Hospital-associated infections (HAIs) are infections patients contract as a result of being hospitalized. HAI rates decreased for almost all pathogens in the past few years, with the exception of Clostridium difficile infections (CDIs), which have been steadily climbing, placing hospital-acquired CDI at the top of the HAI list. The Center for Disease Control and Prevention reported in 2010 almost a half a million people were infected with CDIs yearly in the United States, and CDIs claimed the lives of approximately 29,000 people, representing a 4-fold increase from 1993. To address the problem in the local hospital, a quality improvement initiative called Bleach-It-Away was initiated. The initiative involved nurses wiping down the high touch areas in the patient's medical intensive care (MICU) rooms once every shift. The purpose of this quantitative research project was to evaluate the effectiveness of the Bleach-It-Away practice. The project question asked if the Bleach-It-Away practice was effective in reducing CDI rates. Deidentified CDI rates were provided by the clinical practice site covering a period of 12 months prior to implementation and 12 months after implementation of the practice. An independent t-test was used to determine whether there were significant improvements in CDI rates in the MICU. No significant improvement was seen in the postimplementation total CDI rates (p=.07) compared to the preimplementation rates. While the process did not demonstrate a significant improvement, positive social change is possible as hospitals recognize the many factors contributing to CDIs and the need for collaboration from various disciplines to control the problem.

Made available in DSpace on 2014-06-12T17:21:54Z (GMT). No. of bitstreams: 2 arquivo626_1.pdf: 999304 bytes, checksum: 14f6bb3d425e654951165d07f691a6f2 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / O Setor de Distribuição de Energia Elétrica demanda elevados investimentos para expansão e melhoria de seus sistemas. Dessa forma, as distribuidoras acessam com freqüência o mercado financeiro em busca de financiamentos, seja através das agências de fomento como o Banco Nacional de Desenvolvimento Econômico e Social (BNDES) ou através do mercado de capitais, com emissões de debêntures, entre outras alternativas. As dívidas contratadas podem ser remuneradas por diversos tipos de indexadores. Esse trabalho investiga os indexadores atrelados ao endividamento de distribuidoras de energia elétrica, para a discussão da carteira de indexadores da Companhia de Eletricidade de Pernambuco (Celpe). Adicionalmente, realiza comparação da carteira de indexadores da Celpe com carteira de alocação ótima calculada através da Moderna Teoria de Portfólios. A Celpe foi privatizada no ano 2000, e desde então vem contratando diversas operações para financiamento de suas atividades com a utilização de indexadores variados. Para levantamento dos indexadores das distribuidoras no período de 2004 a 2008 foram selecionadas oito concessionárias entre as dez de capital aberto que apresentaram maior endividamento bruto ao final de 2008. Após análise das notas explicativas que constam das Demonstrações Financeiras Padronizadas das distribuidoras, foi identificado que os indexadores mais utilizados pelas mesmas são a taxa do Certificado de Depósitos Interbancário (CDI), a taxa de juros de longo prazo (TJLP), o Índice Geral de Preços do Mercado (IGP-M), entre outros. Adicionalmente, as distribuidoras localizadas na região nordeste utilizam a linha de crédito do Banco do Nordeste do Brasil (BNB), com recursos prefixados do Fundo Constitucional de Financiamento do Nordeste (FNE). Apesar de apresentarem diferentes concentrações de indexadores da dívida, que podem ser explicadas por diferenças regionais, o indexador CDI é predominante. Ao comparar a carteira de indexadores das distribuidoras com a da Celpe, observa-se uma semelhança no que diz respeito à predominância do CDI como indexador de referência. Já na comparação com a carteira de indexadores de alocação ótima e os indexadores da Celpe, sugere-se um ajuste na alocação de indexadores com redução da exposição ao CDI e inclusão do Índice de Preços ao Consumidor Amplo (IPCA) como indexador da dívida

