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Geothermal energy has the potential to provide long-term, secure base-load energy and greenhouse gas (GHG) emissions reductions. Accessible geothermal energy from the Earth's interior supplies heat for direct use and to generate electric energy. Climate change is not expected to have any major impacts on the effectiveness of geothermal energy utilization, but the widespread deployment of geothermal energy could play a meaningful role in mitigating climate change. In electricity applications, the commercialization and use of engineered (or enhanced) geothermal systems (EGS) may play a central role in establishing the size of the contribution of geothermal energy to long-term GHG emissions reductions.
The natural replenishment of heat from earth processes and modern reservoir management techniques enable the sustainable use of geothermal energy as a low-emission, renewable resource. With appropriate resource management, the tapped heat from an active reservoir is continuously restored by natural heat production, conduction and convection from surrounding hotter regions, and the extracted geothermal fluids are replenished by natural recharge and by injection of the depleted (cooled) fluids.
Global geothermal technical potential is comparable to global primary energy supply in 2008. For electricity generation, the technical potential of geothermal energy is estimated to be between 118 EJ/yr (to 3 km depth) and 1,109 EJ/yr (to 10 km depth). For direct thermal uses, the technical potential is estimated to range from 10 to 312 EJ/yr. The heat extracted to achieve these technical potentials can be fully or partially replenished over the long term by the continental terrestrial heat flow of 315 EJ/yr at an average flux of 65 mW/m2.
To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.
Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).
A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).
Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
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