Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

Infection-control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review)

Background: Nursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection control strategies are important in preventing and controlling MRSA transmission.

Objectives: The objective of this review was to determine the effects of infection control strategies for preventing the transmission of MRSA in nursing homes for older people.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2009, Issue 2), the Cochrane Wounds Group Specialised Register (searched May 29th, 2009). We also searched MEDLINE (from 1950 to May Week 4 2009), Ovid EMBASE (1980 to 2009 Week 21), EBSCO CINAHL (1982 to May Week 4 2009), British Nursing Index (1985 to May 2009), DARE (1992 to May 2009), Web of Science (1981 to May 2009), and the Health Technology Assessment (HTA) website (1988 to May 2009). Research in progress was sought through Current Clinical Trials (www.controlled-trials.com), Medical Research Council Research portfolio, and HSRPRoj (current USA projects). SIGLE was also searched in order to identify atypical material which was not accessible through more conventional sources.

Selection criteria: All randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection control interventions in nursing homes for older people were eligible for inclusion.

Data collection and analysis: Two authors independently reviewed the results of the searches.

Main results: Since no studies met the selection criteria, neither a meta-analysis nor a narrative description of studies was possible.

Authors' conclusions: The lack of studies in this field is surprising. Nursing homes for older people provide an environment likely to promote the acquisition and spread of infection, with observational studies repeatedly reporting that being a resident of a nursing home increases the risk of MRSA colonisation. Much of the evidence for recently-issued United Kingdom guidelines for the control and prevention of MRSA in health care facilities was generated in the acute care setting. It may not be possible to transfer such strategies directly to the nursing home environment, which serves as both a healthcare setting and a resident's home. Rigorous studies should be conducted in nursing homes, to test interventions that have been specifically designed for this unique environment.

Outbreak control and clinical, pathological, and epidemiological aspects and molecular characterization of a bovine herpesvirus type 5 on a feedlot farm in S(a)over-tildeo Paulo State

This paper describes the control, epidemiological, pathological, and molecular aspects of an outbreak of meningoencephalitis in calves due to bovine herpesvirus 5 at a feedlot with 540 animals in Sa (a) over tildeo Paulo State, Brazil. The introduction of new animals and contact between the resident animals and the introduced ones were most likely responsible for virus transmission. Bovine herpesvirus 1 vaccine was used, resulting in the efficacy of the outbreak control, although two bovine herpesvirus 1 positive animals, vaccinated and revaccinated, presented meningoencephalitis, thereby characterizing vaccinal failure.

Options for the Control of Disease 3: Targeting the Environment

Management of wildlife disease can be targeted at pathogens, hosts or vector populations, but may also focus on the environment. As constituent elements of any given environment, resident wildlife populations, and their pathogens, may be profoundly influenced by environmental change, in terms of their abundance, distribution and behavior. Hence, it is reasonable to expect that incorporation of environmental manipulation into a program to control wildlife diseases may potentially result in outcomes as effective as direct intervention aimed at hosts, pathogens and vectors.

Development of Nicarbazin as a Reproductive Inhibitor for Resident Canada Geese

Expanding populations of resident Canada geese that remain in suburban and urban areas year-round often result in increased conflicts with humans. Non-lethal and humane means are needed for managing the size of Canada goose flocks residing near or on airports, golf courses, industrial parks, government sites, and city parks. A side effect of nicarbazin, a veterinary drug used to control coccidiosis in chickens, is decreased egg production and hatching. Exploiting this side effect, studies of nicarbazin for reducing the hatchability of eggs from Canada geese were conducted. An initial study in Coturnix quail verified reduction in hatchability in a species other than chickens. Because plasma nicarbazin was not routinely measured, a study in chickens was conducted to determine the relationship between plasma and egg nicarbazin. A comparative study in chickens, mallards, and Canada geese showed that nicarbazin absorption was lowest in geese. Studies in both penned and wild Canada geese showed that reduction in hatchability was possible but neither study used bait suitable for general field application. Bait development led to the OvoControl-G® (Innolytics LLC) bait, which resulted in reduction in hatchability of 51% at treated sites compared to control sites in the field. Previous studies showed that nicarbazin is practically non-toxic and is environmentally friendly; timing and management of baiting will minimize non-target hazards. OvoControl-G® 2500 ppm nicarbazin bait is recommended for incorporation into a comprehensive management plan as a reproductive inhibitor for use in controlling resident Canada goose flock sizes.