Made available in DSpace on 2014-06-12T23:13:52Z (GMT). No. of bitstreams: 2 arquivo2950_1.pdf: 1304284 bytes, checksum: e378bb9e29624b94c930b4edfbdd07d5 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011 / Faculdade de Amparo à Ciência e Tecnologia do Estado de Pernambuco / O câncer de tecido mamário é o segundo tipo de câncer mais freqüente no mundo e o mais comum entre as mulheres. Dentre os tumores malignos de mama, o carcinoma ductal invasivo (CDI) representam o maior grupo, constituindo cerca de 65 a 80% dos carcinomas mamários. O perfil morfológico e molecular desse carcinoma é bastante heterogêneo, apresentando características bastante variáveis. Uma célula cancerosa não expressa erroneamente apenas proteínas e DNA, mas carboidratos também, o que impulsiona a glicobiologia voltada para dignóstico, prognóstico e terapêuica, sendo as lectinas, uma ferramenta auxiliar. Outra molécula de valor diagnóstico e prognóstico é c-erbB-2 que tem papel chave na proliferação, adesão, diferenciação e motilidade celular. O trabalho objetivou avaliar o perfil de N-aceti-galactosamina em glicoconjugados celulares empregando a histoquímica com lectinas e o perfil imunohistoquímico para c-erbB-2 no CDI. Foram utilizadas 61 biópsias do Setor de Anatomia Patologia do Hospital das Clínicas da Universidade Federal de Pernambuco. Na histoquímica com lectinas os tecidos foram tratados com tripsina e incubados com as lectinas Dolichos biflorus agglutinin (DBA) e Vicia villosa agglutinin (VVA), específicas para N-acetilgalactosamina (GalNAc), conjugadas a biotina (de 80μg/mL). Para a investigação da proteína c-erbB-2 foi utilizado o método da estreptavidina-biotina-peroxidase. Para a revelação, foi utilizada uma solução de diaminobenzidina (DAB) e H2O2. O perfil de c-erbB-2 apresentou correlação entre a sua superexpressão e o grau histológico e a observação de invasão linfonodal. O CDI apresentou um perfil de reconhecimento para GalNAc diferente para as lectinas estudadas. Não se verificou nenhuma relação entre os achados histoquímicos para VVA e DBA e imunohistoquímicos para c-erbB-2. Resultados demonstram a histoquímica com Lectina como uma técnica auxiliar para avaliação do perfil de glicoconjugados no câncer de mama

Loop-mediated isothermal DNA amplification (LAMP) are currently used as standalone diagnostic test for C. difficile infection (CDI). We assessed the diagnostic accuracy of LAMP for the diagnosis of CDI. We searched 5 databases to identify studies that compared LAMP with culture cytotoxicity neutralization assay or anaerobic toxigenic culture (TC) of C. difficile. We used the random-effects model to calculate pooled sensitivities, specificities, diagnostic odds ratios and their 95% confidence intervals (CIs). The search of the databases yielded 16 studies (6,979 samples) that met inclusion criteria. When TC was used as the gold standard (6,572 samples), bivariate analysis yielded a mean sensitivity of 0.95 (95%CI, 0.93-0.97; I2 = 67.4) and a mean specificity of 0.99 (95%CI, 0.96-1.00; I2 = 97.0). LAMP is a useful diagnostic tool with high sensitivity and specificity for detecting CDI. The results should however be interpreted only in the presence of clinical suspicion and symptoms of CDI. / Revisión por pares

