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Introduction/Innovation Concept: University Departments of Emergency Medicine are responsible for the supervision of research and other scholarly projects for fellows, residents and students, though often lack resources to provide adequate input and oversight. Many departments cover large geographical areas and several programs. We piloted new research committee structures and processes to improve oversight and output of research projects. Methods: We created an interactive group supervision tool based around formation of a collaborative research committee, with rotating chairs from each program, to provide supervision and face to face interaction, and direction for research learners. Included were all Dalhousie University adult and pediatric emergency medicine residency and fellowship programs, as well as trauma and EMS programs across Nova Scotia, New Brunswick, and Prince Edward Island. In addition to providing expertise in clinical trial coordination, database management, research administration, grant applications and Research Ethics Board submissions, we have completed a 2-year pilot of our interactive group supervision tool for research projects. Curriculum, Tool, or Material: The interactive tool consists of a structured PICOD form; allocation of topic and research mentors; standardized yearly milestones from project development through presentation and publication; and regular video-conferenced and in-person interactive group sessions involving several project leads, as well as program research directors, researchers, and co-ordinators. To date, all participating program learners have engaged with the tool, with positive feedback from learners, supervisors and program directors. Conclusion: We report our development of a regional collaborative interactive group supervision tool, that maximizes expert resources in the provision of research and scholarly project supervision.
Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006–May 2011) were compared with the intervention period (June 2011–December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.
The objective of this study was to evaluate the impact of restricting high-risk antibiotics on methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in a hospital setting. A secondary objective was to assess the impact of reducing fluoroquinolone use in the primary-care setting on MRSA incidence in the community. This was an interventional, retrospective, ecological investigation in both hospital and community (January 2006 to June 2010). Segmented regression analysis of interrupted time-series was employed to evaluate the intervention. The restriction of high-risk antibiotics was associated with a significant change in hospital MRSA incidence trend (coefficient = −0·00561, P = 0·0057). Analysis showed that the intervention relating to reducing fluoroquinolone use in the community was associated with a significant trend change in MRSA incidence in community (coefficient = −0·00004, P = 0·0299). The reduction in high-risk antibiotic use and fluoroquinolone use contributed to both a reduction in incidence rates of MRSA in hospital and community (primary-care) settings.
An Al 5083 alloy with a bimodal grain size has been previously synthesized using a low-temperature milling process and consolidation via cold isostatic pressing (CIP). This material has been shown to exhibit greatly improved strength when compared to conventional aluminum alloys. Additionally, this material has shown sensitivity to test conditions. In this work, we studied the effects of temperature on the strain rate sensitivity of this material by examining its elastic and plastic properties though uniaxial tension tests conducted under a variety of conditions at temperatures up to 473 K. Serrated stress-strain curves were observed, indicating dynamic strain aging. Strain rate sensitivity was found to depend non-monotonically on the test temperature.
We discuss the role of Configuration Interaction (CI) and the influence of the number of
configurations taken into account in the calculations of nickel and iron spectral
opacities provided by the OPAC international collaboration, including statistical
approaches (SCO, CASSANDRA, STA), detailed accounting (OPAS, LEDCOP, OP, HULLAC-v9) or
hybrid method (SCO-RCG). Opacity calculations are presented for a temperature T of 27.3 eV
and a density of 3.4 mg/cm3, conditions relevant for pulsating stellar
The objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teaching hospitals. The most commonly used antibiotics were combinations of penicillins including β-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement.
Systemic lupus erythematosus (SLE) is a multi-system inflammatory disease where genetic susceptibility coupled with largely undefined environmental factors is reported to underlie the aetiology of the disease. One such factor is low vitamin D status. The primary source of vitamin D is endogenous synthesis following exposure of the skin to UVB light. Photosensitivity, sunlight avoidance and the use of sun protection factor in combination with medications prescribed to treat the symptoms of the disease, puts SLE patients at increased risk of vitamin D deficiency. Decreased conversion of 25-hydroxyvitamin D to the metabolically active form, 1,25-dihydroxyvitamin D3, is possible, due to renal impairment common in SLE putting additional stress on vitamin D metabolism. The majority of studies have identified low 25-hydroxyvitamin D in SLE patients, albeit using varying cut-offs (<25 to <80 nmol/l). Of these studies, fifteen have investigated a link between status and disease activity with conflicting results. Variation with disease activity index measures used alongside methodological limitations within the study design may partially explain these findings. This review discusses the importance of optimal vitamin D status in SLE, critically evaluates research carried out to date that has investigated vitamin D in SLE, and highlights the need for a well-designed observational study that controls for diet, medication use, dietary supplements, UV exposure and seasonality, that uses sensitive methods for measuring vitamin D status and disease activity in SLE to conclusively establish the role of vitamin D in SLE.