Evidence-based polytherapies and long-term mortality after acute myocardial infarction in very old subjects compared with elderly and adults: a nested case-control study

Background: Clinical trials have demonstrated that selected secondary prevention medications for patients after acute myocardial infarction (AMI) reduce mortality. Yet, these medications are generally underprescribed in daily practice, and older people are often absent from drug trials. Objectives: To examine the relationship between adherence to evidence-based (EB) drugs and post-AMI mortality, focusing on the effects of single therapy and polytherapy in very old patients (≥80 years) compared with elderly and adults (<80 years). Methods: Patients hospitalised for AMI between 01/01/2008 and 30/06/2011 and resident in the Local Health Authority of Bologna were followed up until 31/12/2011. Medication adherence was calculated as the proportion of days covered for filled prescriptions of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), β-blockers, antiplatelet drugs, and statins. We adopted a risk set sampling method, and the adjusted relationship between medication adherence (PDC≥75%) and mortality was investigated using conditional multiple logistic regression. Results: The study population comprised 4861 patients. During a median follow-up of 2.8 years, 1116 deaths (23.0%) were observed. Adherence to the 4 EB drugs was 7.1%, while nonadherence to any of the drugs was 19.7%. For both patients aged ≥80 years and those aged <80 years, rate ratios of death linearly decreased as the number of EB drugs taken increased. There was a significant inverse relationship between adherence to each of 4 medications and mortality, although its magnitude was higher for ACEIs/ARBs (adj. rate ratio=0.60, 95%CI=0.52–0.69) and statins (0.60, 0.50–0.72), and lower for β-blockers (0.75, 0.61–0.92) and antiplatelet drugs (0.73, 0.63–0.84). Conclusions: The beneficial effect of EB polytherapy on long-term mortality following AMI is evident also in nontrial older populations. Given that adherence to combination therapies is largely suboptimal, the implementation of strategies and initiatives to increase the use of post-AMI secondary preventive medications in old patients is crucial.

Mutation of the ER retention receptor KDELR1 leads to cell-intrinsic lymphopenia and a failure to control chronic viral infection

Endoplasmic reticulum (ER)-resident proteins are continually retrieved from the Golgi and returned to the ER by Lys-Asp-Glu-Leu (KDEL) receptors, which bind to an eponymous tetrapeptide motif at their substrate's C terminus. Mice and humans possess three paralogous KDEL receptors, but little is known about their functional redundancy, or if their mutation can be physiologically tolerated. Here, we present a recessive mouse missense allele of the prototypical mammalian KDEL receptor, KDEL ER protein retention receptor 1 (KDELR1). Kdelr1 homozygous mutants were mildly lymphopenic, as were mice with a CRISPR/Cas9-engineered frameshift allele. Lymphopenia was cell intrinsic and, in the case of T cells, was associated with reduced expression of the T-cell receptor (TCR) and increased expression of CD44, and could be partially corrected by an MHC class I-restricted TCR transgene. Antiviral immunity was also compromised, with Kdelr1 mutant mice unable to clear an otherwise self-limiting viral infection. These data reveal a nonredundant cellular function for KDELR1, upon which lymphocytes distinctly depend.