Biological tissues are generally conductive and knowing the current distribution in these tissues is of great importance in many biomedical applications. Radio frequency current density imaging (RF-CDI) is a technology that measures current density distributions at the Larmor frequency utilizing magnetic resonance imaging (MRI). RF-CDI computes the applied current density, J, from the non-invasively measured magnetic field, H, produced by J. The previously implemented RF-CDI techniques could only image a single slice at a time. The previous method for RF current density reconstruction only computed one component of J. Moreover, this reconstruction required an assumption about H, which may be easily violated. These technical constraints have limited the potential biomedical applications of RF-CDI. In this thesis, we address the limitations of RF-CDI mentioned above. First, we implement a multi-slice RF-CDI sequence with a clinical MRI system and characterize its sensitivity to MRI random noise. Second, we present a novel method to fully reconstruct all three components of J without relying on any assumption of H. The central idea of our approach is to rotate the sample by 180 degrees in the horizontal plane to collect adequate MR data from two opposite sample orientations to compute one component of J. Furthermore, this approach can be extended to reconstruct the other two components of J by adding one additional sample orientation in the horizontal plane. This method has been verified by simulations and electrolytic phantom experiments. We have therefore demonstrated for the first time the feasibility of imaging the magnitude and phase of all components of the RF current density vector. The work presented in this thesis is expected to significantly enhance RF-CDI to image biological subjects. The current density vector J or any component of J can be measured over multiple slices without the compromise of motions of organs and tissues caused by gravitational force, thanks to the method of horizontal rotations. In addition, the reconstruction of the complex conductivity of biological tissues becomes possible due to the current advance in RF-CDI presented here.

Biological tissues are generally conductive and knowing the current distribution in these tissues is of great importance in many biomedical applications. Radio frequency current density imaging (RF-CDI) is a technology that measures current density distributions at the Larmor frequency utilizing magnetic resonance imaging (MRI). RF-CDI computes the applied current density, J, from the non-invasively measured magnetic field, H, produced by J. The previously implemented RF-CDI techniques could only image a single slice at a time. The previous method for RF current density reconstruction only computed one component of J. Moreover, this reconstruction required an assumption about H, which may be easily violated. These technical constraints have limited the potential biomedical applications of RF-CDI. In this thesis, we address the limitations of RF-CDI mentioned above. First, we implement a multi-slice RF-CDI sequence with a clinical MRI system and characterize its sensitivity to MRI random noise. Second, we present a novel method to fully reconstruct all three components of J without relying on any assumption of H. The central idea of our approach is to rotate the sample by 180 degrees in the horizontal plane to collect adequate MR data from two opposite sample orientations to compute one component of J. Furthermore, this approach can be extended to reconstruct the other two components of J by adding one additional sample orientation in the horizontal plane. This method has been verified by simulations and electrolytic phantom experiments. We have therefore demonstrated for the first time the feasibility of imaging the magnitude and phase of all components of the RF current density vector. The work presented in this thesis is expected to significantly enhance RF-CDI to image biological subjects. The current density vector J or any component of J can be measured over multiple slices without the compromise of motions of organs and tissues caused by gravitational force, thanks to the method of horizontal rotations. In addition, the reconstruction of the complex conductivity of biological tissues becomes possible due to the current advance in RF-CDI presented here.

The study examined the reliability of parents' reports of their child's verbal skills. Parents to 17 children participated and completed the toddler version of the MacArthur-Bates Communicative Development Inventory (CDI). It was found that the correlation between the reports made by the mothers and fathers was very strong. All in all the parents had a very similar understanding of their child's verbal skills. / Denna studie undersökte hur väl föräldrars rapport av deras barns språkförmåga stämmer överens. Föräldrarna till 17 barn deltog och fyllde i toddler-versionen av the MacArthur-Bates Communicative Development Inventory (CDI). Korrelationen mellan mammornas och pappornas rapportering var mycket stark. Överlag så hade föräldrarna en mycket liknande uppfattning av deras barns språkförmåga.

