Bacteraemia during transurethral resection of the prostate: what are the risk factors and is it more common than we think?

The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p=0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p=0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p=0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p=0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p=0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy

Research Ethics and the CGIAR

This report was discussed at the 5th Meeting of the Science Council in April 2006. The report was prepared by an independent panel (see authors) led by Peter Sandoe. The present study is concerned with ethical issues relating to the process involved in the CGIAR mission: scientific research and research-related activities. Roughly, these ethical issues can be divided into three different categories: The first is about the implications of the CGIAR’s overall objective for the way the research activities are conducted, i.e. the requirements of ensuring that the end beneficiaries of the research actually are benefited through dissemination of research results, through empowerment and through participation in relevant parts of the research process. Another implication is the requirement of ensuring a stable and transparent research process through dialogue and communication with the relevant stakeholders. A second type of ethical issue is that relating to the parties affected by the research activities. These are, among others, human or animal research subjects, the environment and the general public. Important issues are concerned with ensuring that research results remain a public good and how to deal with intellectual property (IP) issues. Other important issues are biodiversity protection and biosafety. The third types of issue relate to the ethical requirements internal to the conduct of research activities. These requirements include norms of good scientific practice and norms concerning the handling of funding

Lipid coated liquid crystal droplets for the on-chip detection of antimicrobial peptides

We describe a novel biosensor based on phospholipid-coated nematic liquid crystal (LC) droplets and demonstrate the detection of Smp43, a model antimicrobial peptide (AMP) from the venom of North African scorpion Scorpio maurus palmatus. Mono-disperse lipid-coated LC droplets of diameter 16.7 ± 0.2 μm were generated using PDMS microfluidic devices with a flow-focusing configuration and were the target for AMPs. The droplets were trapped in a bespoke microfluidic trap structure and were simultaneously treated with Smp43 at gradient concentrations in six different chambers. The disruption of the lipid monolayer by the Smp43 was detected (<6 μM) at concentrations well within its biologically active range, indicated by a dramatic change in the appearance of the droplets associated with the transition from a typical radial configuration to a bipolar configuration, which is readily observed by polarizing microscopy. This suggests the system has feasibility as a drug-discovery screening tool. Further, compared to previously reported LC droplet biosensors, this LC droplet biosensor with a lipid coating is more biologically relevant and its ease of use in detecting membrane-related biological processes and interactions has the potential for development as a reliable, low-cost and disposable point of care diagnostic tool

Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC)

OBJECTIVE/BACKGROUND: The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI. METHODS: A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition. RESULTS: Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stent-graft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever ≥38°C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid (≥7 weeks and ≥3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source. CONCLUSION: This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database supported by the Vascular Society of Great Britain & Ireland

ANTICIPATING THE MNEMONIC SHIFT: ORGANIZATIONAL REMEMBERING AND FORGETTING IN 2001

Following a review of prior work, the paper presents a model of organizational memory. Relying on structuration theory for its development, the model overcomes some of the problematic dualisms of conventional approaches (i.e., subjecUobject, social/technical, abstract/concrete). According to the model, co-memory (for collective memory) consists of rules and resources that recursively mediate both interactivity and structure in organizations. The model provides the basis for a taxonomy of existing and projected IT-based co-memory systems. Four classes of co-memory systems are described: transactional, managerial, strategic, and team. An analysis of driving trends concerning people, structure, and technology is used to project four scenarios for organizations in 2001: bureaucracy, factory, affiliation, and infocracy. Co-memory systems that can be expected in each scenario are discussed. Predictions indicate that a mnemonic s

MEETTING IN TIME: RECORDING THE WORKGROUP CONVERSATION

This work investigates the concept of organizational memory within the context of face-to-face meetings. We begin by exploring the theoretical and practical implications of both organizational memory in general, and meeting memory in particular. We propose that meeting memory can be constructed from temporally-structured speech-acts. This proposal is investigated through a case study of an existing meeting memory leading to the development of a meeting memory prototype system. The paper extends current research in the application of speech-act theory to collaborative work in two directions: 1) the support of face-to-face meetings and 2) the recording of group memory

The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations.

Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment

Developing Human Stem Cell Derived Motor Neuron Models of Amyotrophic Lateral Sclerosis

Human neurodegenerative disorders are among the most difficult to study. In particular, the inability to readily obtain the faulty cell types most relevant to these diseases has impeded progress for decades. Amyotrophic lateral sclerosis is a late onset neurodegenerative disease in which the upper and lower motor neurons degenerate, leading to paralysis and eventually death. Recent advances in pluripotent stem cell technology now grant access to significant quantities of disease pertinent neurons both with and without predisposing mutations. The two studies described in this thesis demonstrate the feasibility of using MNs, generated from pluripotent stem cell lines harboring known ALS mutations, to establish in-vitro models of the disease. Specifically, we first used gene targeting to establish genetically controlled systems, able to identify causal relationships between a familial ALS mutation and in vitro phenotypes. Next, using transcriptional profiling, we identified novel pathways altered by the mutation and demonstrated functional consequences of these pathways' misregulation. Furthermore, by monitoring the physiology of the pluripotent stem cell derived MNs, we discovered an increased firing rate in the mutant MNs, and identified an FDA-approved drug, retigabine, capable of rescuing this defect. Lastly, to aid in the discovery of additional therapeutic compounds, we combined gene targeting, transcriptional profiling, and a fluorescent reporter human embryonic stem cell line to establish a well-controlled in vitro system capable of identifying genetic modifiers of the phenotypes described herein

Internal Controls For The Revenue Cycle: A Checklist For The Consumer Products Industry

In today&rsquo;s difficult economic climate, business managers must carefully consider all aspects of business operations to minimize waste and increase efficiency.&nbsp; The revenue cycle continues to be the primary area of fraud and abuse requiring strong, comprehensive internal controls (AICPA 2002).&nbsp; Internal controls in the revenue arena are now more important than ever. The current paper provides a control review checklist for the revenue cycle that will aid managers and independent auditors in the consumer products industry. The checklist is applicable for firms at various levels of the distribution channel and can be used as a general benchmark to perform preliminary evaluations of a company&rsquo;s internal control system. Auditors can compare their company&rsquo;s control objectives with the objectives that are presented. During preliminary investigations of the company&rsquo;s internal control system, auditors should review whether important control objectives have been omitted and whether the omission incurs or heightens risk. The control review checklist can also be used by CFOs or Controllers in the Consumer Products industry in reviewing whether their company&rsquo;s internal control systems are adequate.&nbsp; The checklist provides CFOs or Controllers internal controls that external, independent auditors consider to be important