Estrategias para el control microclimático del espacio entre edificaciones en clima cálido – húmedo

La presente investigación parte del problema en las zonas de clima cálido - húmedo en las cuales se producen impactos asociados a la incomodidad térmica producto de la intensa radiación solar, altas temperaturas y elevada humedad. Estos factores reducen la calidad de los espacios abiertos y desarrollan en la población una actitud de rechazo hacia el uso del microespacio urbano entre edificaciones en los desarrollos urbanos - conjuntos urbanos - , los mismos frecuentemente admiten soluciones que al parecer no contribuyen a la realización de las actividades comunes de esparcimiento de la población residente. Por lo tanto, el objetivo de la investigación es profundizar en la temática urbano - ambiental - social y el diseño urbano vinculada a la particularidad morfológica local, las condiciones microclimáticas, el uso del microespacio y los requerimientos de los usuarios. La finalidad de desarrollar estrategias de control microclimático del microespacio entre edificios en clima cálido - húmedo en búsqueda de soluciones óptimas que satisfagan las necesidades de los usuarios de los espacios exteriores en estas áreas residenciales. La investigación se centra en el estudio de las particularidades contextuales relacionadas con el microclima y las características urbanas - morfotipológicas, básicamente los factores microclimáticos (soleamiento y ventilación), los morfológicos y edificatorios y las características de las superficies (pavimentos). En coherencia con el objetivo propuesto el trabajo se desarrolla en cuatro fases: la primera aborda la revisión documental, literatura relevante e investigaciones relativas a la calidad ambiental, medio social, medio físico, el microespacio urbano, control y diseño sostenible, modelización proyectual y estrategias sostenibles; la segunda fase se refiere al marco contextual, características urbanas, datos climáticos locales, planes y procesos urbanos, tipologías y conformación urbana. En esta fase se describe el proceso de selección, análisis y evaluación urbano - ambiental de los casos de estudio (conjuntos residenciales). En la tercera fase se aborda el marco evaluativo y estudio de casos, consideraciones físicas, climáticas y valoración térmico - ambiental de los conjuntos residenciales seleccionados. En esta fase se aplican Técnicas Estadísticas y de Simulación Computacional y se analizan los resultados obtenidos. Finalmente, la cuarta fase propositiva incluye el establecimiento de Estrategias, Principios y Lineamientos de optimación térmica y se exponen las Conclusiones parciales de la tesis, alcances y perspectivas futuras. Finalmente, los resultados obtenidos en la investigación demuestran que el análisis en las experiencias de la realidad permiten comprobar que las situaciones y alteraciones ambientales sustanciales, los niveles de afectación térmica y las condiciones de confortabilidad e impacto derivan de las características urbanas, los componentes del microespacio y de las condiciones climáticas las cuales afectan el desarrollo de las actividades y el uso efectivo del microespacio entre edificios. El análisis de los factores morfo - climáticos incidentes y el estudio de los efectos de interacción contribuyen al establecimiento de Principios y Lineamientos para la evaluación y diseño sostenible del microespacio entre edificios y el uso correcto de los elementos del clima en estas áreas urbanas destinadas a la actividad social y al esparcimiento de la población residente. ABSTRACT This research starts from the problem of hot - humid climate zones where impacts related to thermal discomfort are produced as a result from the intense solar radiation and high temperatures and humidity. These factors reduce the quality of open spaces and people develop an attitude of rejection towards the use of urban microspace among buildings within urban developments - urban complexes - . Usually, these complexes admit solutions that apparently do not contribute to the achievement of common leisure activities in the resident dwellers. Therefore, the main purpose of this research is to deepen in the urban - environmental - social issue and urban design linked to the local morphological particularity, microclimate conditions, use of microspace and users’ requirements. In order to develop microclimate control strategies of microspace among buildings in hot - humid climate to look for optimal solutions that satisfy users’ needs of outdoors spaces in these residential areas. The research focuses in the study of contextual particularities related to microclimate and urban - morphotypological characteristics. Basically, microclimate (sunlight and ventilation), morphological and building factors as well as road surface characteristics. According to the proposed objective, this research is developed in four phases: the first one considers documentary review, relevant literature and researches related to environmental quality, social environment, physical environment, urban microspace, control and sustainable design, project modelling and sustainable strategies; while the second phase refers to contextual framework, urban characteristics, local climate data, plans and urban processes, typologies and urban structure. In this phase, the process of selection, analysis and urban - environmental evaluation of case studies (residential complexes) is described. The third phase approaches the assessment framework and case studies, physical and climate considerations as well as environmental - thermal evaluation of selected residential complexes. In this phase, statistical techniques and computational simulations are applied. Likewise, results obtained are analysed. Similarly, fourth and proposing phase includes the establishment of strategies, principles and guidelines of thermal optimization and partial conclusions of the thesis, scopes and future perspectives are exposed. Finally, from the results obtained, it is demonstrated that the analysis on reality experiences allow proving that situations and substantial environmental changes, levels of thermal affectations, comfort conditions and impact derive from urban characteristics, microspace components and from climate conditions which affect the development of activities and the effective use of microspace among buildings. The analysis of incidental morpho - climate factors and the study of interaction effects contribute to the establishment of principles and guidelines for the assessment and sustainable design of microspace among buildings as well as the correct use of climate elements in these urban areas oriented to social and leisure activities of resident population.

