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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.
Using a case-series design with double baseline and 10-week maintenance phase, 5 struggling readers from middle- to high-income families (age range 6.4–7.9 years) completed a 5-times-weekly intervention (96 sessions) administered by a parent. All participants completed the intervention with phonological decoding, text-reading accuracy and reading comprehension scores above the 30th percentile. Regular-word reading improved significantly, and 3 out of 5 participants achieved average levels at postintervention testing. Growth of 0.58 standard deviations (SD) was seen in one participant on a test of irregular-word reading. The other 4 participants made growth of > 0.8 SD. However, only 1 participant achieved average levels at postintervention testing on the irregular-word reading measure. Results provide preliminary support for the effectiveness of the intervention in improving word-level decoding and comprehension in struggling readers. Most important, the data provide preliminary evidence that some parents can function as paraprofessionals and provide effective reading intervention for struggling readers. Special education professionals may be able to work around limited funding for struggling readers by recruiting, training, and supervising parents.
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.
We construct a fundamental solution for the n dimensional time independent anisotropic neutron transport equation. This is an operator valued distribution G(x) with a singularity at the origin. By estimating G(x) we are able to construct smooth solutions to the transport equation. We are also able to derive in a straightforward fashion results of Birkhoff and Abu-Shumays on the existence of harmonic solutions to the isotropic transport equation. When n = 1, G(x) is a function which is continuous except at x = 0. We show that the classical formula for the jump of G(x) at the origin is equivalent to the completeness of Case's full range eigenfunction expansion.
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.
We study the effect of stochastic volatility on option prices. In the fast mean-reversion model for stochastic volatility of , we show that there is a full asymptotic expansion for the option price, centered at the Black-Scholes price. We show how to callibrate the first two terms in the expansion with the implied volatility surface. We show, however, that this price does not converge in a strong sense to Black-Scholes as the mean-reversion rate increases.
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