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To describe the pattern of blood culture utilization in an academic university hospital setting.
Retrospective cohort study.
A 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.
We analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.
In total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.
Ordering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.
Psychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service.
To improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department.
Thirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital. Teaching was evaluated using Kirkpatrick's model, and patient transfer numbers were acquired by reviewing in-patient Datix reports and emergency department case notes for 6 months before and after teaching.
The proportion of patients transferred to the emergency department decreased significantly from 90% 6 months before the workshop to 30% 6 months after (P < 0.05). Trainees engaged positively and there was a significant increase in self-confidence rating following the workshop (P < 0.05). The estimated cost saving per transfer was £183.76.
The combination of a peer-led workshop and on-site suturing kit box was effective in reducing transfers to the emergency department and provided a substantial cost saving.
I. De Pater, University of California, Berkeley Berkeley, California, USA,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
M. R. Showalter, SETI Institute Mountain View, California, USA,
H. B. Throop, Planetary Science Institute Tucson, Arizona, USA,
J. A. Burns, Cornell University Ithaca, New York, USA
In this paper, first results comparing modified Longin and ninhydrin collagen extraction methodologies are presented. The goal of this study is to investigate the bones of several species with different ages, preservation conditions, and collagen contents to determine the most suitable preparation method. Different types of samples are used such as VIRI samples, previously dated bones, and background samples. Each bone has undergone elemental analysis, infrared analysis, and 14C measurement. The results are presented and the advantages and disadvantages of each preparation method are discussed. In general, results obtained by the two methods are in accordance with the consensus value for 2σ uncertainty. For VIRI I and a mammoth bone, the ninhydrin preparation gives, respectively, 8450±70 BP and 14,870±60 BP whereas the modified Longin process gives 8365±45 BP and 14,750±100 BP in agreement with the expected values. From the experimental point of view, the modified Longin process is easier to implement than the ninhydrin protocol. From this approach, we can conclude that the modified Longin process could be preferred in most cases and particularly when the amount of bone is small and the sample is not too contaminated.
The Nevado de Toluca is a stratovolcano located in the southwest of the Toluca Valley in central Mexico. At a height of around 4200 m there are two crater lakes: El Sol and La Luna. Since Precolumbian times, people in the surrounding valleys carried out rituals and deposited offerings into the lakes. After the Spanish conquest, these rituals were kept alive clandestinely. Currently, reminiscent of Mesoamerican rituals subsist. Due to the long duration of the ritual at the Nevado de Toluca, it is important to date the materials recovered in the underwater and terrestrial archaeological explorations. This article proposes a chronology of Prehispanic ritual activities performed in the Nevado de Toluca based on the characterization and radiocarbon (14C) dating performed to materials from the volcano’s lakes.
Modern datasets provide the context necessary for accurate interpretations of isotopic data from archaeological faunal assemblages. In this study, we use the oxygen isotope ratios (δ18O) of modern small mammals from Chaco Canyon, New Mexico, to quantify expected isotopic variation in a local population. The δ18O values of local, modern small mammals encompass a broad range (−6.0‰ to 4.8‰ VPDB), which is expected given the extreme seasonal variation in the δ18O of precipitation on the Colorado Plateau (−11‰ to −3‰ VPDB). Isotopic ratios of small mammals obtained from excavated archaeological sites in Chaco Canyon (ca. AD 800 to 1200) show no significant differences with their modern counterparts, suggesting that there is no difference in the origins of the archaeological small-mammal collection and the modern, local Chaco Canyon small-mammal collection. In contrast, δ18O values of large mammals from Chaco archaeological sites are significantly different from those of modern specimens, reflecting a nonlocal, but also nonspecific, source in the past.
