Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients

OBJECTIVE. To evaluate the effectiveness of the oral application of a 0.12% solution of chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients. DESIGN. The study design was a double-blind, randomized, placebo-controlled trial. SETTING. The study was performed in an ICU in a tertiary care hospital at a public university. PATIENTS. Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received chlorhexidine (n = 98) and those who received a placebo (n = 96). INTERVENTION. Oral rinses with chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient`s stay in the ICU. Clinical data were collected prospectively. RESULTS. Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the chlorhexidine and placebo groups. However, patients in the chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]). CONCLUSION. Oral application of a 0.12% solution of chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.

Rethinking the development, dissemination and adoption of agricultural technologies

This paper focuses on the higher order factors affecting successful adoption of technologies. Drawing on the "actor-oriented perspective" in rural sociology, it is argued that successful examples of adoption at this higher level result from a complex conjunction of people and events, with outcomes that may have been quite unanticipated at the outset. From this perspective, research and extension projects and programs are viewed as arenas in which social actors–village leaders, farmers, researchers (local and international), aid officials, municipal agents, extension workers, and traders–pursue their own short- and long-term objectives and strategies. To this end, they maneuver, negotiate, organize, cooperate, participate, coerce, obstruct, form coalitions, adopt, adapt, and reject, all within a specific geographical and historical context.

alpha 1-acid glycoprotein and alpha 1-antitrypsin as early markers of treatment response in patients receiving the intensive phase of tuberculosis therapy

The identification of early markers that predict the response to anti-tuberculosis treatment would facilitate evaluation of new drugs and improve patient management. This study aimed to determine whether selected acute phase proteins and micronutrients measured at the time of diagnosis and during the first weeks of treatment could predict treatment responses during the 2-month standard intensive phase of therapy. For this purpose, alpha 1-antitrypsin, alpha 1-acid gtycoprotein, alpha 2-macroglobutin, C-reactive protein, C3, C4, zinc, copper and selenium concentrations were measured in Brazilian patients with smear-positive tuberculosis at the time of diagnosis and 1, 3, 5 and 8 weeks after initiation of therapy. Patients were classified into fast (n = 29), intermediate (n = 18) and slow responders (n = 10) if they were smear-negative at 3, 5 or 8 weeks of treatment. alpha 1-acid gtycoprotein on enrolment and 1 week of treatment, alpha 1-antitrypsin at week 1 and C-reactive protein and C3 after 3 weeks of therapy were higher in slow responders than in fast responders. alpha 1-antitrypsin and alpha 1-acid glycoprotein may be helpful in predicting treatment response at the time of initiation of therapy, and could be used as early markers to identify patients with an increased likelihood of treatment failure. (C) 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Nutrition Therapy in a Pediatric Intensive Care Unit: Indications, Monitoring, and Complications

Background: Nutrition therapy (NT) is essential for the care of critically ill children. Inadequate feeding leads to malnutrition and may increase the patient`s risk of morbidity and mortality. The aim of this study was to describe the NT used in a tertiary pediatric intensive care unit (PICU). Methods: The authors evaluated NT administered to 90 consecutive patients who were hospitalized for 7 days in the PICU of Instituto da Crianca, Hospital das Clinicas, Universidade de Sao Paulo, Brazil. NT was established according to the protocol provided by the institution`s NT team. NT provided a balance of fluids and nutrients and was monitored with a weekly anthropometric nutrition assessment and an evaluation of complications. Results: NT was initiated, on average, within 72 hours of hospitalization. Most children (80%) received enteral nutrition (EN) therapy; of these, 35% were fed orally and the rest via nasogastric or postpyloric tube. There were gastrointestinal complications in patients (5%) who needed a postpyloric tube. Parenteral nutrition (PN) was used in only 10% of the cases, and the remaining 10% received mixed NT (EN + PN). The average calorie and protein intake was 82 kcal/kg and 2.7 g/kg per day. Arm circumference and triceps skinfold thickness decreased. Conclusions: The use of EN was prevalent in the tertiary PICU, and few clinical complications occurred. There was no statistically significant change in most anthropometric indicators evaluated during hospitalization, which suggests that NT probably helped patients maintain their nutrition status. (JPEN J Parenter Enteral Nutr. 2011;35:523-529)