Maternal undernutrition (MUN) results in growth-restricted newborns with reduced nephron numbers that is associated with increased risk of hypertension and renal disease. The total adult complement of nephrons is set during nephrogenesis suggesting that MUN affects the staged development of nephrons in as yet unknown manner. A possible cause may be the increased renal apoptosis; therefore, we investigated whether apoptotic signaling and cell death were increased in MUN rat kidneys. Pregnant rat dams were fed an ad libitum diet [control] or were 50% food restricted (MUN) starting at embryonic day (E) 10. Male offspring kidneys (n = 5 each, MUN and control) were analyzed for mRNA using quantitative PCR (E20) and for protein expression using Western blotting and immunohistochemistry (E20 and postnatal day 1, P1). Apoptosis was measured by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Upregulation of pro-apoptotic protein expression was detected at E20 (Fas receptor, caspase 9) and at P1 (caspase 3, Bax). The anti-apoptotic factor Bcl2 was significantly decreased in P1 kidneys. Kidney TUNEL showed apoptotic nuclei significantly increased in the P1 nephrogenic zone (MUN 3.3 + 0.3 v. C 1.6 + 0.5, P = 0.002). The majority of apoptotic nuclei co-localized to mesenchyme and pretubular aggregates in the nephrogenic zone. Differential regulation of apoptosis in mesenchyme and pretubular aggregates following parturition suggests a mechanism for nephropenia in gestational programming of the kidney.
The local structural information around the germanium atom in boron doped SiGe alloys is important in understanding the dopant diffusion mechanisms. Epitaxial SiGe test structures with B and C markers were grown on Si substrates by using rapid thermal chemical vapor deposition (RTCVD). The local structure around the Ge atom was probed using Ge K-edge x-ray absorption fine structure spectroscopy (XAFS) to determine the effects of the B and C on the Ge sites. The concentration profiles obtained from secondary ion mass spectroscopy are correlated with the Ge XAFS results. The modifications on the local structure around the Ge atoms are revealed from the multiple scattering analyses on the Ge near-neighbors. First and second shell XAFS fits to the B doped SiGe samples indicate a direct evidence of the Ge trapping of the B atoms whereas the C is randomly distributed to the Si lattice sites.
To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.
Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.
Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.
A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003).
These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.
High energy (56 MeV) oxygen implants into Si, GaAs and InP give rise to sharp, non-Gaussian depth profiles with the distributions skewed towards greater depths. This skewness is probably the result of channeling, and it is a common feature of MeV implants into semiconductors. The ratio of the peak concentration in the depth profile to the concentration at the surface is ≥103 for each material, and the full width at half maximum of each profile is ∼2 μm. The experimental projected ranges for the oxygen are ∼31 μm in GaAs, ∼36 μm in InP and ∼46 μm in Si. These are ∼10% larger than the values predicted by the PRAL code. The photoluminescence intensity from the top 1 μm from the surface of both GaAs and InP is reduced by more than an order of magnitude for 56 MeV oxygen implants at a dose of 1.3 × 1015 cm−2, due to point defect introduction in this region. Potential applications for these high energy implants in electronic and photonic device fabrication will be discussed.
Arsenic or phosphorus doped polycrystalline-Si (poly-Si) acts as a diffusion source when deposited on GaAs. Non-Fickian Si diffusion into GaAs has been observed following heat treatments above 700°C. In this paper, the diffusion of In and P from poly-Si at temperatures between 800 and 1020°C is presented. These impurities, introduced into the poly-Si by in-situ plasma deposition, implantation or vapor annealing, diffuse rapidly into the GaAs. Results from particle induced x-ray analysis, transmission electron microscopy, Rutherford backseat tering and secondary ion mass spectroscopy indicate 80% substitutional In and P at interface concentrations of approximately 10 and 25 at%, respectively.
The diffusivity of Si and P in GaAs encapsulated with heavily-doped polysilicon (poly-Si) is correlated to the flux of Ga and As diffusing from the substrate into the encapsulant. A model based on the diffusion of vacancies into the GaAs is proposed and used to simulate the data.