Little is known about Salmonella serovars circulating in backyard poultry and swine populations worldwide. Backyard production systems (BPS) that raise swine and/or poultry are distributed across Chile, but are more heavily concentrated in central Chile, where industrialized systems are in close contact with BPS. This study aims to detect and identify circulating Salmonella serovars in poultry and swine raised in BPS. Bacteriological Salmonella isolation was carried out for 1744 samples collected from 329 BPS in central Chile. Faecal samples were taken from swine, poultry, geese, ducks, turkeys and peacocks, as well as environmental faecal samples. Confirmation of Salmonella spp. was performed using invA-polymerase chain reaction (PCR). Identification of serovars was carried out using a molecular serotyping approach, where serogroups were confirmed by a multiplex PCR of Salmonella serogroup genes for five Salmonella O antigens (i.e., D, B, C1, C2-C3, and E1), along with two PCR amplifications, followed by sequencing of fliC and fljB genes. A total of 25 samples (1·4% of total samples) from 15 BPS (4·6 % of total sampled BPS) were found positive for Salmonella. Positive samples were found in poultry (chickens and ducks), swine and environmental sources. Molecular prediction of serovars on Salmonella isolated showed 52·0% of S. Typhimurium, 16·0% of S. Infantis, 16·0% S. Enteritidis, 8·0% S. Hadar, 4·0% S. Tennessee and 4·0% S. Kentucky. Poor biosecurity measures were found on sampled BPS, where a high percentage of mixed confinement systems (72·8%); and almost half of the sampled BPS with improper management of infected mortalities (e.g. selling the carcasses of infected animals for consumption). Number of birds other than chickens (P = 0·014; OR = 1·04; IC (95%) = 1·01–1·07), mixed productive objective (P = 0·030; OR = 5·35; IC (95%) = 1·24–27·59) and mixed animal replacement origin (P = 0017; OR = 5·19; IC (95%) = 1·35–20·47) were detected as risk factors for BPS positivity to Salmonella spp. This is the first evidence of serovars of Salmonella spp. circulating in BPS from central Chile. Detected serovars have been linked to human and animal clinical outbreaks worldwide and in Chile, highlighting the importance of BPS on the control and dissemination of Salmonella serovars potentially hazardous to public health.
We present preliminary analysis of new HST observations of the transiting extrasolar planet HD 209458b. Photometric observations were obtained with the Fine Guidance Sensor (FGS) on the Hubble Space Telescope (HST), providing milli-mag precision and high time resolution (40 Hz). The FGS photometry allows us to derive precise stellar/orbital parameters (ephemeris, inclination, limb darkening) and planetary radius, and also allows a search for the presence of planetary rings and satellites. We discuss preliminary results and two approaches to modelling the observations.
The relic “the sack of Saint Francesco” has for the first time been investigated by scientific means. The sack is kept at the Franciscan Friary of Folloni near Montella in southern Italy. According to legend, the sack appeared on the doorstep of the Friary in the winter of 1224 containing bread sent from St Francesco (St Francis of Assisi), who at that time was in France. The bread was allegedly brought to the friary by an angel. We analyzed samples of the sack to obtain a radiocarbon (14C) date and to search for any remaining traces of bread. The 14C date yielded a calibrated age range of AD 1220–1295 (2σ), which places the textile in the right timeframe according to the legend. Chemical analysis by gas-chromatography with mass spectrometric detection (GC-MS) revealed the presence of ergosterol (5, 7, 22-ergostatrien-3b-ol), a known biomarker of brewing, baking, or agriculture. In this paper we have further substantiated the validity of ergosterol as a biomarker for the past presence of bread. It appears that there is a fine correspondence between the Franciscan legend and the two most decisive scientific methods relevant for analyzing the sack. Although it is not proof, our analysis shows that the sack indeed could be authentic.
Firn microstructure is accurately characterized using images obtained from scanning electron microscopy (SEM). Visibly etched grain boundaries within images are used to create a skeleton outline of the microstructure. A pixel-counting utility is applied to the outline to determine grain area. Firn grain sizes calculated using the technique described here are compared to those calculated using the techniques of Gow (1969) and Gay and Weiss (1999) on samples of the same material, and are found to be substantially smaller. The differences in grain size between the techniques are attributed to sampling deficiencies (e.g. the inclusion of pore filler in the grain area) in earlier methods. The new technique offers the advantages of greater accuracy and the ability to determine individual components of the microstructure (grain and pore), which have important applications in ice-core analyses. The new method is validated by calculating activation energies of grain boundary diffusion using predicted values based on the ratio of grain-size measurements between the new and existing techniques. The resulting activation energy falls within the range of values previously reported for firn/ice.
