Microbial contamination of domiciliary nebulisers and clinical implications in chronic obstructive pulmonary disease.

BACKGROUND AND PURPOSE: Domiciliary nebulisers are widely used in chronic obstructive pulmonary disease (COPD) but nebuliser cleaning practice has not been assessed in patients with COPD who are often elderly and may have severe disease and multiple comorbidities. We aimed to evaluate microbial contamination of home nebulisers used by patients with COPD. METHODS: Random microbiological assessment of domiciliary nebulisers was undertaken together with an enquiry into cleaning practices. We also examined the effectiveness of the trust-wide cleaning instructions in eradicating isolated microorganisms in a laboratory setting. RESULTS: The mean age of patients in this study was 71 (range 40-93) years, and in 68% of patients a large number of significant comorbidities were present. Forty-four nebuliser sets were obtained and 73% were contaminated with microorganisms at >100 colony forming units/plate. Potentially pathogenic bacteria colonised 13 of the 44 nebulisers (30%) and organisms isolated included Pseudomonas aeroginosa, Staphylococcus aureus, multidrug resistant Serratia marcesans, Escherichia coli and multiresistant Klebsiella spp, Enterobacteriaceae and fungus Fusarium oxysporum. Washing of nebuliser masks, chambers and mouthpieces achieved complete eradication of Gram-positive bacterial and fungal flora. Gram-negative organisms were incompletely eradicated, which may be attributed to the presence of biofilms. We also found that in patients with pathogenic organisms cultured on the nebuliser sets, there was a higher probability of occurrence of a COPD exacerbation with a mean number of exacerbations of 3.3 (SD=1) per year in the group in whom pathogens were isolated compared with 1.7 (SD=1.2) exacerbations per year in those whose sets grew non-pathogenic flora (p=0.02). CONCLUSIONS: Nebulisers contaminated with microorganisms are potential reservoirs delivering serious pathogens to the lung. Relationships between nebuliser contamination, clinical infection and exacerbations require further examination, but is a potential concern in elderly patients with COPD with comorbidities who fail to effectively maintain reasonable standards of nebuliser cleanliness

How robust are future projections of forest landscape dynamics? Insights from a systematic comparison of four forest landscape models

Projections of landscape dynamics are uncertain, partly due to uncertainties in model formulations. However, quantitative comparative analyses of forest landscape models are lacking. We conducted a systematic comparison of all forest landscape models currently applied in temperate European forests (LandClim, TreeMig, LANDIS-II, iLand). We examined the uncertainty of model projections under several future climate, disturbance, and dispersal scenarios, and quantified uncertainties by variance partitioning. While projections under past climate conditions were in good agreement with observations, uncertainty under future climate conditions was high, with between-model biomass differences of up to 200 t ha−1. Disturbances strongly influenced landscape dynamics and contributed substantially to uncertainty in model projections (~25–40% of observed variance). Overall, model differences were the main source of uncertainty, explaining at least 50% of observed variance. We advocate a more rigorous and systematic model evaluation and calibration, and a broader use of ensemble projections to quantify uncertainties in future landscape dynamics

Lighting energy efficiency opportunities at Cheyenne Mountain Air Station

CMAS is an intensive user of electricity for lighting because of its size, lack of daylight, and 24-hour operating schedule. Argonne National Laboratory recently conducted a lighting energy conservation evaluation at CMAS. The evaluation included inspection and characterization of existing lighting systems, analysis of energy-efficient retrofit options, and investigation of the environmental effects that these lighting system retrofits could have when they are ready to be disposed of as waste. Argonne devised three retrofit options for the existing lighting systems at various buildings: (1) minimal retrofit--limited fixture replacement; (2) moderate retrofit--more extensive fixture replacement and limited application of motion detectors; and (3) advanced retrofit--fixture replacement, reduction in the number of lamps, expansion of task lighting, and more extensive application of motion detectors. Argonne used data on electricity consumption to analyze the economic and energy effects of these three retrofit options. It performed a cost analysis for each retrofit option in terms of payback. The analysis showed that lighting retrofits result in savings because they reduce electricity consumption, cooling load, and maintenance costs. The payback period for all retrofit options was found to be less than 2 years, with the payback period decreasing for more aggressive retrofits. These short payback periods derived largely from the intensive (24-hours-per-day) use of electric lighting at the facility. Maintenance savings accounted for more than half of the annual energy-related savings under the minimal and moderate retrofit options and slightly less than half of these savings under the advanced retrofit option. Even if maintenance savings were excluded, the payback periods would still be impressive: about 4.4 years for the minimal retrofit option and 2 years for the advanced option. The local and regional environmental impacts of the three retrofit options were minimal

Rapid eye movements to a virtual target are biased by illusory context in the Poggendorff figure.

In order to determine the influence of perceptual input upon oculomotor responses, we examined rapid saccadic eye movements made by healthy human observers to a virtual target defined by the extrapolated intersection of a pointer with a distant landing line. While corresponding perceptual judgments showed no evidence of systematic bias, eye movements showed a strong bias, in the direction of assimilation of the saccade trajectory to the shortest path between the end of the pointer and the landing line. Adding an abutting vertical inducing line to make an angle of 45 deg with the pointer led to a larger bias in the same direction as the classical Poggendorff illusion. This additional Poggendorff effect was similar in direction and magnitude for the eye movements and the perceptual responses. Latency and dynamics of the eye movements were closely similar to those recorded for a control task in which observers made a saccade from the start fixation to an explicit target on the landing line. Further experiments with inducing lines presented briefly at various times during the saccade latency period showed that the magnitude of the saccade bias was affected by inducer presentation during the saccade planning process, but not during the saccade itself. We conclude that the neural mechanisms for extrapolation can feed into the control of eye movements without obvious penalties in timing and accuracy and that this information can instantaneously modify motor response throughout the planning phase, suggesting close association between perceptual and motor mechanisms in the process of visuo-spatial extrapolation

Perceptual judgment and saccadic behavior in a spatial distortion with briefly presented stimuli.

When observers are asked to localize the peripheral position of a small probe with respect to the mid-position of a spatially extended comparison stimulus, they tend to judge the probe as being more peripheral than the mid-position of the comparison stimulus. This relative mislocalization seems to emerge from differences in absolute localization, that is the comparison stimulus is localized more towards the fovea than the probe. The present study compared saccadic behaviour and relative localization judgements in three experiments and determined the quantitative relationship between both measures. The results showed corresponding effects in localization errors and saccadic behaviour. Moreover, it was possible to estimate the amount of the relative mislocalization by means of the saccadic amplitude

Wellsprings of a 'World War': An early English attempt to conquer Canada during King William's war, 1688-97

This is the author's PDF version of an article published in Journal of Imperial and Commonwealth History© 2006. The definitive version is available at www.tandf.co.uk/journals/FICHThis article discusses the military history of the early years of King William's War, 1688-97, including an early attempt to conquer French Canada in 1690 by Sir William Phips. The article places this within differeing interpretations of the military historiography of early modern colonial America.This article was submitted to the RAE2008 for the University of Chester - History

Naturalizing action theory

The aim of this paper is to give a new argument for naturalized action theory. The sketch of the argument is the following: the immediate mental antecedents of actions, that is, the mental states that makes actions actions, are not normally accessible to introspection. But then we have no other option but to turn to the empirical sciences if we want to characterize and analyze them