Hanne Foss Hansen

Excretion of ciprofloxacin in sweat and multiresistant Staphylococcus epidermidis

BACKGROUND Staphylococcus epidermidis develops resistance to ciprofloxacin rapidly. That this antibiotic is excreted in apocrine and eccrine sweat of healthy individuals might be the reason for the development of such resistance. We assessed whether S epidermidis isolated from the axilla and nasal flora of healthy people could develop resistance to ciprofloxacin after a 1-week course of this antibiotic. METHODS The concentration of ciprofloxacin in sweat was measured in seven volunteers after oral administration of 750 mg ciprofloxacin twice daily for 7 days, and the development of resistance in S epidermidis from axilla and nostrils was monitored during and 2 months after the treatment. Genotyping of S epidermidis was done by restriction fragment length polymorphism. FINDINGS The mean concentration of ciprofloxacin in sweat increased during the 7 days of treatment-from 2.2 micrograms/mL 2.5 h after the first tablet to 2.5 micrograms/mL after the fifth tablet, and 5.5 micrograms/mL after the 13th tablet. All persons harboured susceptible S epidermidis (minimal inhibitory concentration [MIC] 0.25 microgram/mL) in axilla and nostrils before treatment. Four resistant strains were detected, two intermediate-level (MIC 4-12 micrograms/mL) and two high-level (MIC > 32 micrograms/mL). Three of these strains were found in all the participants, and a ciprofloxacin-sensitive variant of one of the high-level resistant strains was also found before the start of the treatment. The high-level resistant strains were also resistant to methicillin, erythromycin, gentamicin, sulphonamide, and trimethoprim. A mean of 2.7 days after the start of the treatment, development of ciprofloxacin resistance was detected in S epidermidis from the axilla of all persons, compared with 11 days for the appearance of resistant S epidermidis in nostrils. The resistant strains persisted for an average of 37 and 39 days in axilla and nostrils, respectively, after the end of the treatment. INTERPRETATION The rapid development of resistance to ciprofloxacin due to excretion of this drug into the sweat might be involved in the development of multiresistant S epidermidis and possibly other skin bacteria in hospitals and in communities with high use of ciprofloxacin or related drugs.

Choosing Evaluation Models A Discussion on Evaluation Design

A variety of different evaluation models are presented in the evaluation literature. These mostly fall into the following categories: results models, process models, system models, economic models, actor models, and programme theory models. This raises the question:‘how can evaluation sponsors and evaluators decide how to design an evaluation with so many models to choose from?’ In this article, several - mutually incompatible - recommendations are discussed. Design should be determined by the purpose of the evaluation, the object of evaluation or the problem to be solved by the evaluated programme or agency. The recommendations are based on different rationales: goals-means, context-based values and programme theory. Furthermore, in practice other logics may influence the evaluation design processes. Four hypotheses concerning such logics are proposed: negotiation, appropriateness,‘routine’ and projection of competence.

The Evidence Movement: The Development and Consequences of Methodologies in Review Practices

The evidence movement and the idea of systematic reviews, defined as summaries of the results of already existing evaluation and research projects, have gained considerable support in recent years as many international as well as national evidence-producing organizations have been established. This article analyses how the idea is practised in the areas of health, social welfare and education and shows that evidence-producing organizations work differently. Some subscribe to the hierarchy of evidence, others to a typology of evidence. The consequences of these variations are discussed.

Public Organizations, Multiple Constituencies, And Governance

Public organizations vary considerably. Yet little attention has been paid to the systematic analysis of this diversity. Drawing on case studies of four public organizations and a survey on all central government organizations in Denmark, variations in tasks, environments, constituencies, and central governance are conceptualized. Public organization tasks can be analysed at three levels ranging from user-oriented outputs, general outputs which can further be divided into policy goals, scope of profile, standard setting and capital accumulation, to the normative base of the public sector. Public organizations vary with regard to the emphasis put on level of output and on how the different aspects of the tasks are interrelated. Variations in constituencies and exchange cycles with the environment are further related to different task profiles. Finally it is shown that central oversight organizations compete with other actors in the public organizations’ environment in the governance of public organizations. From an organizational point of view ‘the state’ appears to have a humble and remote position.