This paper discusses the chronology of burial grounds containing specific Seima-Turbino type bronze weaponry (spears, knives, and celts). The “transcultural” Seima-Turbino phenomenon relates to a wide distribution of specific objects found within the sites of different Bronze Age cultures in Eurasia, not immediately related to each other. The majority of the Seima-Turbino objects represent occasional findings, and they are rarely recovered from burial grounds. Here, we present a new set of 14C dates from cemeteries in western Siberia, including the key Asian site Rostovka, with the largest number of graves containing Seima-Turbino objects. Currently, the presented database is the most extensive for the Seima-Turbino complexes. The resulting radiocarbon (14C) chronology for the western Siberian sites (22nd–20th centuries cal BC) is older than the existing chronology based on typological analysis (16th–15th centuries BC) and some earlier 14C dates for the Seima-Turbino sites in eastern Europe. Another important aspect of this work is 14C dating of complexes within specific bronze objects—daggers with figured handles—which some researchers have related to the Seima-Turbino type objects. These items are mostly represented by occasional finds in Central Asia, however, in western Siberia these have been recovered from burials, too. The 14C dating attributes these daggers to the end of the 3rd millennium cal BC, suggesting their similar timing to the Seima-Turbino objects. Further research into freshwater reservoir offsets in the region is essential for a more reliable reconstruction of the chronology of the Seima-Turbino phenomenon and the daggers with figured handles.
This paper investigates the effectiveness of using a UAV with dual commercial off-the-shelf (COTS) cameras, one un-modified and one modified to sense near infra-red (NIR) wavelengths to identify the onset of disease within a trial crop of potatoes. The trial was composed of 2 plots of 16 drills containing 12 tubers exposed to the blackleg disease-causing bacterial pathogen (Pectobacterium atrosepticum) in order to demonstrate best practise tuber storage and haulm destruction methods. Eleven sets of aerial data were gathered between 27/5/2016~29/7/2016 and compared with ground truth data collected on 14/7/2016. Visual analysis of the data could only detect the onset of disease and not the specific infection and resulted in a user accuracy (UA) of 83% and producer accuracy (PA) of 78%, with a total accuracy (TA) of 91% and Kappa coefficient (K) of 0.75. The building blocks of an automated classification routine have been constructed using pixel and object based image analysis (OBIA) methods, which have shown promising first results (UA 65%, PA 73%, TA 87%, K 0.61) but requires further refinement to achieve an equivalent level of accuracy as that of the visual analysis.
A dark line appears on a recent satellite image of McMurdo Ice Shelf, Antarctica. It is parallel to the calving front. Initial thoughts were that the line marks an opening crevasse associated with an impending major calving event. The feature was studied by means of a strain and surface-elevation grid that was surveyed twice, 25 d apart, using global positioning system (GPS) techniques. Results show that the dark line is not due to an opening crevasse. The feature is probably the surface expression of firn collapse over sea water soaking horizontally into the ice shelf.
Cathars have long been regarded as posing the most organised challenge to orthodox Catholicism in the medieval West, even as a "counter-Church" to orthodoxy in southern France and northern Italy. Their beliefs, understood to be inspired by Balkan dualism, are often seen as the most radical among medieval heresies. However, recent work has fiercely challenged this paradigm, arguing instead that "Catharism" was a construct of its persecutors, mis-named and mis-represented by generations of subsequent scholarship, and its supposedly radical views were a fantastical projection of the fears of orthodox commentators. This volume brings together a wide range of views from some of the most distinguished international scholars in the field, in order to address the debate directly while also opening up new areas for research. Focussing on dualism and anti-materialist beliefs in southern France, Italy and the Balkans, it considers a number of crucial issues. These include: what constitutes popular belief; how (and to what extent) societies of the past were based on the persecution of dissidents; and whether heresy can be seen as an invention of orthodoxy. At the same time, the essays shed new light on some key aspects of the political, cultural, religious and economic relationships between the Balkans and more western regions of Europe in the Middle Ages.
Antonio Sennis isSenior Lecturer in Medieval History at University College London Contributors: John H. Arnold, Peter Biller, Caterina Bruschi, David d'Avray, Jörg Feuchter, Bernard Hamilton, Robert I. Moore, MarkGregory Pegg, Rebecca Rist, Lucy Sackville, Antonio Sennis, Claire Taylor, Julien Théry-Astruc, Yuri Stoyanov