Migration of Husbands, Remittances and Agricultural Production: Impacts when Wives Head Households in Rural Kenya

This paper uses data collected from migrants' wives in the Nyeri district of Kenya. The main objective is to determine whether migration and remittances contribute to the development of agriculture. Our results suggest that most migrants are pushed out of rural areas, belong to the group of low-paid workers in urban areas, send little and irregular remittances to their wives back in rural areas and that these remittances are mainly used for consumption purposes and do not contribute to any significant development in agriculture. Our results also indicate that altruism or social obligation might be the main reason for migrants sending remittances back to their rural wives.

Sustainable agriculture

This paper provides an overview of concepts of sustainable agriculture and possible methods of attaining sustainability of agricultural yields and production. Reasons are given as to why modern industrialised agriculture might be less sustainable in terms of yields than traditional agriculture. The question of whether organic agriculture is likely to be more sustainable than non-organic agriculture is considered as well as organic agriculture’s likely impact on wild biodiversity. The impact of the development of agriculture on wild biodiversity is assessed because some environmentalists see the conservation of wild biodiversity as an important ingredient of sustainable development. However, there is a policy conflict between conservationist groups. Some see intensive agriculture (including silviculture) as favourable to the conservation of wild biodiversity whereas others oppose such production methods as being unfavourable to wild biodiversity conservation. Reasons why modern industrialised agricultural systems are so widely adopted (and continue to be adopted) despite their apparent lack of sustainability are suggested. Market systems may tend to lock producers into unsustainable production methods.

Robust parameter settings of evolutionary algorithms for the optimisation of agricultural systems models

Numerical optimisation methods are being more commonly applied to agricultural systems models, to identify the most profitable management strategies. The available optimisation algorithms are reviewed and compared, with literature and our studies identifying evolutionary algorithms (including genetic algorithms) as superior in this regard to simulated annealing, tabu search, hill-climbing, and direct-search methods. Results of a complex beef property optimisation, using a real-value genetic algorithm, are presented. The relative contributions of the range of operational options and parameters of this method are discussed, and general recommendations listed to assist practitioners applying evolutionary algorithms to the solution of agricultural systems. (C) 2001 Elsevier Science Ltd. All rights reserved.

Foraging by the endangered black-breasted button-quail (Turnix melanogaster) within fragmented rainforest of an agricultural landscape

We studied the foraging habitat of the endangered black-breasted button-quail (Turnix melanogaster) in 13 rainforest patches of an agricultural landscape (23.4 km(2)) in eastern Australia to assess its use of fragmented habitats outside conservation reserves. The species foraged only in the three largest patches (17.4, 40.0, 63.8 ha in size), all of which were connected to open eucalypt forest, and in intact rainforest. Occurrence of birds was greatest in the largest patch. The maximum number of individuals within the study area was estimated to be 22. Radio-tracking of nine birds revealed that three were resident in the largest patch for periods of over 100 days; no movements between patches were detected. Three radio-tagged birds were taken by avian and mammalian predators. Our results indicated that the long-term future of the species in agricultural landscapes is bleak and that management action is urgently needed to arrest its decline in these ecosystems, (C) 2001 Elsevier Science Ltd. All rights reserved.

Asian elephants as agricultural pests: Economics of control and compensation in Sri Lanka

Despite growing attention to crop and property damage caused by the Asian elephant, uncertainty exists about the magnitude of this problem. This article explores the nature and, Magnitude of this problem in Sri Lanka. An economic analysis of individual farmers'. decisions to control elephants is provided. Government policies to assist farmers in coping with the elephant pest problem are assessed. Appropriate compensation schemes for farmers are seen as potentially more effective for conserving elephants in Sri Lanka than legal prohibitions on the killing of elephants. The issues raised here have wider relevance than merely to Sri Lanka or Asian elephants.