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A survey of hospital antimicrobial stewardship programs was performed to validate core element achievement data from the National Healthcare Safety Network’s (NHSN) Patient Safety Component Annual Survey. In total, 89% of hospitals met all 7 core elements, compared to only 68% according to the NHSN survey.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Chronic spontaneous urticaria (CSU) has been associated with depression and can have an impact on quality of life. Therefore, researchers have suggested the potential utility of psychological interventions for targeting depression among CSU patients. Psychological interventions that may hold the most promise are those that are brief and easily transportable, such as brief behavioural activation treatment for depression. We report results of a preliminary investigation of an uncontrolled open trial of a one-session behavioural activation treatment for depression designed for patients with CSU (BATD-CSU) at a university-based allergy and immunology clinic. Participants were 11 females with chronic, poorly controlled urticaria and symptoms of depression. Following the completion of pretreatment questionnaires, participants were administered BATD-CSU primarily by non-mental health professionals trained and supervised in its delivery. One month post-BATD-CSU, participants completed follow-up questionnaires. Participants exhibited significant reductions in depression severity, avoidance/rumination, and work/school impairment. BATD-CSU was also associated with improvements in urticaria control one month post-treatment. Moreover, five of nine patients reported reliable and clinically significant improvement on at least one outcome. Results demonstrate that BATD-CSU may have benefits for CSU patients even when consisting of one session and delivered by professionals with limited background in psychological interventions, thus speaking to its feasibility and transportability.
After the Portuguese discovered the Cape Verde Islands in AD 1456 they divided its main island, Santiago, into two governing captaincies. The founding settlement in the south-west, Cidade Velha, soon became the Islands’ capital and a thriving trade centre; in contrast, that in the east, Alcatrazes, only lasted as an official seat from 1484–1516 and is held to have ‘failed’ (see Richter 2015).
We present VLT/MUSE observations of NGC 2070, the dominant ionizing nebula of 30 Doradus in the LMC, plus HST/STIS spectroscopy of its central star cluster R136. Integral Field Spectroscopy (MUSE) and pseudo IFS (STIS) together provides a complete census of all massive stars within the central 30×30 parsec2 of the Tarantula. We discuss the integrated far-UV spectrum of R136, of particular interest for UV studies of young extragalactic star clusters. Strong He iiλ1640 emission at very early ages (1–2 Myr) from very massive stars cannot be reproduced by current population synthesis models, even those incorporating binary evolution and very massive stars. A nebular analysis of the integrated MUSE dataset implies an age of ~4.5 Myr for NGC 2070. Wolf-Rayet features provide alternative age diagnostics, with the primary contribution to the integrated Wolf-Rayet bumps arising from R140 rather than the more numerous H-rich WN stars in R136. Caution should be used when interpreting spatially extended observations of extragalactic star-forming regions.
We present results from optical and ultraviolet analysis of nine LMC/SMC supergiants. Temperatures, mass-loss rates and CNO abundances are obtained using the non-LTE, line-blanketed model atmosphere code of Hillier & Miller (1998). In general, the derived temperatures are significantly lower than those determined from unblanketed, plane-parallel models.
We have investigated the properties of main-sequence O-type stars in the SMC. Mass-loss rates, luminosities and Teff are much smaller for these stars than for Galactic ones, resulting in a steeper wind-momentum relation.
We present CNO abundance determinations in 11 Magellanic Cloud O and early B supergiants based on physical parameters obtained from FUSE, HST/IUE and VLT spectroscopy, plus model atmospheres which allow for stellar winds and line blanketing. In all cases, nitrogen is substantially enhanced whilst carbon and generally oxygen are moderately depleted, indicative of rotationally induced mixing of unprocessed and CNO processed material at their stellar surfaces.
The transition to the diverse and complex biosphere of the Ediacaran and early Paleozoic is the culmination of a complex history of tectonic, climate, and geochemical development. Although much of this rise occurred in the middle and late intervals of the Neoproterozoic Era (1000–541 million years ago [Ma]), the foundation for many of these developments was laid much earlier, during the latest Mesoproterozic Stenian Period (1200–1000 Ma) and early Neoproterozoic Tonian Period (1000–720 Ma). Concurrent with the development of complex ecosystems, changes in the composition, configuration, and tectonic interaction between continental plates have been proposed as major shapers of both climate and biogeochemical cycling, but there is little support in the geologic record for overriding tectonic controls. Biogeochemical evidence, however, suggests that an expansion of marine oxygen concentrations may have stabilized nutrient cycles and created more stable environmental conditions under which complex, eukaryotic life could gain a foothold and flourish. The interaction of tectonic, biogeochemical, and climate processes, as described in this paper, resulted in the establishment of habitable environments that fostered the Ediacaran and early Phanerozoic radiations of animal life and the emergence of complex, modern-style ecosystems.
Prevention of heartworm disease caused by Dirofilaria immitis in domestic dogs and cats relies on a single drug class, the macrocyclic lactones (MLs). Recently, it has been demonstrated that ML-resistant D. immitis are circulating in the Mississippi Delta region of the USA, but the prevalence and impact of these resistant parasites remains unknown. We review published studies that demonstrated resistance in D.immitis, along with our current understanding of its mechanisms. Efforts to develop in vitro tests for resistance have not yet yielded a suitable assay, so testing infected animals for microfilariae that persist in the face of ML treatment may be the best current option. Since the vast majority of D. immitis populations continue to be drug-sensitive, protected dogs are likely to be infected with only a few parasites and experience relatively mild disease. In cats, infection with small numbers of worms can cause severe disease and so the clinical consequences of drug resistance may be more severe. Since melarsomine dihydrochloride, the drug used to remove adult worms, is not an ML, the ML-resistance should have no impact on our ability to treat diseased animals. A large refugium of heartworms that are not exposed to drugs exists in unprotected dogs and in wild canids, which may limit the development and spread of resistance alleles.