Herramienta de control de dispositivo móvil mediante un ordenador

Este trabajo fin de máster se integra con el sistema Localiza, un sistema previamente desarrollado para la localización bajo demanda de personas que requieran un cierto grado de supervisión. El proyecto amplia las funciones del sistema Localiza, añadiendo una nueva funcionalidad que permita a un usuario con movilidad reducida controlar su dispositivo móvil a través de su ordenador personal. Este proyecto se integra con el proyecto Localiza bajo el título: “Desarrollo de una herramienta software para el manejo de un teléfono móvil adaptada a personas con discapacidad física severa”. El proyecto citado se centra en el desarrollo de una aplicación móvil, que se comunicara con el ordenador personal del usuario. El desarrollo del sistema residente en el ordenador personal, es el ámbito central que ocupa a este trabajo fin de Master. El usuario final al que está destinada la aplicación desarrollada en este proyecto, es un usuario con grado de discapacidad motórica, de forma que con ligeros movimientos de cabeza sea capaz de controlar remotamente el terminal móvil a través de un ordenador personal. El objetivo principal del proyecto es el control remoto de un terminal móvil desde un ordenador personal. La comunicación entre el terminal móvil y el ordenador personal se ha realizado bajo el protocolo Bluetooth. Para desarrollar la aplicación residente en el ordenador personal, se ha utilizado la plataforma Java. SUMMARY. This Master Tesis develops an application, which is intended to provide an added value to the already existing project Localiza, on-demand position system for people with severe disabilities. This project extends the functions of the Localiza system, adding a new feature that allows a user with limited mobility to control their mobile device. This project is integrated with the project under the title: “Desarrollo de una herramienta software para el manejo de un teléfono móvil adaptada a personas con discapacidad física severa”. The above project it is focused on the development of mobile application and the development of the application that resides in the personal computer is the main work of this project. Both projects are closely related and together they complement. The end-user of the application that is developed in this project is a person with motor disabilities. This person may control the computer mouse with slight head movements. The aim of this project is to facilitate the access to the personal computer and to the mobile telephony environment for disabled people. The Communication between the mobile and personal computer has been conducted under the Bluetooth protocol. To develop the application resident on the personal computer have been used the Java platform.

