Optimal management of urinary tract infections in older people

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials

Stranded Structure Development in Thermally Produced Protein Concentrate Gel

Scanning electron micrographs of thermally induced whey protein concentrate gels were taken. Sample preparation was accomplished by glutaraldehyde fixation, osmium tetroxide post fixation and critical point dehydration. Stranded or beaded gel structures were observed on the external surface of a gas bubble, suggesting that a string-of-beads gel microstructure may result from bubble formation during thermal treatment

Poetic Threshold Moments: From Fledgling to Published Author

This paper presents perspectives from award-winning poets on an initiative where they were involved in publishing with undergraduate students who were completing a creative writing class at a tertiary education institution in NSW, Australia. This initiative provided students with the opportunity to be both taught by and publish with world-class poets. As a culmination of the semester’s class the students also had an opportunity for selected work to be published alongside high profile writers in a collaborative anthology. The recent Wording the World (2010) and Here Not There (2012) poetry anthologies are printed artefacts of this process. While reflecting on their experience of the initiative, the established writers provide interesting insights on the pedagogical value of such a program. It is also of interest to appreciate what motivates these poets to contribute their time and works to a project that assists student-writers to successfully cross a literary threshold. While reflecting on their journeys in achieving literary notoriety, the poets relate how they reached an understanding of threshold concepts associated with their identity as authors, their skills as writers, the way in which they influence other authors, and the way in which the writing community perceives them. One of the key findings that emerges from the study of this initiative, where the experts so generously give of themselves, is that through their experiences of the potentially isolating act of writing poetry when they were younger, they are able provide a sense of inclusivity and opportunity for newly emerging writers wishing to find a shape, voice and publication point for their creativity. Rather than seeing the process of poetry writing as a journey or a path, the data gathered from the established poets in this program indicates that there are a number of threshold points that poets experience as they move from being a fledgling to a published author

Structure and Composition of Apple Juice Haze

Haze obtained from commercial apple juice over the 1991 season contained from 11.4 to 29.0% protein (w/w) , trace quantities of both metal cations and polymeric carbohydrate, and gave strong responses to tests for phenolic compounds indicating a protein-phenol haze. SDS-PAGE of the 2-mercaptoethanol reduced , guanidinium hydrochloride dissaggregated haze particles gave a continuous smear indicating a population of molecules ranging from 29K to greater than 205K daltons. Transmission electron microscopy of negatively stained preparations revealed the presence of spherical bodies only partially penetrable by stain and possessin g a suhunit structure. These particles were embedded in a material presumably polymerized in such a way as to form chain-like aggregates. Protein-phenol haze particles consist of two structural components: spherical particles, probably protein , embedded in polymerized phenolics

Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards

Objectives To understand how frontline reports of day-to-day care failings might be better translated into improvement. Design Qualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS. Results PCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described. Conclusions Prospective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are goals for learning healthcare organisations