Switching From Saline Solution to an Antimicrobial Solution for Pre-Catheter Skin Cleansing

The Infection Prevention and Control team at Rotherham Foundation Trust made the decision to switch from saline solution to an antimicrobial solution for skin cleansing prior to urinary catheterisation. The first stage of the switch has taken place in the community, with secondary care likely to follow suit at a later stage. The rationale for the switch, the two year journey it took to implement the changes and the parameters by which the success of the switch will be evaluated, are discussed in this article.Catheter-associated urinary tract infections (CAUTI) are a cause of considerable concern and any measures which can be taken to potentially reduce the rate of CAUTI’s should be given careful consideration. In 2012 the Infection Prevention and Control team at Rotherham Foundation Trust switched from saline solution to an antimicrobial solution (Octenilin® cleaning solution sachets) for skin cleansing prior to urinary catheterisation to try to reduce CAUTI’s. Initially, Octenilin cleansing solution sachets were intended for use solely for patients with a current or historical confirmed result of MRSA in the urine and/or other sites. However, use has been extended to other patients, including those with a history of E. coli or Klebsiella, Gram-negative organisms frequently identified as a source of UTI’s. Early feedback from using Octenilin cleansing solution sachets in place of saline solution has indicated a high level of satisfaction from both patients and health-care professionals. Reports of catheterisation-associated trauma have reduced significantly and no CAUTI’s have been identified to date

Particulate organic matter in artificial soils

It is estimated that around 2 ×109 hectares of land (15% of global land area) has been degraded by human activity, and rates of soil degradation are increasing. Soil is a precious resource, it sustains almost all terrestrial life and provides 90% of the food that feeds humanity. New methods are needed to improve degraded soils and recover desertified soils, particularly in higher risk areas such as deforested areas in the tropics. Waste products of industrial bio-refining may provide a convenient and abundant material for use as a soil amendment, with the added benefit of increasing the carbon sequestration potential of bio-based products. Unfortunately, knowledge of how soils can be restored in a targeted manner are missing. This thesis aims to determine the key inter-particulate interactions which promote the formation of stable aggregates, with a focus on bio-refinery products as soil amendments. New methodologies are established in order to explore particulate interactions in the context of soils, and tested on artificial soils and aggregates with defined compositions. Abiotic artificial soils are studied, to identify the physical and chemical aggregate forming processes separately of biological processes. Particulate - clay interactions are found to be complex, and the mechanical properties of the aggregate are found not only to be dependent on surface chemistry but also on the fabric morphology, pore space and particle shape. Organosolv lignin, a biorefinery waste product, was shown to bind to the silica face of kaolinite, driven by hydrophobic interactions in suspension, and were found to strengthen kaolinite aggregates up to a percolation threshold. Video image analysis is used to determine slaking kinetics of aggregates submerged in a flow cell. The role of these interactions for soil development is also investigated, in order to determine if aggregates form by accumulating stable organo-mineral interactions over repeated wet/dry cycles. The nature of lignin-kaolinite interactions are investigated using solid-state magic angle spinning NMR and T1 relaxation NMR. Finally, a soil microcosm experiment was carried out, in order to determine the microbial response to the addition of lignin, which present a challenging substrate for ecosystems of degraded soils. These experiments illustrate the importance of particulate interactions for forming stable soil aggregates and soil structure, and the results provide insights into how particulates may be engineered to improve soils with a targeted approach.Open Acces

Star Trek, Star Wars, or Battlestar Galactica—the Occurring Privatization of Space Exploration, and the Need for “Global” Regulations

Privatized space travel is not innately bad because of its commercial nature. Commercialization leads to efficient innovation; and our scientific pursuits benefit from advancements in technology in every space-related industry. This is not to say that privatized space travel is not without disgust and dissenters. As a dissenter, Buzz Aldrin questioned Elon Musk’s Mars proposal by arguing, “Well, now, when your [rocket] lands on Mars with people, is there going to be anything down there for you to live in or do?” Buzz Aldrin is not alone in his questioning of the motives behind mega corporations’ space projects. Billionaire-funded space travel can be a viable new market, but there is a balance of ideals we must maintain—that of corporate profit and innovation, and global public interests. The global community cannot allow corporate giant egos to stifle valid criticisms regarding consumer safety and the global community, including international relations and foreign policy. Until international governments rethink current ratified treaties and agreements, nations will not be able to provide the security that may sway dissenters to the side of privatized space travel. Commercial space travel is here, let’s ensure regulations can meet it halfway