The Construction and Standardization of Evaluation: The Case of the Danish University Sector

Evaluation as an organizational element has spread across countries and organizational fields. Yet little attention has been paid to the comparative analysis of adoption, construction and implementation processes of evaluation within different organizational fields. The article is based on an empirical study of research evaluation and evaluation of education within the Danish university sector. It conceptualizes and explains similarities and differences in adoption processes and constructed evaluation standards within the two subfields. Three models are used for explaining differences and similarities: a stakeholder model, an institutional field model and an institutional heritage model. The article shows how evaluation as an organizational element is used simultaneously for processes of change and processes of reproduction of norms and values.

Experimental toothclenching in common migraine

The effect of 30 min voluntary toothclenching was studied in 48 patients with common migraine, randomized in two groups. Group 1 performed low-level tension at 5% and group 2, high-level tension at 30% the individual maximum, as judged by surface EMG from the temporal muscle. Pericranial muscle tenderness was evaluated by manual palpation and a four-point verbal scale. Headache, nausea, and soreness of the chewing muscles were scored on visual analogue scales. Although surface EMG, soreness, blood pressure, heart rate and difficulty in completing the toothclenching session all showed that group 2 patients were subjected to significantly higher levels of muscle tension than group 1 patients, headache developed equally often in both groups (63%). Headache was even more pronounced in group 1 (n.s.). Five patients in group 1 and none in group 2 developed an attack of migraine during the following 24 h. Pericranial muscle tenderness was unaffected by the experimental procedure. There was no significant correlation between headache intensity and pericranial muscle tenderness. Muscle ischemia, muscle “fatigue”, and strain on muscle insertions are thus unlikely to cause attacks of common migraine.

The Local Construction and Enactment of Standards for Research Evaluation The Case of the Copenhagen Business School

The local adaptation of research evaluation at faculty and departmental level is analysed in terms of the processes through which an evaluation standard is stipulated and enacted. Three aspects of the interplay of the standard with the local evaluation context are discussed: conflict regulation; activity coordination; and processing of local problems and issues. A ‘soft’ standard appears as a compromise between different interested parties, which allows for some coordination between loosely coupled actors, and which functions as an open garbage can for departmental problems and issues. The evaluation standard is discussed in relation to local sense-making processes, the introduction of ‘managerialism’ in academia, and organization development and exploration.

Educational Evaluation in Scandinavian Countries: Converging or Diverging Practices?

Current educational evaluation is institutionalized as an element in national educational policy in Sweden, Denmark, and Norway. This article analyses how higher education and primary and lower secondary education have adopted and institutionalized educational evaluation. The analysis shows similarities and differences in organizing and practicing evaluation both across educational levels and across countries. Sweden was an early adaptor, Denmark and Norway later ones. Educational evaluation was institutionalized in higher education prior to primary and secondary education. In both cases international dynamics have played an important role.

Organisation of evidence-based knowledge production: Evidence hierarchies and evidence typologies

The evidence movement and the idea of systematically synthesising results from primary studies has gained support in recent years. As the movement has moved into still more policy fields, from medical treatment to, for example, public health, social welfare, and education, review practice has also been developed. The initial evidence hierarchy based standard given priority to randomised controlled trials and meta-analysis advocated by the Cochrane and Campbell collaborations has become supplemented with evidence typologies and review practice paradigms stressing the importance of contextual factors as explanations of differences in effects. In addition to analysing and discussing this development, the article discusses the organisation of dissemination of evidence. This topic is interesting because it is part of the self-perception of the evidence movement that evidence should be brought to use in both practice and policy making.

Mergers in Danish Higher Education: An Overview over the Changing Landscape

The Danish Higher Education landscape has experienced profound changes as a result of mergers over the past 15 years. All parts of the higher education system, including short-cycle and medium-cycle institutions, the university sector and the governmental research institutes (GRIs), have been involved in these processes, resulting in a considerable reduction in the number of institutions. However, the processes have differed in both timing and content across the different sectors. This chapter outlines the changes across three different higher education sectors – short, medium and long-cycle – and analyses the merger processes in the university and GRI sectors in more detail. Although there are important differences between the three sectors, it is argued that the similarities in development between these sectors are substantial. The chapter also analyses and discusses the specific Danish setting which enabled and supported the merger processes and highlights some of the major challenges associated with the actual processes.