Throat and rectal swabs may have an important role in MRSA screening of critically ill patients.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem in intensive care units (ICU). International guidelines recommend screening patients for MRSA on admission, although consensus on sites required for optimum detection has not been reached. Our aim was to determine whether throat and rectal swabs identified a significant number of additional MRSA-colonised patients not captured by swabbing at keratinized skin carriage sites (anterior nares, perineum and axillae). DESIGN: Prospective cohort study. SETTING: 30-Bed medical and surgical ICU in a tertiary teaching hospital. PATIENTS: One thousand four hundred and eighty adult patients consecutively admitted over 15 months. MEASUREMENTS AND RESULTS: Swabs from carriage sites (anterior nares, perineum, axillae, throat and rectum), wounds and clinical samples taken within 48 h of ICU admission were analysed to identify patients admitted with MRSA. A complete set of carriage swabs were received from 1,470 patients. 105 (7%) patients were admitted with MRSA of which 63 (60%) were detected by a pooled keratinized skin swab (anterior nares, perineum, axillae). A further 36 (34%) patients were detected only by throat or rectal swabs. Indeed, throat and rectal swabs combined had a higher sensitivity than pooled keratinised skin swabs (76 vs. 60% P = 0.0247). Swabs from all carriage sites together detected 95% (100) of MRSA positive patients, with five patients being positive at wound sites only. CONCLUSIONS: The throat and rectum are important and potentially hidden sites of MRSA carriage in critically ill patients. These findings prompt the need for larger studies to determine the most cost-effective screening strategy for MRSA detection. DESCRIPTOR: Non-pulmonary nosocomial infections

The effect of firms reporting to the Carbon disclosure project on their CO2 emissions.: An empirical study based on the synthetic control approach

Whoever is not “green” is not “in”. That’s the latest trend of the market. This environmental movement pushes the companies to review their policies and assure a sustainable development by reducing their Carbon Dioxide (CO2) emissions and use of natural resources or in general show an eco-friendly behaviour. The objective of our work is to assess the pertinence of green policy introduction at the business level. For our analysis, we are using unique data sets of the firm’s CO2 emissions. We built our data by adding several firms’ characteristics to an initial database provided by South Pole Group. Based on particular companies’ specificities we were then able to select the suitable treated and control groups. Carbon Disclosure Project (CDP) is a non-profit organisation allowing companies to report and manage their emissions, climate risk and reduction goals. And in our study, we intend to evaluate whether signing up to the CDP has a positive effect on the firms’ emissions. It is a typical causal effect evaluation problem that we solve using a relatively new approach called “Synthetic Control Method (SCM)” introduced by Abadie and Gardeazabal (2003). The objective of this method is to build the synthetic control unit, which is the weighted combinations of available control units that most closely resemble the treated unit before the treatment in term of different characteristics. This synthetic control unit allows us to define the counterfactual outcome, that is then compared to the actual outcome to evaluate the treatment effect. We chose the synthetic control method because it allows researchers to analyse phenomena that occur in a limited population or that apply to only a small number of firms, which is ideally suited to our problematic. Almer and Winkler (2013) used this method in environmental problematic, but to our knowledge, it has never been applied to evaluate firms’ politics, and indeed we will use this approach to analyse the environmental programme at a company level. To complete the investigation of the general impact of this program on firms’ emissions, we also focus on three geographic regions: the United States (US), the United Kingdom (UK), and the rest of European Union (EU)

State space modelling of extreme values with particle filters

State space models are a flexible class of Bayesian model that can be used to smoothly capture non-stationarity. Observations are assumed independent given a latent state process so that their distribution can change gradually over time. Sequential Monte Carlo methods known as particle filters provide an approach to inference for such models whereby observations are added to the fit sequentially. Though originally developed for on-line inference, particle filters, along with related particle smoothers, often provide the best approach for off-line inference. This thesis develops new results for particle filtering and in particular develops a new particle smoother that has a computational complexity that is linear in the number of Monte Carlo samples. This compares favourably with the quadratic complexity of most of its competitors resulting in greater accuracy within a given time frame. The statistical analysis of extremes is important in many fields where the largest or smallest values have the biggest effect. Accurate assessments of the likelihood of extreme events are crucial to judging how severe they could be. While the extreme values of a stationary time series are well understood, datasets of extremes often contain varying degrees of non-stationarity. How best to extend standard extreme value models to account for non-stationary series is a topic of ongoing research. The thesis develops inference methods for extreme values of univariate and multivariate non-stationary processes using state space models fitted using particle methods. Though this approach has been considered previously in the univariate case, we identify problems with the existing method and provide solutions and extensions to it. The application of the methodology is illustrated through the analysis of a series of world class athletics running times, extreme temperatures at a site in the Antarctic, and sea-level extremes on the east coast of England

