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Initiation of the VAP bundle is associated with a significantly reduced incidence of VAP in patients in the SICU and with cost savings. Initiation of a VAP bundle protocol is an effective method for VAP reduction when compliance is maintained.

Objective-To examine the efficacy and safety of conservative management of mild otitis media ("the acute red ear") in children.Design-Double blind placebo controlled trial. Setting-17 group general practices (48 general practitioners) in Southampton, Bristol, and Portsmouth.Patients-232 children aged 3-10 years with acute earache and at least one abnormal eardrum (114 allocated to receive antibiotic, 118 placebo).Interventions -Amoxycillin 125 mg three times a day for seven days or matching placebo; 100ml paracetamol 120 mg/5 ml.Main outcome measures-Diary records of pain and crying, use of analgesic, eardrum signs, failure of treatment, tympanometry at one and three months, recurrence rate, and ear, nose, and throat referral rate over one year.Results -Treatment failure was eight times more likely in the placebo than the antibiotic group (14-4% v 1*7%, odds ratio 8-21, 95% confidence interval 1.94 to 34.7). Children in the placebo group showed a significantly higher incidence of fever on the day after entry (20% v 8%, p<0 05), mean analgesic consumption (0-36 ml/h v 0-21 ml/h, difference 0-14, 95% confidence interval 0-07 to 0-23; p=0.0022), mean duration of crying (1-44 days v 0 50 days, 0 94; 0 50 to 1-38; p<0-001), and mean absence from school (1-96 days v 0 52 days, 1-45; 0-46 to 2-42; p=0-0132). Differences in recorded pain were not significant.The prevalence of middle ear effusion at one or three months, as defined by tympanometry, was not significantly different, nor was there any difference in recurrence rate or in ear, nose, and throat referral rate in the follow up year.

Abstract. the use of true gas plasmas for the inactivation of microorganisms is an area of dynamic research. many types of gases are used as a source of plasma, and different plasma production methods have been applied. the antimicrobial mechanisms of oxygen-based gas plasmas may be due to an etching effect on microbial structures, particularly bacterial endospores resulting in shrinkage. By contrast, the definite mechanisms of actions of other gas plasma sources, such as n 2 , He, Ne, Ar and Xe gases, have not been clearly defined and indeed may be distinct. the speculated mechanisms of these gas plasmas involve the direct attack of metastable (excited molecular), UV and/or VUV to microbial structures, specifically the inner membrane and dna in the core of bacterial endospores. according to this speculation, sterilized spore figures would remain unchanged. However, these mechanisms remain to be clarified. Future perspectives on the use of gas plasma for sterilization are of interest, as it is possible that appropriate sterility assurance levels can be obtained in parallel with material and functional compatibility. Traditional sterilization methods are often limited in these requirements. therefore, gas plasma sterilization may prove to be an appropriate alternative sterilization procedure.

Interferon (IFN) induces transcription of major histocompatibility class I genes by way of the conserved cis-acting regulatory element, termed the IFN consensus sequence (ICS). Binding of nuclear factors to the ICS was studied in gel mobility shift assays with the 5' upstream region of the murine H-2Ld gene. We found that the ICS binds a constitutive nuclear factor present in lymphocytes and fibroblasts regardless of IFN treatment. (12-20 ,ug) was incubated with the end-labeled probe (5000 cpm, 0.1-0.5 ng) and 2.5 jig of poly(dI-dC)poly(dI-dC) (Pharmacia) in [20][21][22][23][24][25][26][27][28][29][30] Al of a solution of 10 mM Tris HCl (pH 7.5), 50 mM NaCl, 1 mM EDTA, 1 mM dithiothreitol, and 10% (vol/vol) glycerol for 15-20 min at room temperature. The mixtures were electrophoresed in a 4% polyacrylamide gel in 0.4 x Tris/EDTA/borate buffer (18) at 150 V for 2 hr. Methylation interference experiments were performed as described (18,20).Site-Directed Mutagenesis and Chloramphenicol Acetyltransferase (CAT) Assay. Site-directed mutagenesis was performed as described by Taylor et al. (21) by using the =400-base-pair (bp) Xba I-HindIII fragment of the H-2Ld gene containing the ICS and the class I regulatory element (CRE) (22, 23) (see Fig. 1C Table 3). Mutant CAT genes were introduced transiently into Ltk -cells (9) IFN-a/,B at 800 units/ml for 12-14 hr, and CAT activity of each culture was measured.

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