'Saving Children 2009' : evaluating quality of care through mortality auditing

No abstract available.http://www.sajch.org.za/index.php/SAJC

B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial:a randomised, double-blind, parallel, placebo-controlled trial

SummaryBackgroundEpidemiological studies suggest that raised plasma concentrations of total homocysteine might be a risk factor for major vascular events. Whether lowering total homocysteine with B vitamins prevents major vascular events in patients with previous stroke or transient ischaemic attack is unknown. We aimed to assess whether the addition of once-daily supplements of B vitamins to usual medical care would lower total homocysteine and reduce the combined incidence of non-fatal stroke, non-fatal myocardial infarction, and death attributable to vascular causes in patients with recent stroke or transient ischaemic attack of the brain or eye.MethodsIn this randomised, double-blind, parallel, placebo-controlled trial, we assigned patients with recent stroke or transient ischaemic attack (within the past 7 months) from 123 medical centres in 20 countries to receive one tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B6, and 0·5 mg vitamin B12). Patients were randomly allocated by means of a central 24-h telephone service or an interactive website, and allocation was by use of random permuted blocks stratified by hospital. Participants, clinicians, carers, and investigators who assessed outcomes were masked to the assigned intervention. The primary endpoint was the composite of stroke, myocardial infarction, or vascular death. All patients randomly allocated to a group were included in the analysis of the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT00097669, and Current Controlled Trials, ISRCTN74743444.FindingsBetween Nov 19, 1998, and Dec 31, 2008, 8164 patients were randomly assigned to receive B vitamins (n=4089) or placebo (n=4075). Patients were followed up for a median duration of 3·4 years (IQR 2·0–5·5). 616 (15%) patients assigned to B vitamins and 678 (17%) assigned to placebo reached the primary endpoint (risk ratio [RR] 0·91, 95% CI 0·82 to 1·00, p=0·05; absolute risk reduction 1·56%, −0·01 to 3·16). There were no unexpected serious adverse reactions and no significant differences in common adverse effects between the treatment groups.InterpretationDaily administration of folic acid, vitamin B6, and vitamin B12 to patients with recent stroke or transient ischaemic attack was safe but did not seem to be more effective than placebo in reducing the incidence of major vascular events. These results do not support the use of B vitamins to prevent recurrent stroke. The results of ongoing trials and an individual patient data meta-analysis will add statistical power and precision to present estimates of the effect of B vitamins.FundingAustralia National Health and Medical Research Council, UK Medical Research Council, Singapore Biomedical Research Council, Singapore National Medical Research Council, Australia National Heart Foundation, Royal Perth Hospital Medical Research Foundation, and Health Department of Western Australia

Outbreak of multi-drug resistant Pseudomonas aeruginosa bloodstream infection in the haematology unit of a South African academic hospital

Objective: To describe an outbreak of multi-resistant Pseudomonas aeruginosa bloodstream infections (MRPA-BSI) that occurred in the haematology ward of a tertiary academic hospital in Cape Town, South Africa, and determine risk factors for acquisition of MRPA-BSI. METHODS: The outbreak investigation included a search for additional cases, review of patient records, environmental and staff screening, molecular typing using pulsed-field gel electrophoresis (PFGE) and Multi-locus sequencing (MLST) and a retrospective case-control study. RESULTS: Ten MRPA-BSI cases occurred in the haematology ward between January 2010 and January 2011. The case fatality rate was 80%. Staff screening specimens were negative for MRPA and an environmental source was not identified. PFGE showed that 9/10 isolates were related. MLST showed that 3 of these 9 isolates belonged to Sequence type (ST) 233 while the unrelated isolate belonged to ST260. CONCLUSION: We have described an outbreak of MRPA-BSI occurring over an extended period of time among neutropenic haematology patients. Molecular typing confirms that the outbreak was predominantly due to a single strain. The source of the outbreak was not identified, but the outbreak appears to have been controlled following intensive infection control measures

One future or many? November 14, 15, and 16, 2002

This repository item contains a single issue of the Pardee Conference Series, a publication series that began publishing in 2006 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future. This was the Center's 2nd annual Conference that took place during November 14, 15, and 16, 2002.The conference brought together some 30 experts from various disciplines to discuss whether the trajectories of the future will be ‘global’ or ‘regional’ in nature. Different panels looks at the future trajectories for Europe, the Western Hemisphere, Central Asia and the Former Soviet Union, and on Asia and in each case the discussion looked at the relative importance of the regional and of global dynamics on teh forces shaping the future of these regions.Carnegie Council on Ethics and International Affair

Galaxy Zoo: dust lane early-type galaxies are tracers of recent, gas-rich minor mergers

We present the second of two papers concerning the origin and evolution of local early-type galaxies exhibiting dust features. We use optical and radio data to examine the nature of active galactic nucleus (AGN) activity in these objects, and compare these with a carefully constructed control sample. We find that dust lane early-type galaxies are much more likely to host emission-line AGN than the control sample galaxies. Moreover, there is a strong correlation between radio and emission-line AGN activity in dust lane early-types, but not the control sample. Dust lane early-type galaxies show the same distribution of AGN properties in rich and poor environments, suggesting a similar triggering mechanism. By contrast, this is not the case for early-types with no dust features. These findings strongly suggest that dust lane early-type galaxies are starburst systems formed in gas-rich mergers. Further evidence in support of this scenario is provided by enhanced star formation and black hole accretion rates in these objects. Dust lane early-types therefore represent an evolutionary stage between starbursting and quiescent galaxies. In these objects, the AGN has already been triggered but has not as yet completely destroyed the gas reservoir required for star formation.Comment: 11 pages, 18 figures, 4 tables, MNRAS (Accepted for publication- 2012 January 19

