Patients' advocacy: the development of a service at the State Hospital, Carstairs, Scotland

Advocacy is part of the process of empowering patients and involving them in the development of services. This paper describes the development of an advocacy service in the State Hospital at Carstairs and explores the issues involved in advocacy in a maximum secure environment. Using a model of citizen advocacy the service was started in September 1997. Patient involvement throughout the hospital was high with approximately 88% of patients having some contact with the service by January 2000. Most of the issues raised by patients are similar to those in any mental health advocacy project. Entrapment is a particular issue for some patients. Safety and security issues influence every aspect of the service. This ranges from advocates having to do more for patients rather than enable them to do things for themselves (e.g. make telephone calls) to the principle of the patients' wishes being paramount being tempered by security demands

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network

OBJECTIVE To investigate clinically relevant microbiological characteristics of uropathogens and to compare patients with catheter-associated urinary tract infections (CAUTIs) to those with non-CAUTIs. METHODS All urine cultures from the calendar year 2019 of the Swiss Centre for Antibiotic Resistance database were analyzed. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from CAUTI and non-CAUTI samples were investigated. RESULTS Data from 27,158 urine cultures met the inclusion criteria. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis together represented 70% and 85% of pathogens identified in CAUTI and non-CAUTI samples, respectively. Pseudomonas aeruginosa was significantly more often detected in CAUTI samples. The overall resistance rate for the empirically often-prescribed antibiotics ciprofloxacin (CIP), norfloxacin (NOR), and trimethoprim-sulfamethoxazole (TMP-SMX) was between 13% and 31%. Except for nitrofurantoin, E. coli from CAUTI samples were more often resistant (P ≤ .048) to all classes of antibiotics analyzed, including third-generation cephalosporines used as surrogate for extended-spectrum β-lactamase (ESBL). Significanty higher resistance proportions in CAUTI samples versus non-CAUTI samples were observed for CIP (P = .001) and NOR (P = .033) in K. pneumoniae, for NOR (P = .011) in P. mirabilis, and for cefepime (P = .015), and piperacillin-tazobactam (P = .043) in P. aeruginosa. CONCLUSION CAUTI pathogens were more often resistant to recommended empirical antibiotics than non-CAUTI pathogens. This finding emphasizes the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives

Synthesis of two-phase polymer particles in supercritical carbon dioxide

The synthesis of particles with discrete phases using traditional emulsion polymerisation is a well-established process. Phase-separated particles have a wide range of applications, such as in coatings, drug delivery, impact modification and as supports in catalysis. However, as a dry powder is often desired for the end application, post-polymerisation, energy intensive drying steps are usually required for the removal of water. Alternatively, dispersion polymerisation utilising supercritical carbon dioxide (scCO2) as a reaction medium allows for the production of dry, free-flowing powders upon release of the CO2. Here, we present the innovative use of scCO2 to provide a novel and environmentally acceptable route for creating phase-separated particles. Particles containing a high Tg poly(methyl methacrylate) (PMMA) phase, combined with a low Tg polymer phase of either poly(benzyl acrylate) (PBzA) or poly(butyl acrylate) (PBA), were investigated. Both monomers were added to the reaction after the formation of PMMA seed particles. Benzyl acrylate (BzA) was chosen as a model low Tg monomer, with well-defined and detectable functionality when mixed with PMMA. Butyl acrylate (BA) was also used as an alternative, more industrially relevant monomer. The loading of the low Tg monomer was varied and full characterisation of the particles produced was performed to elucidate their internal morphologies and compositions

Deep Space Network information system architecture study

The purpose of this article is to describe an architecture for the Deep Space Network (DSN) information system in the years 2000-2010 and to provide guidelines for its evolution during the 1990s. The study scope is defined to be from the front-end areas at the antennas to the end users (spacecraft teams, principal investigators, archival storage systems, and non-NASA partners). The architectural vision provides guidance for major DSN implementation efforts during the next decade. A strong motivation for the study is an expected dramatic improvement in information-systems technologies, such as the following: computer processing, automation technology (including knowledge-based systems), networking and data transport, software and hardware engineering, and human-interface technology. The proposed Ground Information System has the following major features: unified architecture from the front-end area to the end user; open-systems standards to achieve interoperability; DSN production of level 0 data; delivery of level 0 data from the Deep Space Communications Complex, if desired; dedicated telemetry processors for each receiver; security against unauthorized access and errors; and highly automated monitor and control

Effects of Hikers and Boats on Tule Elk Behavior in a National Park Wilderness Area

Human disturbance of wildlife may cause disruption of normal feeding, resting, reproduction, or care for juveniles. Such disturbance may be particularly undesirable in federally managed wilderness areas designed to minimize human influences on natural resources. We recorded tule elk (Cervus elephus nannodes) responses (standing, walking away, running) to off-trail hikers, off-shore boats, and other natural and anthropogenic factors in Point Reyes National Seashore in northern California during 2002 to 2008. Most disturbance behaviors were related to other elk exhibiting rutting behaviors, but off-trail hikers still explained a 100% increase and off-shore boats a 15% increase in baseline disturbance behaviors by elk. However, off-trail hikers and boats did not cause elk to enter or leave the study area during the sample periods. Elk were more prone to human disturbance when herd sizes wereand, to a lesser extent, offshore boats appear to disturb natural tule elk behavior, but the physiological or population-level effects of this disturbance are unknown. Our quantitative results may help park managers minimize or mitigate human–elk interactions in wilderness areas