Mollusca Non-Grata: The influence of top-down control and residence time on the abundance, distribution, and behavior of non-native marine snails in Washington State

Thesis (Ph.D.)--University of Washington, 2016-06

Common variants of the TCF7L2 gene are associated with increased risk of type 2 diabetes mellitus in a UK-resident South Asian population

Background - Recent studies have implicated variants of the transcription factor 7-like 2 (TCF7L2) gene in genetic susceptibility to type 2 diabetes mellitus in several different populations. The aim of this study was to determine whether variants of this gene are also risk factors for type 2 diabetes development in a UK-resident South Asian cohort of Punjabi ancestry. Methods - We genotyped four single nucleotide polymorphisms (SNPs) of TCF7L2 (rs7901695, rs7903146, rs11196205 and rs12255372) in 831 subjects with diabetes and 437 control subjects. Results - The minor allele of each variant was significantly associated with type 2 diabetes; the greatest risk of developing the disease was conferred by rs7903146, with an allelic odds ratio (OR) of 1.31 (95% CI: 1.11 – 1.56, p = 1.96 × 10-3). For each variant, disease risk associated with homozygosity for the minor allele was greater than that for heterozygotes, with the exception of rs12255372. To determine the effect on the observed associations of including young control subjects in our data set, we reanalysed the data using subsets of the control group defined by different minimum age thresholds. Increasing the minimum age of our control subjects resulted in a corresponding increase in OR for all variants of the gene (p ≤ 1.04 × 10-7). Conclusion - Our results support recent findings that TCF7L2 is an important genetic risk factor for the development of type 2 diabetes in multiple ethnic groups.

International comparative field evaluation of a traffic-responsive signal control strategy in three cities

The recently developed network-wide real-time signal control strategy TUC has been implemented in three traffic networks with quite different traffic and control infrastructure characteristics: Chania, Greece (23 junctions); Southampton, UK (53 junctions); and Munich, Germany (25 junctions), where it has been compared to the respective resident real-time signal control strategies TASS, SCOOT and BALANCE. After a short outline of TUC, the paper describes the three application networks; the application, demonstration and evaluation conditions; as well as the comparative evaluation results. The main conclusions drawn from this high-effort inter-European undertaking is that TUC is an easy-to-implement, inter-operable, low-cost real-time signal control strategy whose performance, after very limited fine-tuning, proved to be better or, at least, similar to the ones achieved by long-standing strategies that were in most cases very well fine-tuned over the years in the specific networks.

Comparative field evaluation of the signal control strategy TUC in three traffic networks.

This paper describes how the recently developed network-wide real-time signal control strategy TUC has been implemented in three traffic networks with quite different traffic and control infrastructure characteristics: Chania, Greece (23 junctions); Southampton, U.K. (53 junctions); and Munich, Germany (25 junctions), where it has been compared to the respective resident real-time signal control strategies TASS, SCOOT and BALANCE. After a short outline of TUC, the paper describes the three application networks; the application, demonstration and evaluation conditions; as well as the comparative evaluation results. The main conclusions drawn from this high-effort inter-European undertaking is that TUC is an easy-to-implement, inter-operable, low-cost real-time signal control strategy whose performance, after limited fine-tuning, proved to be better or, at least, similar to the ones achieved by long-standing strategies that were in most cases very well fine-tuned over the years in the specific networks.

Review of the Community Residential Care Facilities Program, Department of Health and Environmental Control

This review was predicated on a credible complaint alleging substantial health and safety deficiencies in the care of a resident placed in a Community Residential Care Facility (CRCF) in Kershaw County, South Carolina. Initial investigation with subject matter experts, non-profit advocacy groups, and CRCF inspection reports revealed this single incident might be a symptom of systemic health and safety deficiencies throughout DHEC’s CRCF Program, which regulates 471 CRCFs with the approximately 17,000 vulnerable clients, primarily elderly and disabled. This review’s scope and objectives were: Assess the risk of a vulnerable population of elderly and disabled citizens residing in CRCFs living in unsatisfactory health and safety conditions; Evaluate DHEC’s CRCF Program inspection process capabilities to identify and address CRCFs with unsatisfactory health and safety living conditions; Recommend opportunities to improve the CRCF Program.