Linear plasma experiment for non-linear microwave interaction experiments

As a non-linear medium, plasma can exhibit diverse dynamics when excited bymultiple EM waves. Electromagnetic waves are vital to the introduction of energyin laser plasma interactions and the heating of magnetically confined fusion reactors.In laser plasma applications Raman coupling via a Langmuir oscillation or Brillouinscattering mediated by ion-acoustic waves are of interest. Signals with normalisedintensities approaching those used in some recent laser plasma interactions can begenerated using powerful and flexible microwave amplifiers, interacting in relativelytenuous, cool and accessible plasma. Other multi-wave interactions are interesting formagnetic confinement fusion plasmas, for example beat-wave interactions betweentwo microwave signals coupling to cyclotron motion of the ions and electrons or thelower hybrid oscillations may be useful in heating the plasmas or for driving currents.A linear plasma experiment is being built to test such multifrequency microwaveinteraction in plasma, based on prior research on geophysical cyclotron wave emissionand propagation [1,2]. The main section of the plasma will be magnetised at up to0.05T, with the plasma created by an RF helicon source to generate a dense, large,cool plasma with a high ionisation fraction. A range of frequency-flexible sources willprovide microwave beams to enable multi-wave coupling experiments. The paper willpresent progress on this apparatus and experiments.The authors gratefully acknowledge support from the EPSRC, MBDA UK Ltd andTMD Technologies Ltd.[1] Ronald K., Speirs D.C., McConville S.L., Phelps A.D.R., Robertson C.W., WhyteC.G., He W., Gillespie K.M., Cross A.W., Bingham R., 2008, Phys. Plasmas, 15,art.056503[2] Speirs, D.C., Bingham, R., Cairns, R.A., Vorgul, I., Kellett, B.J., Phelps, A.D.R.,Ronald, K, 2014, Phys. Rev. Lett., 113, art 15500

The sweet spot in sustainability: a framework for corporate assessment in sugar manufacturing

The assessment of corporate sustainability has become an increasingly important topic, both within academia and in industry. For manufacturing companies to conform to their commitments to sustainable development, a standard and reliable measurement framework is required. There is, however, a lack of sector-specific and empirical research in many areas, including the sugar industry. This paper presents an empirically developed framework for the assessment of corporate sustainability within the Thai sugar industry. Multiple case studies were conducted, and a survey using questionnaires was also employed to enhance the power of generalisation. The developed framework is an accurate and reliable measurement instrument of corporate sustainability, and guidelines to assess qualitative criteria are put forward. The proposed framework can be used for a company’s self-assessment and for guiding practitioners in performance improvement and policy decision-maki

Galaxy Zoo: morphological classification of galaxy images from the Illustris simulation

Modern large-scale cosmological simulations model the universe with increasing sophistication and at higher spatial and temporal resolutions. These ongoing enhancements permit increasingly detailed comparisons between the simulation outputs and real observational data. Recent projects such as Illustris are capable of producing simulated images that are designed to be comparable to those obtained from local surveys. This paper tests the degree to which Illustris achieves this goal across a diverse population of galaxies using visual morphologies derived from Galaxy Zoo citizen scientists. Morphological classifications provided by these volunteers for simulated galaxies are compared with similar data for a compatible sample of images drawn from the Sloan Digital Sky Survey (SDSS) Legacy Survey. This paper investigates how simple morphological characterization by human volunteers asked to distinguish smooth from featured systems differs between simulated and real galaxy images. Significant differences are identified, which are most likely due to the limited resolution of the simulation, but which could be revealing real differences in the dynamical evolution of populations of galaxies in the real and model universes. Specifically, for stellar masses, a substantially larger proportion of Illustris galaxies that exhibit disk-like morphology or visible substructure, relative to their SDSS counterparts. Toward higher masses, the visual morphologies for simulated and observed galaxies converge and exhibit similar distributions. The stellar mass threshold indicated by this divergent behavior confirms recent works using parametric measures of morphology from Illustris simulated images. When , the Illustris data set contains substantially fewer galaxies that classifiers regard as unambiguously featured. In combination, these results suggest that comparison between the detailed properties of observed and simulated galaxies, even when limited to reasonably massive systems, may be misleading

Loss of microbial diversity and pathogen domination of the gut microbiota in critically ill patients

Among long-stay critically ill patients in the adult intensive care unit (ICU), there are often marked changes in the complexity of the gut microbiota. However, it remains unclear whether such patients might benefit from enhanced surveillance or from interventions targeting the gut microbiota or the pathogens therein. We therefore undertook a prospective observational study of 24 ICU patients, in which serial faecal samples were subjected to shotgun metagenomic sequencing, phylogenetic profiling and microbial genome analyses. Two-thirds of the patients experienced a marked drop in gut microbial diversity (to an inverse Simpson's index of <4) at some stage during their stay in the ICU, often accompanied by the absence or loss of potentially beneficial bacteria. Intravenous administration of the broad-spectrum antimicrobial agent meropenem was significantly associated with loss of gut microbial diversity, but the administration of other antibiotics, including piperacillin/tazobactam, failed to trigger statistically detectable changes in microbial diversity. In three-quarters of ICU patients, we documented episodes of gut domination by pathogenic strains, with evidence of cryptic nosocomial transmission of Enterococcus faecium. In some patients, we also saw an increase in the relative abundance of apparent commensal organisms in the gut microbiome, including the archaeal species Methanobrevibacter smithii. In conclusion, we have documented a dramatic absence of microbial diversity and pathogen domination of the gut microbiota in a high proportion of critically ill patients using shotgun metagenomics