Towards Systemic Evaluation

Problems of conventional evaluation models can be understood as an impoverished ‘conversation’ between realities (of non-linearity, indeterminate attributes, and ever-changing context), and models of evaluating such realities. Meanwhile, ideas of systems thinking and complexity science—grouped here under the acronym STCS—struggle to gain currency in the big ‘E’ world of institutionalized evaluation. Four evaluation practitioners familiar with evaluation tools associated with STCS offer perspectives on issues regarding mainstream uptake of STCS in the big ‘E’ world. The perspectives collectively suggest three features of practicing systemic evaluation: (i) developing value in conversing between bounded values (evaluations) and unbounded reality (evaluand), with humility; (ii) developing response-ability with evaluand stakeholders based on reflexivity, with empathy; and (iii) developing adaptive rather than mere contingent use(fulness) of STCS ‘tools’ as part of evaluation praxis, with inevitable fallibility and an orientation towards bricolage (adaptive use). The features hint towards systemic evaluation as core to a reconfigured notion of developmental evaluation

The personal experience of parenting a child with Juvenile Huntington’s Disease: perceptions across Europe

The study reported here presents a detailed description of what it is like to parent a child with juvenile Huntington’s disease in families across four European countries. Its primary aim was to develop and extend findings from a previous UK study. The study recruited parents from four European countries: Holland, Italy, Poland and Sweden,. A secondary aim was to see the extent to which the findings from the UK study were repeated across Europe and the degree of commonality or divergence across the different countries. Fourteen parents who were the primary caregiver took part in a semistructured interview. These were analyzed using an established qualitative methodology, interpretative phenomenological analysis. Five analytic themes were derived from the analysis: the early signs of something wrong; parental understanding of juvenile Huntington’s disease; living with the disease; other people’s knowledge and understanding; and need for support. These are discussed in light of the considerable convergence between the experiences of families in the United Kingdom and elsewhere in Europe

Bio-Economic Analyses of Biofuel-Based Integrated Farm Drainage Management Systems on Marginal Land in a Salinity and Drainage Impacted Region: The Case of California's Central Valley

Two seemingly separate areas motivate this work. The first is the water scarcity, salinization, and drainage concerns that cause both environmental and private damages in arid regions throughout the world, including the San Joaquin Valley of California's Central Valley. The second is interest in producing bioenergy in an energetically, privately, and environmentally positive manner. These two branches intersect with the growth of highly energetic biofuel crops on marginal, or poor quality, land with saline drainage water as a form of Integrated Farm Drainage Management (IFDM). To analyze this intersection, this dissertation contains three chapters. The first paper consists of background information on the San Joaquin Valley, marginal land, biofuels, and drainage water, and an arithmetic estimation of potential Bermuda grass (Cynodon dactylon) bioenergy production as an IFDM crop. The second paper develops yield as a function of salinity, irrigation systems, irrigation timing, nitrogen, climate effects, and applied water. The functions, which are very flexible, are compared to other functions used in the literature and the results from a field experiment. These functions are used in the third paper, which develops a farm-level bio-economic optimization model of IFDM crops, including the biofuel crop, Brassica spp. These works show that growing biofuel crops, and other IFDM crops, on marginal lands in drainage-impacted regions can be privately beneficial and provide environmental benefits relative to traditional approaches

Making sense of frailty: An ethnographic study of the experience of older people living with complex health problems

Aim: To explore how older people with complex health problems experience frailty in their daily lives. Background: A better understanding of the personal experience of frailty in the context of fluctuating ill-health has the potential to contribute to the development of personalised approaches to care planning and delivery. Design: An ethnographic study of older people, living at home, receiving support from a community matron service in a large city in the North of England. Methods: Up to six care encounters with each of ten older people, and their community matron, were observed at monthly intervals, over a period of time ranging from four to eleven months. Semi-structured interviews were conducted with the older participants in their own homes. Fieldwork took place over a four-year period. Data analysis was undertaken using the constant comparative method. Findings: The experience of frailty was understood through the construction of four themes: Fluctuating ill-health and the disruption of daily living; Changes to the management of daily living; Frailty as fear, anxiety and uncertainty; Making sense of changes to health and daily living. Conclusions: Older people work hard to shape and maintain daily routines in the context of complicated and enduring transitions in health and illness. However, they experience episodic moments of frailty, often articulated as uncertainty, where daily living becomes precarious and their resilience is threatened. Developing an understanding of the personal experiences of frail older people in the context of transition has the potential to inform nursing practice in person centred care