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We compared antibiotic prescribing to older people in different settings to inform antibiotic stewardship interventions. We used data linkage to stratify individuals aged 65 years and over in Northern Ireland, 1st January 2012–31st December 2013, by residence: community dwelling, care home dwelling or ‘transitioned’ if admitted to a care home. The odds of being prescribed an antibiotic by residence were analysed using logistic regression, adjusting for patient demographics and selected medication use (proxy for co-morbidities). Trends in monthly antibiotic prescribing were examined in the 6 months pre- and post-admission to the care home. The odds of being prescribed at least one antibiotic were twofold higher in care homes compared with community dwellers (adjusted odds ratio 2.05, 95% CI 1.93–2.17). There was a proportionate increase of 51.5% in the percentage prescribed an antibiotic on admission, with a monthly average of 23% receiving an antibiotic in the 6 months post admission. While clinical need likely accounts for some of the observed antibiotic prescribing in care homes we cannot rule out more liberal prescribing, given the twofold difference between care home residents and their community dwelling peers having accounted for co-morbidities. The appropriateness of antibiotic prescribing in the care home setting should be examined.
Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars (Z ≲ 10−5) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z ≤ 10−5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z ≤ 10−5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10−5. We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.
We review the lives, deaths and nucleosynthetic signatures of intermediate-mass stars in the range ≈6–12 M⊙, which form super-AGB stars near the end of their lives. The critical mass boundaries both between different types of massive white dwarfs (CO, CO–Ne, ONe), and between white dwarfs and supernovae, are examined along with the relative fraction of super-AGB stars that end life either as an ONe white dwarf or as a neutron star (or an ONeFe white dwarf), after undergoing an electron capture supernova event. The contribution of the other potential single-star channel to electron-capture supernovae, that of the failed massive stars, is also discussed. The factors that influence these different final fates and mass limits, such as composition, rotation, the efficiency of convection, the nuclear reaction rates, mass-loss rates, and third dredge-up efficiency, are described. We stress the importance of the binary evolution channels for producing electron-capture supernovae. Recent nucleosynthesis calculations and elemental yield results are discussed and a new set of s-process heavy element yields is presented. The contribution of super-AGB star nucleosynthesis is assessed within a Galactic perspective, and the (super-)AGB scenario is considered in the context of the multiple stellar populations seen in globular clusters. A brief summary of recent works on dust production is included. Last, we conclude with a discussion of the observational constraints and potential future advances for study into these stars on the low mass/high mass star boundary.
Floor type is one of the main features influencing the welfare of sows and piglets in farrowing crates. Yet it is difficult to reconcile the needs of the sow and her piglets through the use of one floor (Furniss et al., 1986). Hence the aim of this study was to identify a floor combination that optimises the welfare of the piglets in the farrowing crate.
22q11.2 deletion syndrome (22q11.2DS) is associated with a high risk of childhood as well as adult psychiatric disorders, in particular schizophrenia. Childhood cognitive deterioration in 22q11.2DS has previously been reported, but only in studies lacking a control sample.
To compare cognitive trajectories in children with 22q11.2DS and unaffected control siblings.
A longitudinal study of neurocognitive functioning (IQ, executive function, processing speed and attention) was conducted in children with 22q11.2DS (n = 75, mean age time 1 (T1) 9.9, time 2 (T2) 12.5) and control siblings (n = 33, mean age T1 10.6, T2 134).
Children with 22q11.2DS exhibited deficits in all cognitive domains. However, mean scores did not indicate deterioration. When individual trajectories were examined, some participants showed significant decline over time, but the prevalence was similar for 22q11.2DS and control siblings. Findings are more likely to reflect normal developmental fluctuation than a 22q11.2DS-specific abnormality.
Childhood cognitive deterioration is not associated with 22q11.2DS. Contrary to previous suggestions, we believe it is premature to recommend repeated monitoring of cognitive function to identifying individual children with 22q11.2DS at high risk of developing schizophrenia.
Wolf-Rayet stars could be rapid rotators. We must ask if a rotationally flattened wind can lead to an observed continuous spectrum that depends on the angle of inclination. Schmid-Burgk (1982) showed that in the radio region the spectral shape is not changed. Here we consider the optical region, where both thermal emission and electron scattering are important. This study uses a simple, idealized model of a rotating wind in which v(r) is from Friend and Abbott (1986), but depends on polar angle in the manner of Poe et al. (1989). Equatorial densities are five times polar values at the same radial distance. The wind consists only of fully ionized He surrounding a spherical core and has a radial optical depth of 2.0 in the equator in the limit of pure electron opacity, essentially at wavelengths less than 2000A. Radiative transfer in the wind is fully treated by a second-order moment method based on the equation of transfer in general spherical coordinates (Doherty 1989). A constant flux at the core boundary is assumed. This flux corresponds to a T = 4×104K blackbody and the wind temperature is 2×104 . The shape of the emergent spectrum in the region computed (2500—7500A) changes little with inclination and resembles the spectrum of a spherical wind with intermediate density. Thus a rotating wind may masquerade as spherical but, in the present model at least, vary in flux by nearly a factor of two from pole to equator. This can affect the apparent magnitude, wind polarization, and possibly the line spectrum and wind acceleration.
Planetary nebulae retain the signature of the nucleosynthesis and mixing events that occurred during the previous AGB phase. Observational signatures complement observations of AGB and post-AGB stars and their binary companions. The abundances of the elements heavier than iron such as Kr and Xe in planetary nebulae can be used to complement abundances of Sr/Y/Zr and Ba/La/Ce in AGB stars, respectively, to determine the operation of the slow neutron-capture process (the s process) in AGB stars. Additionally, observations of the Rb abundance in Type I planetary nebulae may allow us to infer the initial mass of the central star. Several noble gas components present in meteoritic stardust silicon carbide (SiC) grains are associated with implantation into the dust grains in the high-energy environment connected to the fast winds from the central stars during the planetary nebulae phase.
