Infections and Multidrug-Resistant Pathogens in ICU Patients

This chapter aims to highlight the main types of infections in the ICU, in order to improve diagnostic and therapeutic management. Risk factors for patients hospitalised in the ICU will be raised: the increasing use of invasive devices and procedures, aggressive antimicrobial therapies, surgical interventions, immunosuppressive treatments or co-morbidities responsible for immune deficiencies. Starting from the rising mortality risk among patients with hospital-acquired infections (HAI), in the case of failure to control the pathogen in the first 24–48 h, we will tackle about the prevention, reduction and control of the emergence of resistant pathogens. The rational administration of antibiotics will also be addressed, with the aim of reducing adverse reactions, including secondary infections, decreasing the mortality rate, length of hospital stay and costs of health care

Beyond Brain Drain: The Dynamics of Geographic Mobility and Educational Attainment of B.C. Young Women and Men

In recent years, the topic of "brain drain" has gained considerable attention, both in public and intellectual spheres. Despite the media frenzy, few data sets and related studies exist to examine the nature and extent to which brain drain occurs. The purpose of this study is to extend the scope of the way we think about "brain drain," both conceptually and analytically, by examining the geographic migration and mobility patterns over a 10 year period of a large sample of young adults from British Columbia. Through analyses of detailed longitudinal questionnaire data, we examine geographic mobility patterns in relation to (a) B.C. college region of origin, (b) post-secondary educational completion patterns, and (c) gender. Findings reveal that migration patterns are both gendered and geographically complex. Our findings support the claim that brain drain to the U.S. is a mere trickle, not a flood. When examining gender differences of respondents living in the U.S. and outside North America, the vast majority of women who live outside of Canada have earned university credentials, which suggests that global mobility for women appears to be related to university degree completion. These findings challenge the narrow definition of brain drain as simply a Canada - U.S.A. issue where Canada's "best and brightest" are lured from Canada and invite us to consider the implications of intra- and extra-provincial brain drain (and gain), primarily within the confines of Canada.Au cours des dernières années, 1' "exode des compétences" a reçu une attention considérable dans les sphères publiques et intellectuelles. En dépit de la frénésie des médias, il y a peu de données et d'études pertinentes qui examinent la nature et l'ampleur de ce phénomène. Le but de cette étude est de réviser le concept de « l'exode des compétences» en examinant des modèles géographiques de migration et de mobilité d'un groupe de jeunes adultes de la Colombie-Britannique au cours d'une période de dix ans. La présente enquête longitudinale examine des modèles géographiques de mobilité par rapport (a) à la région d'origine à l'intérieur de la Colombie-Britannique, (b) aux parcours d'études post-secondaires, et (c) au genre. Les résultats indiquent que les modalités de migration sont géographiquement complexes et différentiées par le genre. Nos résultats soutiennent la thèse que l'exode des compétences de la Colombie-Britannique vers les États-Unis représente un ruissellement et non une inondation. En examinant les différences de genre des répondants établis aux États-Unis et à l'extérieur de l'Amérique du Nord, la grande majorité des femmes qui vivent en dehors du Canada ont obtenu des diplômes universitaires, ce qui suggère que la mobilité globale des femmes est liée à l'obtention d'un diplôme universitaire. Ces résultats défient la définition étroite de l'exode des compétence comme tout simplement un problème limité aux plus capables des Canadiens qui sont leurrés par les Etats-Unis. La présente étude nous invitent donc à considérer les implications des mouvements intra et interprovinciaux, principalement  ceux à l'intérieur du Canada, pour une meilleure compréhension de ce phénomène