Effects of vitamin D deficiency on neurobehavioural outcomes in children: a systematic review

Introduction: Vitamin D plays an important role in brain development in experimental studies; however, the effect of vitamin D deficiency on child development remains inadequately characterized. We aimed to estimate the effects of vitamin D deficiency on neurobehavioural outcomes in children up to 18 years of age. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus, Cochrane Library, Web of Science and Open Grey for published studies up to 10th January 2020. We included all studies that assessed the effects of maternal or child vitamin D status or vitamin D supplementation on neurobehavioural outcomes in children. Study findings were synthesized qualitatively as the high level of heterogeneity in study populations and methodologies precluded a quantitative meta-analysis. Results: Our search identified 5,633 studies, of which 31 studies with 31,375 participants from 18 countries were included in the systematic review. Of the studies identified, one was a randomised controlled trial (RCT) of vitamin D supplementation in children, while 30 were observational. The RCT (n=55) reported a beneficial effect of supplementation with lower doses compared to higher doses of vitamin D on motor development. Twelve mother-child studies (n=17,136) and five studies in children (n=1,091) reported an association between low maternal or child 25-hydroxyvitamin D levels and impaired neurobehavioural outcomes in children, while 15 mother-child studies (n=20,778) and eight studies in children (n=7,496) reported no association. Conclusions: Although animal studies point to an effect of vitamin D deficiency on brain development, there are few studies on the effects of vitamin D deficiency on neurobehavioural outcomes in children and their findings are inconsistent. There is a need for well-conducted, adequately powered studies to further determine these effects in children

Upper ocean manifestations of a reducing meridional overturning circulation

Most climate models predict a slowing down of the Atlantic Meridional Overturning Circulation during the 21st century. Using a 100year climate change integration of a high resolution coupled climate model, we show that a 5.3Sv reduction in the deep southward transport in the subtropical North Atlantic is balanced solely by a weakening of the northward surface western boundary current, and not by an increase in the southward transport integrated across the interior ocean away from the western boundary. This is consistent with Sverdrup balance holding to a good approximation outside of the western boundary region on decadal time scales, and may help to spatially constrain past and future change in the overturning circulation. The subtropical gyre weakens by 3.4Sv over the same period due to a weakened wind stress curl. These changes combine to give a net 8.7Sv reduction in upper western boundary transport. © 2012. American Geophysical Union. All Rights Reserved

Eddy Impacts on the Florida Current

The Gulf Stream in the Atlantic carries warm water northwards and forms both the return closure of the subtropical gyre as well as the upper limb of the meridional overturning circulation. Recent time series recorded east of the Bahamas at 26°N indicate that from May 2009 to April 2011, in contrast with past observations, the northward flowing Antilles Current covaried with the Gulf Stream in the Florida Straits—the Florida Current—even though the Florida and Antilles Currents are separated by banks and islands spanning 150?km. The peak-to-trough amplitude of transport variations during this period was 15?×?106?m3?s?1 for the Florida Current and 12?×?106?m3?s?1 for the Antilles Current, at time scales of 50?days to a year. From satellite observations, we show that the fluctuations in both the Florida and Antilles Currents between May 2009 and April 2011 are driven by eddy activity east of the Bahamas. Since the Florida Current time series is a critical time series for the state of the oceans, and often compared to climate models, this newly identified source of variability needs careful consideration when attributing the variability of the Florida Current to changes in the larger-scale circulations (e.g., gyre and overturning) or wind forcing.<br/

Hierarchy and Feedback in the Evolution of the E. coli Transcription Network

The E.coli transcription network has an essentially feedforward structure, with, however, abundant feedback at the level of self-regulations. Here, we investigate how these properties emerged during evolution. An assessment of the role of gene duplication based on protein domain architecture shows that (i) transcriptional autoregulators have mostly arisen through duplication, while (ii) the expected feedback loops stemming from their initial cross-regulation are strongly selected against. This requires a divergent coevolution of the transcription factor DNA-binding sites and their respective DNA cis-regulatory regions. Moreover, we find that the network tends to grow by expansion of the existing hierarchical layers of computation, rather than by addition of new layers. We also argue that rewiring of regulatory links due to mutation/selection of novel transcription factor/DNA binding interactions appears not to significantly affect the network global hierarchy, and that horizontally transferred genes are mainly added at the bottom, as new target nodes. These findings highlight the important evolutionary roles of both duplication and selective deletion of crosstalks between autoregulators in the emergence of the hierarchical transcription network of E.coli.Comment: to appear in PNA