We provide an overview of diagnostic stewardship with key concepts that include the diagnostic pathway and the multiple points where interventions can be implemented, strategies for interventions, the importance of multidisciplinary collaboration, and key microbiologic diagnostic tests that should be considered for diagnostic stewardship. The document focuses on microbiologic laboratory testing for adult and pediatric patients and is intended for a target audience of healthcare workers involved in diagnostic stewardship interventions and all workers affected by any step of the diagnostic pathway (ie, ordering, collecting, processing, reporting, and interpreting results of a diagnostic test). This document was developed by the Society for Healthcare Epidemiology of America Diagnostic Stewardship Taskforce.

Six pairs of steers were allowed to choose between two types of floors in a paired choice test. The four floors tested were a fully slatted floor, a fully slatted floor covered with rubber mats, a solid floor with sawdust bedding, and a solid floor with straw bedding. All combinations of floor types were tested and the choices were repeated eight times, using naïve animals. The animals were allowed 17 days to habituate, and on days 18-21 their behaviour was recorded by video for 72 hours. Straw was the most preferred floor type, followed by sawdust, then mats, and finally slats. During a second test period, rubber mats were compared with rubber strips, and no significant preferences were found.

This study aimed to evaluate the effect of using different floor types to accommodate growing and finishing beef cattle on lameness. In all, 80 dairy origin bulls were blocked according to live weight and breed into 20 groups, and randomly allocated within groups to one of four treatments. The floor types studied were fully slatted flooring throughout the entire experimental period (CS); fully slatted flooring covered with rubber strips throughout the entire experimental period (RS); fully slatted flooring during the growing period and then moved to a solid floor covered with straw bedding during the finishing period (CS-S) and fully slatted flooring during the growing period and then moved to fully slatted flooring covered with rubber strips during the finishing period (CS-RS). The total duration of the study was 204 days. The first 101 days was defined as the growing period, with the remainder of the study defined as the finishing period. During the growing period, there was a tendency for bulls accommodated on CS to have a higher locomotion score compared with those accommodated on RS (P=0.059). However, floor type had no significant effect on locomotion score during the finishing period. There was also no significant effect of floor type on digital dermatitis during both the growing or finishing period. Floor type had no significant effect on swelling at the leg joints at the end of the finishing period. Bulls accommodated on RS had the least probability of bruised soles during both the growing and finishing period (P<0.01). Growing bulls accommodated on CS had significantly greater front heel height net growth compared with those accommodated on RS (P<0.05). However, bulls accommodated on RS had a tendency to have greater front toe net growth compared with those accommodated on CS (P=0.087). Finishing bulls accommodated on CS-RS had the greatest front toe net growth (P<0.001). Heel height net growth was greatest in bulls accommodated on CS-S (P<0.001). Floor type had no significant effect on mean maximum hoof temperature during the growing period. Finishing bulls accommodated on CS-S had a significantly lower mean maximum hoof temperature compared with those accommodated on any other floor type (P<0.001). The study concluded that rubber flooring is a suitable alternative to fully slatted flooring, reducing the prevalence of bruised soles. Despite greater toe net growth in bulls accommodated on rubber flooring, there was no effect of floor type on locomotion score, suggesting that increased toe net growth does not adversely affect walking ability. In addition, although mean maximum hoof temperature was lowest in bulls accommodated on straw bedding, there was no evidence to suggest this is indicative of improved hoof health.

The aim of this study was to evaluate the effect of using different floor types to accommodate growing and finishing beef cattle on their performance, cleanliness, carcass characteristics and meat quality. In total, 80 dairy origin young bulls (mean initial live weight 224 kg (SD=28.4 kg)) were divided into 20 blocks with four animals each according to live weight. The total duration of the experimental period was 204 days. The first 101 days was defined as the growing period, with the remainder of the study defined as the finishing period. Cattle were randomly assigned within blocks to one of four floor type treatments, which included fully slatted flooring throughout the entire experimental period (CS); fully slatted flooring covered with rubber strips throughout the entire experimental period (RS); fully slatted flooring during the growing period and moved to a solid floor covered with straw bedding during the finishing period (CS-S) and fully slatted flooring during the growing period and moved to fully slatted flooring covered with rubber strips during the finishing period (CS-RS). Bulls were offered ad libitum grass silage supplemented with concentrates during the growing period. During the finishing period, bulls were offered concentrates supplemented with chopped barley straw. There was no significant effect of floor type on total dry matter intake (DMI), feed conversion ratio, daily live weight gain or back fat depth during the growing and finishing periods. Compared with bulls accommodated on CS, RS and CS-RS, bulls accommodated on CS-S had a significantly lower straw DMI (P<0.01). Although bulls accommodated on CS and CS-S were significantly dirtier compared with those accommodated on RS and CS-RS on days 50 (P<0.05) and 151 (P<0.01), there was no effect of floor type on the cleanliness of bulls at the end of the growing and finishing periods. There was also no significant effect of floor type on carcass characteristics or meat quality. However, bulls accommodated on CS-S had a tendency for less channel, cod and kidney fat (P=0.084) compared with those accommodated on CS, RS and CS-RS. Overall, floor type had no effect on the performance, cleanliness, carcass characteristics or meat quality of growing or finishing beef cattle.

