The use of conversation mapping to frame key perceptual issues facing the general dental practice system in England

<b>Objective</b>: To demonstrate the use of a novel qualitative methodology namely conversation mapping, which can be used to capture differences in stakeholder perspectives and give a root definition of the problem in a complex policy area. The methodology is used in the context of the changes introduced in the English general dental practice system in April 2006, to investigate the key issues facing the system, as perceived by general dental practitioners (GDPs). <b>Basic research design</b>: From a broad trigger statement, three transformational statements were produced. Each participant recorded their contribution on a hard diagrammatic form as a ‘map’, with others responding with their own written comment, thus generating three conversation maps. Thematic analysis resulted in the generation of a preliminary model summarising key perceptual issues. <b>Results</b>: The five emergent themes identified were: financing, dentists’ wants/needs, the role of the public and patients, system goals and policy level decision making. Financing was identified as the core category to which all other categories were related. <b>Conclusions</b>: Conversation mapping, a methodology arising from a systems approach, can be used to develop a ‘rich picture’ of an oral health care system in order to define the core problem within this policy area. Findings suggest that GDPs identify the financing of the system as a fundamental source of problems within the general dental practice system. This appears to be at variance with the perception of policy makers, who report a more limited view, identifying the system of remuneration as the ‘heart of the problem’

Lax Operator for the Quantised Orthosymplectic Superalgebra U_q[osp(2|n)]

Each quantum superalgebra is a quasi-triangular Hopf superalgebra, so contains a \textit{universal $R$-matrix} in the tensor product algebra which satisfies the Yang-Baxter equation. Applying the vector representation $\pi$, which acts on the vector module $V$, to one side of a universal $R$-matrix gives a Lax operator. In this paper a Lax operator is constructed for the $C$-type quantum superalgebras $U_q[osp(2|n)]$. This can in turn be used to find a solution to the Yang-Baxter equation acting on $V \otimes V \otimes W$ where $W$ is an arbitrary $U_q[osp(2|n)]$ module. The case $W=V$ is included here as an example.Comment: 15 page

Exact approximation of Rao-Blackwellised particle filters

Particle methods are a category of Monte Carlo algorithms that have become popular for performing inference in non-linear non-Gaussian state-space models. The class of 'Rao-Blackwellised' particle filters exploits the analytic marginalisation that is possible for some state- space models to reduce the variance of the Monte Carlo estimates. Despite being applicable to only a restricted class of state-space models, such as conditionally linear Gaussian models, these algorithms have found numerous applications. In scenarios where no such analytical integration is possible, it has recently been proposed in Chen et al. [2011] to use 'local' particle filters to carry out this integration numerically. We propose here an alternative approach also relying on \local" particle filters which is more broadly applicable and has attractive theoretical properties. Proof-of-concept simulation results are presented

Glass Foundation Chemosensor Synthesis and Functionality Analysis

Chemosensors are created through a series of reaction steps on controlled pore class (CPG) and terminate with a Cu2+ metal binding site. Each monolayer of reactant insures that the metal binding site exposed to solution would serve as an indicator displacement assay (IDA) sensor. The purpose of this research is to create a molecular sensor with a high density of terminal metal sites to quantify bidentate substrates. To accomplish this, each synthetic step of the sensor is examined in order to test the effects of new linkers, ligands, and variously sized dendrimers to see if small structural changes could promote a higher density of terminal metal sites. For linkers, the results show that CDI and TESPSA are comparable in functionality, whereas the ligand, lysine-NTA outperforms an amino-functionalized terpyridine in metal chelation. For dendrimers, higher generation dendrimers lead to more terminal Cu2+ metal binding sites than lower generation dendrimers

Generalised Perk--Schultz models: solutions of the Yang-Baxter equation associated with quantised orthosymplectic superalgebras

The Perk--Schultz model may be expressed in terms of the solution of the Yang--Baxter equation associated with the fundamental representation of the untwisted affine extension of the general linear quantum superalgebra $U_q[sl(m|n)]$, with a multiparametric co-product action as given by Reshetikhin. Here we present analogous explicit expressions for solutions of the Yang-Baxter equation associated with the fundamental representations of the twisted and untwisted affine extensions of the orthosymplectic quantum superalgebras $U_q[osp(m|n)]$. In this manner we obtain generalisations of the Perk--Schultz model.Comment: 10 pages, 2 figure

Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum -lactamase (ESBL)- producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens

Measuring the effect of enhanced cleaning in a UK hospital : a prospective cross-over study

Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at handtouch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both handtouch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus infections were identified 2 to 4 weeks after the cleaner left both wards. Enhanced cleaning saved the hospital £30,000 to £70,000.Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection