Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department.

Preventing and controlling methicillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient\u27s stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as \u27risk group\u27 (RG) on their arrival in the ED and were compared with \u27non-risk group\u27 (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9h, respectively. Female sex, age \u3e65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them

Epidemics in Networks of Spatially Correlated Three-dimensional Root Branching Structures

Using digitized images of the three-dimensional, branching structures for root systems of bean seedlings, together with analytical and numerical methods that map a common 'SIR' epidemiological model onto the bond percolation problem, we show how the spatially-correlated branching structures of plant roots affect transmission efficiencies, and hence the invasion criterion, for a soil-borne pathogen as it spreads through ensembles of morphologically complex hosts. We conclude that the inherent heterogeneities in transmissibilities arising from correlations in the degrees of overlap between neighbouring plants, render a population of root systems less susceptible to epidemic invasion than a corresponding homogeneous system. Several components of morphological complexity are analysed that contribute to disorder and heterogeneities in transmissibility of infection. Anisotropy in root shape is shown to increase resilience to epidemic invasion, while increasing the degree of branching enhances the spread of epidemics in the population of roots. Some extension of the methods for other epidemiological systems are discussed.Comment: 21 pages, 8 figure

The effect of heterogeneity on invasion in spatial epidemics: from theory to experimental evidence in a model system

Heterogeneity in host populations is an important factor affecting the ability of a pathogen to invade, yet the quantitative investigation of its effects on epidemic spread is still an open problem. In this paper, we test recent theoretical results, which extend the established “percolation paradigm” to the spread of a pathogen in discrete heterogeneous host populations. In particular, we test the hypothesis that the probability of epidemic invasion decreases when host heterogeneity is increased. We use replicated experimental microcosms, in which the ubiquitous pathogenic fungus Rhizoctonia solani grows through a population of discrete nutrient sites on a lattice, with nutrient sites representing hosts. The degree of host heterogeneity within different populations is adjusted by changing the proportion and the nutrient concentration of nutrient sites. The experimental data are analysed via Bayesian inference methods, estimating pathogen transmission parameters for each individual population. We find a significant, negative correlation between heterogeneity and the probability of pathogen invasion, thereby validating the theory. The value of the correlation is also in remarkably good agreement with the theoretical predictions. We briefly discuss how our results can be exploited in the design and implementation of disease control strategies

Negotiating professional and social voices in research principles and practice

This paper draws on work conducted for a qualitative interview based study which explores the gendered racialised and professional identifications of health and social care professionals. Participants for the project were drawn from the professional executive committees of recently formed Primary Care Trusts. The paper discusses how the feminist psychosocial methodological approach developed for the project is theoretically, practically and ethically useful in exploring the voices of those in positions of relative power in relation to both health and social care services and the social relations of gender and ethnicity. The approach draws on psychodynamic accounts of (defended) subjectivity and the feminist work of Carol Gilligan on a voice-centred relational methodology. Coupling the feminist with the psychosocial facilitates an emphasis on voice and dialogic communication between participant and researcher not always captured in psychosocial approaches which tend towards favouring the interviewer as ‘good listener’. This emphasis on dialogue is important in research contexts where prior and ongoing relationships with professional participants make it difficult and indeed undesirable for researchers to maintain silence

Educating Pharmacy Students to Improve Quality (EPIQ) in Colleges and Schools of Pharmacy

Objective. To assess course instructors’ and students’ perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum. Methods. Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students’ perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire. Results. Scores on all questionnaire items indicated improvement in students’ perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students’ scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education. Conclusion. The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement

Listening and learning : the reciprocal relationship between worker and client

The relationship between worker and client has for the best part of 100 years been the mainstay of probation, and yet has recently been eroded by an increased emphasis on punishment, blame and managerialism. The views of offenders are in direct contradiction to these developments within the criminal justice system and this article argues that only by taking account of the views of those at the 'coal face' will criminologists, policy makers and practitioners be able to effect real change in crime rates. The article thus focuses on the views of a sample of previously persistent offenders in Scotland about offending, desistance and how the system can help them. It explores not only their need for friendship and support in youth but also the close association between relationships and the likelihood of offending. It also demonstrates the views of offenders themselves about the importance of the working relationship with supervising officers in helping them desist from crime. The article concludes that the most effective way of reducing offending is to re-engage with the message of the Probation Act of 100 years ago, namely, to 'advise, assist and befriend' offenders rather than to 'confront, challenge and change' offending behaviour

A Cellular Automata Model for Citrus Variagated Chlorosis

A cellular automata model is proposed to analyze the progress of Citrus Variegated Chlorosis epidemics in S\~ao Paulo oranges plantation. In this model epidemiological and environmental features, such as motility of sharpshooter vectors which perform L\'evy flights, hydric and nutritional level of plant stress and seasonal climatic effects, are included. The observed epidemics data were quantitatively reproduced by the proposed model varying the parameters controlling vectors motility, plant stress and initial population of diseased plants.Comment: 10 pages, 10 figures, Scheduled tentatively for the issue of: 01Nov0

Voting in the bicameral Congress: large majorities as a signal of quality

publication-status: Acceptedtypes: ArticleWe estimate a model of voting in Congress that allows for dispersed information about the quality of proposals in an equilibrium context. In equilibrium, the Senate only approves House bills that receive the support of a supermajority of members of the lower chamber. We estimate this endogenous supermajority rule to be about four-fifths on average across policy areas. Our results indicate that the value of information dispersed among legislators is significant, and that in equilibrium a large fraction of House members' (40–50%) votes following their private information. Finally, we show that the probability of a type I error in Congress (not passing a good bill) is on average about twice as high as the probability of a type II error (passing a low-quality bill)

Gender and educational leadership in England: a comparison of secondary headteachers' views over time

In the context of gender being a barrier to accessing leadership, this paper presents a comparison of the views of men and women head teacher (principals) of secondary schools in England in the 1990s and in 2004. The same survey instrument was used on both occasions. The perceptions of the head teachers show change in some areas and no change in others. Overall, women are more likely to become head teachers and are now less likely to be categorised into pastoral roles, but in some cases women still meet prejudice from governors and others in the wider community. Women head teachers are more likely to have partners and children than in the 1990s, sharing equally or carrying most of the domestic responsibilities, whereas male colleagues are most likely to have partners who take the majority of responsibility in the home. Essentialist stereotypes about women and men as leaders still prevail, although both the women and men head teachers see themselves as adopting a traditionally ‘feminine’ style of leadership. Women head teachers are likely to see some benefits in being a woman in a role stereotypically associated with men. However, there has been an increase in the proportion of women who feel that they have to prove their worth as a leader, and this may be linked with increased levels of accountability in schools

Engaging with childhood: student placements and the employability agenda.

Employability is a particular organising narrative within the global, neoliberal economic discourse, with increasing relevance across different educational contexts. For universities in the UK, student employability, that is the readiness of students to gain and maintain employment and contribute to the economy, is a significant feature of accountability with employability outcomes increasingly used by students in making their decision of which university to attend. Yet little attention is paid to the organizing power of the employability agenda and to university students’ participation in that agenda apart from focussing on knowledge and skills relevant to gain employment. This is particularly concerning in university programmes that develop professionals who work with children. Placement, gaining knowledge, skills and experience in the places where children and young people are found, is a common aspect of employability being embedded within programme curricula. This article explores the organising power of the employability agenda for children and young people in a context of university placements. Focused on student experiences on placement in primary school settings in the north of England analysis considers students’ engagement with their own learning and the children who are essential to that learning