Background: The ketogenic diet (KD) is used to treat severe childhood-onset epileptic encephalopathies, such as Infantile Spasms (IS). Unfortunately, limited resources for KD initiation result in treatment delays. We ask if earlier KD treatment of early-onset drug-resistant epilepsy results in better seizure outcomes. Methods: Children who started KD before age 4 years between 2000-present at SickKids Hospital were identified. Six-month seizure outcome was calculated as percent of pre-diet baseline seizure frequency (BSF). Results: 67 children were identified. 30 (44.8%) started KD <2 years old, 37 (55.2%) started KD 2-4 years old. Among <2 years old group, 83.3% achieved 50% reduction in BSF and 36.7% achieved 90% reduction. Among 2-4 year old group, 62.2% achieved 50% reduction in BSF and 24.3% achieved 90% reduction. 38 children had a history of IS; 17 with IS at diet initiation and 21 with past history of IS. 41.2% of the spasms cohort achieved 90% reduction in BSF, compared to 23.8% of the post-spasms cohort. Conclusions: KD was more effective when started before age 2 years than 2-4 years, and more effective in children with IS than in children with past history of IS. A rapid protocol for KD initiation in young infants and children may improve long-term outcomes

The Darwin region in northern Australia has experienced rapid population growth in recent years, and with it, an increased incidence of melioidosis. Previous studies in Darwin have associated the environmental presence of Burkholderia pseudomallei, the causative agent of melioidosis, with anthropogenic land usage and proximity to animals. In our study, we estimated the occurrence of B. pseudomallei and Burkholderia spp. relatives in faecal matter of wildlife, livestock and domestic animals in the Darwin region. A total of 357 faecal samples were collected and bacteria isolated through culture and direct DNA extraction after enrichment in selective media. Identification of B. pseudomallei, B. ubonensis, and other Burkholderia spp. was carried out using TTS1, Bu550, and recA BUR3–BUR4 quantitative PCR assays, respectively. B. pseudomallei was detected in seven faecal samples from wallabies and a chicken. B. cepacia complex spp. and Pandoraea spp. were cultured from wallaby faecal samples, and B. cenocepacia and B. cepacia were also isolated from livestock animals. Various bacteria isolated in this study represent opportunistic human pathogens, raising the possibility that faecal shedding contributes to the expanding geographical distribution of not just B. pseudomallei but other Burkholderiaceae that can cause human disease.

The Millimetre Astronomy Legacy Team 90 GHz (MALT90) survey aims to characterise the physical and chemical evolution of high-mass star-forming clumps. Exploiting the unique broad frequency range and on-the-fly mapping capabilities of the Australia Telescope National Facility Mopra 22 m single-dish telescope1, MALT90 has obtained 3′ × 3′ maps towards ~2 000 dense molecular clumps identified in the ATLASGAL 870 μm Galactic plane survey. The clumps were selected to host the early stages of high-mass star formation and to span the complete range in their evolutionary states (from prestellar, to protostellar, and on to $\mathrm{H\,{\scriptstyle {II}}}$ regions and photodissociation regions). Because MALT90 mapped 16 lines simultaneously with excellent spatial (38 arcsec) and spectral (0.11 km s−1) resolution, the data reveal a wealth of information about the clumps’ morphologies, chemistry, and kinematics. In this paper we outline the survey strategy, observing mode, data reduction procedure, and highlight some early science results. All MALT90 raw and processed data products are available to the community. With its unprecedented large sample of clumps, MALT90 is the largest survey of its type ever conducted and an excellent resource for identifying interesting candidates for high-resolution studies with ALMA.