The Labour movement in Nottingham 1880-1918

This study of the Labour Movement in Nottingham 1880-1918 sets out to examine the development in size, self confidence and influence of the working class institutions built by the men and women workers of Nottingham in a period when Socialism in all its variegated forms was becoming the established philosophy of the British working class.Attention is given to the manner in which the Nottingham workers responded to the specific threats and challenges of the period. The main concern of the thesis, however, is to try to understand how it was that although in 1873 the vangard of the local labour movement could earn for Nottingham the description of "advanced" or ''banner town", its developed mass movement was in 1918 being described as "the despair of labour politicians".Part of the explanation for this seeming paradox, it is suggested lies in demographic factors which, up until the First World War, gave'control of the Trades Council to an alliance ot aristocratic lace workers and newly urbanised colliers who tor many years were politically dominated by Liberal coal owners. It is also argued that political "accidents" of personality and geographical factors which ensured that Parliamentary "two member" alliances could not be struck with the Liberals need to be taken into consideration.Less certainly, the geological conditions of the Nottinghamshire coalfield which may have dampened the militancy of the mining community are pointed to as a possible retarding factor. Similarly, it is argued that the appeal of protectionism for some lace workers, and the a-political or anti-political attitudes of the exceptionally large female proletariat were together with the attitudes of the casual poor important special elements in the Nottingham situation which helped to explain its relative backwardness

Practical aspects of treatment with drotrecogin alfa (activated)

In November 2001, drotrecogin alfa (activated) was approved by the US Food and Drug Administration; in August 2002 it was approved by the European Medicines Agency. Since the approval of drotrecogin alfa (activated), however, critical care physicians have been faced with several challenges, namely its costs, selection of patients who are more likely to benefit from it, and the decision regarding when to start drotrecogin alfa (activated) treatment. There are also operational issues such as how to manage the infusion to deliver an effective treatment while minimizing the risk for bleeding, particularly in patients with deranged clotting, at around the time of surgery or during renal replacement therapy. While addressing these issues, this review remains practical but evidence based as much as possible

A multi‐scale framework for flood risk analysis at spatially distributed locations

This paper presents a multi‐scale framework for flood risk analysis from fluvial and coastal sources at broad (including national) scales. The framework combines an extreme value spatial model of fluvial and coastal flood hazards using the Heffernan and Tawn conditional dependence model, with a new Markov approach to representing the spatial variability of flood defences. The nested multi‐scale structure enables spatial and temporal dependence at a national scale to be combined with detailed local analysis of inundation and damage. By explicitly considering each stage of the process, potential uncertainties in the risk estimate are identified and can be communicated to end users to encourage informed decision making. The framework is demonstrated by application to an insurance portfolio of static caravan sites across the UK worth over £2bn. In the case study, the largest uncertainties are shown to derive from the spatial structure used in the statistical model and limited data on flood defences and receptor vulnerability

Randomized trial evaluating serial protein C levels in severe sepsis patients treated with variable doses of drotrecogin alfa (activated)

International audienceINTRODUCTION: Serial alterations in protein C levels appear to correlate with disease severity in patients with severe sepsis, and it may be possible to tailor severe sepsis therapy with the use of this biomarker. The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis. METHODS: This was a phase 2 multicenter, randomized, double-blind, controlled study. Adult patients with two or more sepsis-induced organ dysfunctions were enrolled. Protein C deficient patients were randomized to standard therapy (24 μg/kg/hr infusion for 96 hours) or alternative therapy (higher dose and/or variable duration; 24/30/36 μg/kg/hr for 48 to 168 hours). The primary outcome was a change in protein C level in the alternative therapy group, between study Day 1 and Day 7, compared to standard therapy. RESULTS: Of 557 patients enrolled, 433 patients received randomized therapy; 206 alternative, and 227 standard. Baseline characteristics of the groups were largely similar. The difference in absolute change in protein C from Day 1 to Day 7 between the two therapy groups was 7% (P = 0.011). Higher doses and longer infusions were associated with a more pronounced increase in protein C level, with no serious bleeding events. The same doses and longer infusions were associated with a larger increase in protein C level; higher rates of serious bleeding when groups received the same treatment; but no clear increased risk of bleeding during the longer infusion. This group also experienced a higher mortality rate; however, there was no clear link to infusion duration. CONCLUSIONS: The study met its primary objective of increased protein C levels in patients receiving alternative therapy demonstrating that variable doses and/or duration of drotrecogin alfa (activated) can improve protein C levels, and also provides valuable information for incorporation into potential future studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00386425