Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs

Recipes and mechanisms of cellular reprogramming: a case study on budding yeast Saccharomyces cerevisiae

<p>Abstract</p> <p>Background</p> <p>Generation of induced pluripotent stem cells (iPSCs) and converting one cell type to another (transdifferentiation) by manipulating the expression of a small number of genes highlight the progress of cellular reprogramming, which holds great promise for regenerative medicine. A key challenge is to find the recipes of perturbing genes to achieve successful reprogramming such that the reprogrammed cells function in the same way as the natural cells.</p> <p>Results</p> <p>We present here a systems biology approach that allows systematic search for effective reprogramming recipes and monitoring the reprogramming progress to uncover the underlying mechanisms. Using budding yeast as a model system, we have curated a genetic network regulating cell cycle and sporulation. Phenotypic consequences of perturbations can be predicted from the network without any prior knowledge, which makes it possible to computationally reprogram cell fate. As the heterogeneity of natural cells is important in many biological processes, we find that the extent of this heterogeneity restored by the reprogrammed cells varies significantly upon reprogramming recipes. The heterogeneity difference between the reprogrammed and natural cells may have functional consequences.</p> <p>Conclusions</p> <p>Our study reveals that cellular reprogramming can be achieved by many different perturbations and the reprogrammability of a cell depends on the heterogeneity of the original cell state. We provide a general framework that can help discover new recipes for cellular reprogramming in human.</p

Adolescent Daily Cigarette Smoking: Is Rural Residency a Risk Factor?

Introduction: Daily cigarette smoking among US adolescents remains a significant public health problem. Understanding risk is important in order to develop strategies to reduce this type of tobacco use. Purpose: The primary objective of this research was to examine whether rural residency is an independent risk factor for being a daily smoker among adolescents ages 12 to 18 years. Methods: This is a cross-sectional study where univariate, bivariate, and multivariate analyses were performed on a merged 1997- 2003 Youth Risk Behavior Surveillance System dataset to determine whether rural residence was a significant risk factor for daily cigarette smoking, after adjusting for demographic factors. Results: Using daily smoking as the dependent variable, initial multivariate analyses revealed that adolescents who lived either in suburban (OR=.34, CI=.32, .36) or urban (OR=.33, CI=.31, .35) locales were less likely to become daily smokers than adolescents living in rural locales. Subsequent logistic regression analysis yielded that rural youths who became daily smokers were more likely to: have used smokeless tobacco products in the past 12 months (OR=1.25, CI=1.04,1.51); be female (OR=1.42, CI=1.23, 1.64); be Caucasian (OR=1.53, CI=1.28, 1.84); have first smoked a whole cigarette when they were 12 years of age or younger (OR=2.08, CI=1.82, 2.38); and have smoked at school in the past 30 days (OR=14.52, CI=11.97, 17.60). Conclusions: The results indicate that rural residency is a risk factor for tobacco use among US youth

A Resource Management System Based on the ODP Trader Concepts and X.500

Distributed computing systems are composed of various types of hardware and software resources. Providing a reliable and efficient distributed computing environment largely depends on the effective management of these resources and the services that they provide. ISO has begun work on a proposed standard for Open Distributed Processing (ODP). The ODP framework includes a mechanism called the Trader which provides a framework for exchanging services in an open distributed computing environment. This paper presents a design of a resource information management system which employs and extends the ODP Trader concepts to facilitate the management and use of resources, information about resources and the services provided by the resources. We describe the architecture, information model, and user interface of the resource management system. We also describe a prototype implementation which uses the X.500 Directory Service as its repository for resource information and report on our experien..

I 508 Services supporting

management of distributed applications and systems A distributed computing system consists of heterogeneous computing devices, communication networks, operating system services, and applications. As organisations move toward distributed computing environments, there will be a corresponding growth in distributed applications central to the enterprise. The design, development, and management of distributed applications presents many difficult challenges. As these systems grow to hundreds or even thousands of devices and similar or greater magnitude of software components, it will become increasingly difficult to manage them without appropriate support tools and frameworks. Further, the design and deployment of additional applications and services will be, at best, ad hoc without modelling tools and timely data on which to base design and configuration decisions. This paper presents a framework for management of distributed applications and systems. The framework is based on a set of common management services that support management activities. The services include monitoring, control, configuration, and data repository services. A prototype system built on the framework is described that implements and integrates management applications providing visualisation, fault location, performance monitoring and modelling, and configuration management. The prototype also demonstrates how various management services can be implemented. by M. A. Baue

Association of the built environment with physical activity and adiposity in rural and urban youth

OBJECTIVE: To determine if: (1) differences exist for body mass index (BMI) and moderate-to-vigorous physical activity (MVPA) between rural and urban youth, and (2) perceived and objective measures of environmental supports for physical activity differentially correlate with BMI and MVPA in middle school rural and urban youth. METHOD: Cross-sectional analyses were performed in spring 2012 on data collected from December 2008 until May 2010 for 284 middle school youth from a rural county and an adjacent urbanized area. Multivariable linear models estimated associations between BMI/MVPA and perceived environmental barriers/supports for physical activity and objectively measured neighborhood spatial variables. RESULTS: Mean MVPA was significantly lower for rural youth (15.9 minutes/day) compared to urban youth (19.2 minutes/day). No differences were observed between rural and urban youth for BMI or BMI percentile. Significant differences in both perceived and objective correlates for MVPA and BMI percentile were found in multivariable models between rural and urban youth. CONCLUSION: Differences observed for correlates of MVPA and BMI across the settings suggest that rurality should be considered when identifying targets for intervention to promote MVPA and prevent adiposity in youth