into the explanatory power of heterogeneous agent models.