Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreak

Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

AMTV headway sensor and safety design

A headway sensing system for an automated mixed traffic vehicle (AMTV) employing an array of optical proximity sensor elements is described, and its performance is presented in terms of object detection profiles. The problem of sensing in turns is explored experimentally and requirements for future turn sensors are discussed. A recommended headway sensor configuration, employing multiple source elements in the focal plane of one lens operating together with a similar detector unit, is described. Alternative concepts including laser radar, ultrasonic sensing, imaging techniques, and radar are compared to the present proximity sensor approach. Design concepts for an AMTV body which will minimize the probability of injury to pedestrians or passengers in the event of a collision are presented

Analysis Of Hofstedes 5-D Model: The Implications Of Conducting Business In Saudi Arabia

This paper analyzes the business and legal environment of Saudi Arabia using Hofstedes five dimensions: power distance, individualism vs. collectivism, masculinity vs. femininity, uncertainty avoidance, and short-term orientation vs. long-term orientation. The purpose of this paper is to provide a comparative analysis of several key traits of the culture in the United States and Saudi Arabia, examine various concepts in Saudi Arabias business environment that are illustrative of its ranking, and demonstrate the continued viability of Hofstedes model as a stepping-stone to appreciation of culture

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated

Breaking down automaticity: Case ambiguity and the shift to reflective approaches in clinical reasoning

Context: Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form of clinical reasoning is suggested to combine both modes. Conditions leading doctors to shift from the usual mode of non-analytical reasoning to reflective reasoning have not been identified. This paper reports a study aimed at exploring these conditions by investigating the effects of ambiguity of clinical cases on clinical reasoning. Methods: Participants were 16 internal medicine residents in the Brazilian state of Ceará. They were asked to diagnose 20 clinical cases and recall case information. The independent variable was the degree of ambiguity of clinical cases, with 2 levels: straightforward (i.e. non-ambiguous) and ambiguous. Dependent variables were processing time, diagnostic accuracy and proposition per category recalled. Data were analysed using a repeated measures design. Results: Participants processed straightforward cases faster and more accurately than ambiguous ones. The proportion of text propositions recalled was significantly lower (t[15] = 2.29, P = 0.037) in ambiguous cases, and an interaction effect between case version and proposition category was also found (F[5, 75] = 4.52, P = 0.001, d = 0.232, observed power = 0.962). Furthermore, participants recalled significantly more literal propositions from the ambiguous cases than from the straightforward cases (t[15] = 2.28, P = 0.037). Conclusions: Ambiguity of clinical cases was shown to lead residents to switch from automatic to reflective reasoning, as indicated by longer processing time, and more literal propositions recalled in ambiguous cases

Cost Effectiveness of Bio-Gas Systems for Dairy Farms

Considerable attention has recently been focused on the development of farm management practices that utilize the total resource potential of animal wastes. In addition to the fertilizer value of manure, energy in the form of bio-gas can be generated from manure wastes by an anaerobic digestion process. The purpose of this economic analysis was to evaluate the feasibility of producing energy from the anaerobic digestion of dairy-cow manure. Anaerobic digestion systems were rationally designed for several farm management practices on Vermont dairy farms. These designs were sized to accommodate dairy herds of 20, 50, 100, and 200 cows for both free- and tie-stall arrangements. The realistic evaluation of the potential of any energy source must include a cost effectiveness analysis. This 1974 economic analysis, with selected 1977 cost updatings, included considerations of both the total annual financial investment and the unit cost of net energy production. Minimum unit costs of net energy production for 1977 prices are approximately $0.19 per kwh for the 20-cow operation, but these values decrease with increasing herd size to$0.05 per kwh for the 200-cow dairy farm. At the present time, the generation of bio-gas from the anaerobic digestion of dairy farm manures becomes economically feasible as an alternate source of energy for dairy farms in excess of 200 cows

Fiber Optic Tactical Local Network (FOTLAN)

A 100 Mbit/s FDDI (fiber distributed data interface) network interface unit is described that supports real-time data, voice and video. Its high-speed interrupt-driven hardware architecture efficiently manages stream and packet data transfer to the FDDI network. Other enhancements include modular single-mode laser-diode fiber optic links to maximize node spacing, optic bypass switches for increased fault tolerance, and a hardware performance monitor to gather real-time network diagnostics

Enabling Entry Technologies for Ice Giant Missions

The highest priority science goals for Ice Giant missions are: 1) Interior structure of the Planet, and 2) Bulk composition that includes isotopes and noble gases. The interaction between the planetary interior and the atmosphere requires sustained global measurements. Noble gas and Isotope measurements require in situ measurement. Drag modulated aerocapture utilizing ADEPT offers more mass delivered to the Ice Giants than with propulsive orbit insertion. The Galileo Probe entered at a hot spot which created interpretation challenges. Juno is providing valuable orbital measurements, but without in situ measurements the story is incomplete. Planetary scientists interested in Ice Giant missions should perform mission design studies with these new Entry System technologies to assess the feasibility within the context of the international collaboration framework. A mission architecture that includes probe(s) along with an orbiting spacecraft can deploy the probes at the desired location while taking simultaneous measurements from orbit to provide invaluable data that can correlate both global and local measurements. Entry System Technologies currently being developed by NASA are poised to enable missions that position the Orbiter & Probes through drag modulated aerocapture (ADEPT), and HEEET enables the Probes to survive the extreme environments encountered for entry into the atmospheric interior