CATheter Infections in CHildren (CATCH): a randomised controlled trial and economic evaluation comparing impregnated and standard central venous catheters in children.

BACKGROUND: Impregnated central venous catheters (CVCs) are recommended for adults to reduce bloodstream infection (BSI) but not for children. OBJECTIVE: To determine the effectiveness of impregnated compared with standard CVCs for reducing BSI in children admitted for intensive care. DESIGN: Multicentre randomised controlled trial, cost-effectiveness analysis from a NHS perspective and a generalisability analysis and cost impact analysis. SETTING: 14 English paediatric intensive care units (PICUs) in England. PARTICIPANTS: Children aged  1.2 per 1000 CVC-days. CONCLUSIONS: The primary outcome did not differ between impregnated and standard CVCs. However, antibiotic-impregnated CVCs significantly reduced the risk of BSI compared with standard and heparin CVCs. Adoption of antibiotic-impregnated CVCs could be beneficial even for PICUs with low BSI rates, although uncertainty remains whether or not they represent value for money to the NHS. Limitations - inserting clinicians were not blinded to allocation and a lower than expected event rate meant that there was limited power for head-to-head comparisons of each type of impregnation. Future work - adoption of impregnated CVCs in PICUs should be considered and could be monitored through linkage of electronic health-care data and clinical data on CVC use with laboratory surveillance data on BSI. TRIAL REGISTRATION: ClinicalTrials.gov NCT01029717. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 18. See the NIHR Journals Library website for further project information

A Flight Research Overview of WSPR, a Pilot Project for Sonic Boom Community Response

In support of NASAs ongoing effort to bring supersonic commercial travel to the public, NASA Dryden Flight Research Center and NASA Langley Research Center, in cooperation with other industry organizations, conducted a flight research experiment to identify the methods, tools, and best practices for a large-scale quiet (or low) sonic boom community human response test. The name of the effort was Waveforms and Sonic boom Perception and Response. Such tests will go towards building a dataset that governing agencies like the Federal Aviation Administration and International Civil Aviation Organization will use to establish regulations for acceptable sound levels of overland sonic booms. Until WSPR, there had never been an effort that studied the response of people in their own homes and performing daily activities to non-traditional, low sonic booms.WSPR was a NASA collaborative effort with several industry partners, in response to a NASA Aeronautics Research Mission Directorate Research Opportunities in Aeronautics. The primary contractor was Wyle. Other partners included Gulfstream Aerospace Corporation, Pennsylvania State University, Tetra Tech, and Fidell Associates, Inc.A major objective of the effort included exposing a community with the sonic boom magnitudes and occurrences expected in high-air traffic regions with a network of supersonic commercial aircraft in place. Low-level sonic booms designed to simulate those produced by the next generation of commercial supersonic aircraft were generated over a small residential community. The sonic boom footprint was recorded with an autonomous wireless microphone array that spanned the entire community. Human response data was collected using multiple survey methods. The research focused on essential elements of community response testing including subject recruitment, survey methods, instrumentation systems, flight planning and operations, and data analysis methods.This paper focuses on NASAs role in the efforts logistics and operations including human response subject recruitment, the operational processes involved in implementing the surveys throughout the community, instrumentation systems, logistics, flight planning, and flight operations. Findings discussed in this paper include critical lessons learned in all of those areas. The paper also discusses flight operations results. Analysis of the accuracy and repeatability of planning and executing the unique aircraft maneuver used to generate low sonic booms concluded that the sonic booms had overpressures within 0.15 pounds-per-square-feet of the planned values for 76 of t he attempts. Similarly, 90 of the attempts to generate low sonic booms within the community were successful

Personal Papers (MS 80-0002)

Annotated business card for Harold White of Thos. Cook & Son Incorporated. It includes some notes on the front side introducing his friend Mr. Kempner to Mr. Piccioli from Rome.

Personal Papers (MS 80-0002)

Business card for Harold White from Thos. Cook & Son Incorporated. It includes some notes on the front side introducing his friend Mr. Kempner to Mr. Tyler from London

Increased patient co-payments and changes in PBS-subsidised prescription medicines dispensed in Western Australia

The definitive version may be found at www.wiley.comObjectiveTo determine whether a 24% increase in patient co-payments in January 2005 and two related co-payment changes for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) were associated with changes in dispensings in Western Australia (WA).MethodWe analysed aggregate monthly prescription counts and defined daily dose per 1,000 population per day (DDD/1,000/day) for atypical antipsychotics, combination asthma medicines, HmgCoA reductase inhibitors (statins) and proton-pump inhibitors (PPIs). Trends pre and post the co-payment increase in January 2005 were compared.ResultsIn three of the four categories examined, prescription counts were significantly lower following the increase in co-payment thresholds. Compared with dispensings prior to the co-payment increase, prescriptions fell by 8% for combination asthma medicines (pConclusions and implicationsThe reduction in the both prescription counts and DDD/1,000/day observed for combination asthma medicines, PPIs and statins, which all remained above co-payment thresholds, suggests the increase in PBS co-payments has affected utilisation of these subsidised medicines. The results indicate that increases in patient contributions particularly impact on concessional patients' ability to afford prescription medicines.Anna Hynd, Elizabeth E. Roughead, David B. Preen, John Glover, Max Bulsara and James Semmen