The H2O Southern Galactic Plane Survey (HOPS) has observed 100 deg2 of the Galactic plane, using the Mopra radio telescope to search for emission from multiple spectral lines in the 12-mm band (19.5–27.5 GHz). Perhaps the most important of these spectral lines is the 22.2-GHz water-maser transition. We describe the methods used to identify water-maser candidates and subsequent confirmation of the sources. Our methods involve a simple determination of likely candidates by searching peak emission maps, utilising the intrinsic nature of water-maser emission, spatially unresolved and spectrally narrow-lined. We estimate completeness limits and compare our method with results from the duchamp source finder. We find that the two methods perform similarly. We conclude that the similarity in performance is due to the intrinsic limitation of the noise characteristics of the data. The advantages of our method are that it is slightly more efficient in eliminating spurious detections and is simple to implement. The disadvantage is that it is a manual method of finding sources and so is not practical on datasets much larger than HOPS, or for datasets with extended emission that needs to be characterised. We outline a two-stage method for the most efficient means of finding masers, using duchamp.

Extended abstract of a paper presented at Microscopy and Microanalysis 2012 in Phoenix, Arizona, USA, July 29 – August 2, 2012.

Over the past 3 years, we have conducted a survey of 100 square degrees of the southern Galactic plane with the Mopra radiotelescope (HOPS). The survey includes observations of multiple spectral lines in the 12 mm band, with the most important being the water maser transition at 22.2 GHz and the non-metastable inversion transitions of ammonia. We report on initial results from HOPS, including the detection of 540 water masers, about two-thirds of which appear to be new detections. We also find widespread emission in the NH3 (1,1) line, as well as detec tions in the NH3 (2,2), (3,3), (6,6) and (9,9) lines.

We study the relationship between the H2 and CO abundances in simulated molecular clouds using a fully dynamical model of magnetized turbulence coupled to a detailed chemical network. We find that the CO-to-H2 conversion factor for a given molecular cloud, the so-called X-factor, is determined primarily by the mean extinction of the cloud, rather than by its metallicity. Our results explain the discrepancy observed in low metallicity systems between cloud masses derived from CO observations and other techniques such as infrared emission, and predict that CO-bright clouds in low metallicity systems should be systematically larger and/or denser than Milky Way clouds.

An enzyme-linked immunosorbent assay has been used to diagnose serologically the prevalence of Helicobacter pylori infection in Asian life-long vegans. There was no difference in the seropositivity between these individuals and a group of age-and sex-matched Asian meat-eaters, indicating the meat consumption is not a risk factor for H. pylori infection. However, both Asian groups had a higher prevalence of infection than age- and sex-matched Caucasian meat-eaters. Additionally, the Asian individuals had a wider range of specific IgG antibody concentrations than the Caucasians. This did not appear to be due to antigenic cross-reactivity between H. pylori and Campylobacter jejuni. The significance of these observations to the establishment of cut-off levels for the serodiagnosis of certain ethnic groups is discussed.

We present a new method developed for measuring radiocarbon of methane (14CH4) in ancient air samples extracted from glacial ice and dating 11,000–15,000 calendar years before present. The small size (∼20 μg CH4 carbon), low CH4 concentrations ([CH4], 400–800 parts per billion [ppb]), high carbon monoxide concentrations ([CO]), and low 14C activity of the samples created unusually high risks of contamination by extraneous carbon. Up to 2500 ppb CO in the air samples was quantitatively removed using the Sofnocat reagent. 14C procedural blanks were greatly reduced through the construction of a new CH4 conversion line utilizing platinized quartz wool for CH4 combustion and the use of an ultra-high-purity iron catalyst for graphitization. The amount and 14C activity of extraneous carbon added in the new CH4 conversion line were determined to be 0.23 ± 0.16 μg and 23.57 ± 16.22 pMC, respectively. The amount of modern (100 pMC) carbon added during the graphitization step has been reduced to 0.03 μg. The overall procedural blank for all stages of sample handling was 0.75 ± 0.38 pMC for ∼20-μg, 14C-free air samples with [CH4] of 500 ppb. Duration of the graphitization reactions for small (<25 μg C) samples was greatly reduced and reaction yields improved through more efficient water vapor trapping and the use of a new iron catalyst with higher surface area. 14C corrections for each step of sample handling have been determined. The resulting overall 14CH4 uncertainties for the ancient air samples are ∼1.0 pMC.