Duplo: A framework for OCaml post-link optimisation

We present a novel framework, Duplo , for the low-level post-link optimisation of OCaml programs, achieving a speedup of 7% and a reduction of at least 15% of the code size of widely-used OCaml applications. Unlike existing post-link optimisers, which typically operate on target-specific machine code, our framework operates on a Low-Level Intermediate Representation (LLIR) capable of representing both the OCaml programs and any C dependencies they invoke through the foreign-function interface (FFI). LLIR is analysed, transformed and lowered to machine code by our post-link optimiser, LLIR-OPT. Most importantly, LLIR allows the optimiser to cross the OCaml-C language boundary, mitigating the overhead incurred by the FFI and enabling analyses and transformations in a previously unavailable context. The optimised IR is then lowered to amd64 machine code through the existing target-specific code generator of LLVM, modified to handle garbage collection just as effectively as the native OCaml backend. We equip our optimiser with a suite of SSA-based transformations and points-to analyses capable of capturing the semantics and representing the memory models of both languages, along with a cross-language inliner to embed C methods into OCaml callers. We evaluate the gains of our framework, which can be attributed to both our optimiser and the more sophisticated amd64 backend of LLVM, on a wide-range of widely-used OCaml applications, as well as an existing suite of micro- and macro-benchmarks used to track the performance of the OCaml compiler. EPSRC EP/P020011/1, Cambridge Trust

Information infrastructure governance and windows of opportunity

This document reinterprets C. P. Snow’s famous “Two Cultures” (the so-called “literary elite” and scientists) lecture of 1959, in light of advances in information systems in the past fifty years. While Snow referred to specific groups, his analysis is generalizable: cultural groups differentiate through lack of communication. Here Snow’s analysis and advice are applied to a different pair of “cultures”(IT purveyors and IT users) as an example of his general principles. At a time of great unease about terrorism in the face of apparently relentless technological advance – analogous to Snow’s speech at the height of the Cold War—and also during a time of (then) apparently dramatic technological advance, the lessons Snow derived can now apply usefully to today’s specific “two cultures” case

Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery

INTRODUCTION: In lung cancer surgery, large tidal volume and elevated inspiratory pressure are known risk factors of acute lung (ALI). Mechanical ventilation with low tidal volume has been shown to attenuate lung injuries in critically ill patients. In the current study, we assessed the impact of a protective lung ventilation (PLV) protocol in patients undergoing lung cancer resection. METHODS: We performed a secondary analysis of an observational cohort. Demographic, surgical, clinical and outcome data were prospectively collected over a 10-year period. The PLV protocol consisted of small tidal volume, limiting maximal pressure ventilation and adding end-expiratory positive pressure along with recruitment maneuvers. Multivariate analysis with logistic regression was performed and data were compared before and after implementation of the PLV protocol: from 1998 to 2003 (historical group, n = 533) and from 2003 to 2008 (protocol group, n = 558). RESULTS: Baseline patient characteristics were similar in the two cohorts, except for a higher cardiovascular risk profile in the intervention group. During one-lung ventilation, protocol-managed patients had lower tidal volume (5.3 +/- 1.1 vs. 7.1 +/- 1.2 ml/kg in historical controls, P = 0.013) and higher dynamic compliance (45 +/- 8 vs. 32 +/- 7 ml/cmH2O, P = 0.011). After implementing PLV, there was a decreased incidence of acute lung injury (from 3.7% to 0.9%, P < 0.01) and atelectasis (from 8.8 to 5.0, P = 0.018), fewer admissions to the intensive care unit (from 9.4% vs. 2.5%, P < 0.001) and shorter hospital stay (from 14.5 +/- 3.3 vs. 11.8 +/- 4.1, P < 0.01). When adjusted for baseline characteristics, implementation of the open-lung protocol was associated with a reduced risk of acute lung injury (adjusted odds ratio of 0.34 with 95% confidence interval of 0.23 to 0.75; P = 0.002). CONCLUSIONS: Implementing an intraoperative PLV protocol in patients undergoing lung cancer resection was associated with improved postoperative respiratory outcomes as evidence by significantly reduced incidences of acute lung injury and atelectasis along with reduced utilization of intensive care unit resources

Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery

Background. Thoracic epidural analgesia (TEA) is effective in alleviating pain after major thoracoabdominal surgery and may also reduce postoperative mortality and morbidity. This study investigated cardiovascular autonomic control in patients undergoing elective thoracic surgery and its modulation by continuous TEA. Methods. Thirty‐eight patients were randomly assigned to receive patient‐controlled analgesia (PCA group) or thoracic epidural analgesia (TEA group) with doses of bupivacaine (0.25% during operation, 0.125% after operation) and fentanyl (2 µgml-1). Heart rate variability (HRV), baroreflex function and pressure response to nitroglycerine and phenylephrine were assessed before operation, 4 h after the end of surgery (POD 0) and on the first and second postoperative days (POD1 and POD2). Results. Early after surgery, all HRV variables and baroreflex sensitivities were markedly decreased in both groups. In the TEA group, total HRV and its high‐frequency components (HF) increased towards preoperative values at POD1 and POD2, whereas the ratio of low to high frequencies (LF/HF) was significantly reduced (mean (sd), -44 (15)% at POD 0, -38 (17)% at POD1, -37 (18%) at POD2) and associated with blunting of the postoperative increase in heart rate and blood pressure. In the PCA group, the ratio of LF/HF remained unchanged and the decrements in HRV variables persisted until POD2. In the two groups, baroreflex sensitivities and pressure responses recovered preoperative values at POD2. Conclusions. In contrast with PCA management, TEA using low concentrations of bupivacaine and fentanyl blunted cardiac sympathetic neural drive, resulting in vagal predominance, while HRV variables were better restored after surgery. Br J Anaesth 2003; 91: 525-3

Customer Satisfaction with Cell Phone Banking in South Africa

The purpose of this study was to investigate the factors influencing satisfaction with cell phone banking in South Africa. The study followed a qualitative approach in which in-depth interviews were conducted with a set of South African cell phone banking users. Thematic analysis was employed to analyse the data. It was confirmed that factors known to influence satisfaction with other electronic services such as Internet banking were of relevance for cell phone banking too, i.e. Service Quality; Information Quality, System Quality; Transaction and Payment Quality, Perceived Usefulness, Innovativeness, Trust and Security. In addition it was found that prior electronic banking experience, the type of phone used and the type of banking service employed play a secondary role in influencing customer cell phone banking satisfaction. These findings are discussed and implications drawn

Applying Computers to Clinical Social Work

This paper discusses the application of computer technology to clinical social work. It is based on a three-year research and demonstration project on microcomputer applications to clinical social work. The paper reviews the use of computers in social work, contrasting the developments in this field with those that hove occurred in psychiatry and clinical psychology. It then describes the two major components of the integrated software package for supporting clinical social work that has been developed and is currently being tested. The paper concludes with a discussion of the misconceptions and realities of introducing computer technology to a clinical social work agency

L’utilisation des ordinateurs et l’intervention clinique en service social

Cet article traite de l'utilisation de la technologie informatique dans la pratique clinique du service social. S'appuyant sur une recherche et un projet-pilote d'une durée de trois ans, il passe en revue les utilisations de l'ordinateur en service social, et compare les développements en ce domaine avec ceux qui ont été observés en psychiatrie et en psychologie clinique. Il décrit ensuite les deux principales composantes du progiciel intégré, élaboré pour servir d'auxiliaire à l'intervention clinique, et qu'on est présentement à évaluer. Pour conclure, on y traite des erreurs à éviter et des réalités dont il faut tenir compte lorsqu'on veut implanter la technologie informatique dans un organisme de service social

Myocardial revascularization and bilateral lung transplantation without cardiopulmonary bypass

Coronary artery disease is occasionally encountered in lung transplant recipients and is a risk factor for perioperative complications and poor survival. Besides combined heart-lung transplantation, various techniques of myocardial revascularization can be performed before, or at the time of lung transplantation. We report herein a patient with end-stage bronchoemphysema and two-vessel coronary disease who underwent ‘off-pump' coronary artery bypass graft immediately followed by bilateral lung transplantatio