The number of cases of Clostridium difficile infection (CDI) has been increasing globally. CDI is the main cause of nosocomial diarrhoea, which may be life-threatening in complicated cases, and also costs the health care societies millions of pounds annually. The predominant types and their resistance to antibiotics have been changing and one of the major selective pressures which causes this is antimicrobial use. Although much is known about the role of the toxins in pathogenesis of CDI, the role of immunogenic cell wall components is unclear. They may play a role in colonisation and pathology and a study of these could clarify the infection process. It is therefore important to study the immune responses against these bacterial wall components from different strains and their effects on stimulation of leukocytes to produce cytokines and chemokines. This study was divided into four parts: 1. An epidemiological study to determine frequencies of the predominant types of C. difficile, thus 140 C. difficile isolates from surgical patients and their environment during 2009 were investigated to define their PCR ribotype. This utilised capillary sequencing gel electrophoresis for their analysis. 2. The determination of antimicrobial susceptibility to six antibiotics (ampicillin, erythromycin, tetracycline, metronidazole, moxifloxacin and vancomycin) was assessed and MIC determination by agar dilutions. 3. Investigation of host immunity to molecules with conserved molecular patterns. Surface-layer proteins (SLPs), lipocarbohydrate (LC) and flagellar proteins were separated and purified from five ribotypes of C. difficile (001, 002, 027, 078 and106) predominant in Scotland. a) The immune responses to these molecules were assessed by ELISA by exposing serum of patients and healthy donors and measuring specific IgG levels. b) Innate immunity was investigated by distinguishing responses of a macrophage cell line (THP1) to the above molecules. Induction of interleukins (IL)-1β, IL-6, IL- 8, IL-10 and IL-12 interleukins and TNF-α was detected by ELISA. In this study 15 different ribotypes were identified. The most frequent were 001, 020, 106 ribotypes (52.8%, 7.4% and 5.7%), respectively, while 13 isolates could not be assigned a ribotype. However, all isolates were sensitive to vancomycin, metronidazole and moxifloxacin, but 74.28% of isolates were resistant to erythromycin. The IgG level against bacterial antigens (SLPs, LC and flagella proteins) in donors’ serum showed almost normal distribution to all antigens from the different ribotypes and the sensitivity of the assays was increased by raising the concentration of antigens. Levels to SLPs were generally the highest, but the flagellar protein exceeded the SLPs of the 027 ribotype. The donors, controls, patients and carrier sera gave similar results. The greatest induction of interleukins was obtained using 50μg of antigen with the THP-1 cells activated with 50ng of PMA. The highest induction of all antigens was for IL-10. The highest values for the control LPS was with IL-12. But the best effect for SLPs of 027 was for IL-10 (109.1ng/ml), while the weakest for TNF for SLPs of 027 (4.7ng/ml). In general the IL-1β, IL-6, IL-8 and TNF concentrations ranged from 4.7-60ng/ml for all antigens and in contrast IL-12 and IL-10 average ranged 11- 109.1ng/ml. To conclude, the prevalence of C. difficile and their antibiotic susceptibility are constantly changing. IgG antibodies to SLPs and flagellar proteins from the hypervirulent ribotype 027 were highest in the community and hospitalized individuals. The molecules of conserved molecular patterns are immunogenic with various levels of response in the monocytic THP1 cells. SLPs were best in inducing interleukins. Flagellar proteins from 027 ribotypes accompanied SLPs in IL-10 induction levels. Consequently SLPs and flagellar proteins from 027 ribotypes appeared the best immunogenic bacterial molecules.

Class of 2009 Abstract / OBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.

<p>Ångestsyndrom tillhör den vanligaste psykiatriska problematiken hos barn. Ångestsyndrom börjar ofta i tidig ålder, medför stort lidande och predicerar psykiatrisk problematik senare i livet. Det är viktigt att undersöka hur ångestsyndrom kan förebyggas eftersom få barn med denna problematik kommer i kontakt med behandling. Syftet med studien var att undersöka om FRIENDS, ett preventionsprogram från Australien, fungerar i en svensk kontext. Femtio barn i nioårsåldern undervisades i FRIENDS under tio lektioner. Barnens ångestsymptom, depressionssymptom och generella psykiska hälsa mättes vid tre tillfällen med formulären SCAS, CDI och SDQ. Mätningarna skedde tio veckor innan interventionen, veckan innan och veckan efter interventionen. Resultaten visade att FRIENDS minskade barnens depressionssymptom samt minskade ångest hos barn med förhöjd risk för ångestproblematik. Efter FRIENDS skattade lärarna lägre tendens till psykisk ohälsa hos barnen. Enligt utvärderingen var barn och föräldrar nöjda med programmet. Sammantaget visar studien att FRIENDS är en lovande intervention i en svensk kontext.</p>