The efforts of many neuroscientists are directed toward understanding the appreciable plasticity of the brain and behavior. In recent years, epigenetics has become a core of this focus as a prime mechanistic candidate for behavioral modifications. Animal models have been instrumental in advancing our understanding of environmentally driven changes to the epigenome in the developing and adult brain. This review focuses mainly on such discoveries driven by adverse environments along with their associated behavioral outcomes. While much of the evidence discussed focuses on epigenetics within the central nervous system, several peripheral studies in humans who have experienced significant adversity are also highlighted. As we continue to unravel the link between epigenetics and phenotype, discerning the complexity and specificity of epigenetic changes induced by environments is an important step toward understanding optimal development and how to prevent or ameliorate behavioral deficits bred by disruptive environments.
The Universities of Adelaide and Tasmania (UAT) have now collaborated in the preparation of four experiments on British Skylark rockets. Two independent X-ray detectors of total sensitive area 40 cm2 were flown on each of two rocket flights launched in April, 1967. The most significant result of these measurements was the discovery of Cen XR-2 and the measurement of the variation in its intensity and spectrum. The third flight, launched in December 1967, carried three X-ray detectors of total area 140 cm2. One of the main results from this flight, evidence for a new X-ray source at high galactic latitude, will be presented in the following paper.
There is a paucity of data on the effect of preterm birth on the immunological composition of breast milk throughout the different stages of lactation. We aimed to characterise the effects of preterm birth on the levels of immune factors in milk during the 1st month postpartum, to determine whether preterm milk is deficient in antimicrobial factors. Colostrum (days 2–5 postpartum), transitional milk (days 8–12) and mature milk (days 26–30) were collected from mothers of extremely preterm (<28 weeks of gestation, n 15), very preterm (28–<32 weeks of gestation, n 15), moderately preterm (32–<37 weeks of gestation, n 15) and term infants (37–41 weeks of gestation, n 15). Total protein, lactoferrin, secretory IgA, soluble CD14 receptor (sCD14), transforming growth factor-β2 (TGF-β2), α defensin 5 (HD5), β defensins 1 (HBD1) and 2, IL-6, IL-10, IL-13, interferon-γ, TNF-α and lysozyme (LZ) were quantified in milk. We examined the effects of lactation stage, gestational age, volume of milk expressed, mode of delivery, parity and maternal infection on milk immune factor concentrations using repeated-measures regression analysis. The concentrations of all factors except LZ and HD5 decreased over the 1st month postpartum. Extremely preterm mothers had significantly higher concentrations of HBD1 and TGF-β2 in colostrum than term mothers did. After controlling for other variables in regression analyses, preterm birth was associated with higher concentrations of HBD1, LZ and sCD14 in milk samples. In conclusion, preterm breast milk contains significantly higher concentrations of some immune proteins than term breast milk.
To increase reliability of the algorithm used in our fully automated electronic surveillance system by adding rules to better identify bloodstream infections secondary to other hospital-acquired infections.
Intensive care unit (ICU) patients with positive blood cultures were reviewed. Central line–associated bloodstream infection (CLABSI) determinations were based on 2 sources: routine surveillance by infection preventionists, and fully automated surveillance. Discrepancies between the 2 sources were evaluated to determine root causes. Secondary infection sites were identified in most discrepant cases. New rules to identify secondary sites were added to the algorithm and applied to this ICU population and a non-ICU population. Sensitivity, specificity, predictive values, and kappa were calculated for the new models.
Of 643 positive ICU blood cultures reviewed, 68 (10.6%) were identified as central line–associated bloodstream infections by fully automated electronic surveillance, whereas 38 (5.9%) were confirmed by routine surveillance. New rules were tested to identify organisms as central line–associated bloodstream infections if they did not meet one, or a combination of, the following: (I) matching organisms (by genus and species) cultured from any other site; (II) any organisms cultured from sterile site; (III) any organisms cultured from skin/wound; (IV) any organisms cultured from respiratory tract. The best-fit model included new rules I and II when applied to positive blood cultures in an ICU population. However, they didn’t improve performance of the algorithm when applied to positive blood cultures in a non-ICU population.
Electronic surveillance system algorithms may need adjustment for specific populations.
Infect. Control Hosp. Epidemiol. 2015;36(12):1396–1400
This volume of the Haskins Society Journal furthers the Society's commitment to historical and interdisciplinary research on the early and central Middle Ages, especially in the Anglo-Saxon, Anglo-Norman, and Angevin worlds but also on the continent. The topics of the essays it contains range from the curious place of Francia in the historiography of medieval Europe to strategies of royal land distribution in tenth-century Anglo-Saxon England to the representation of men and masculinity in the works of Anglo-Norman historians. Essays on the place of polemical literature in Frutolf of Michelsberg's Chronicle, exploration of the relationship between chivalry and crusading in Baudry of Bourgeuil's History, and Cosmas of Prague's manipulation of historical memory in the service of ecclesiastical privilege and priority each extend the volume's engagement with medieval historiography, employing rich continental examples to do so. Investigations of comital personnel in Anjou and Henry II's management of royal forests and his foresters shed new light on the evolving nature of secular governance in the twelfth centuries and challenge and refine important aspects of our view of medieval rule in this period. The volume ends with a wide-ranging reflection on the continuing importance of the art object itself in medieval history and visual studies. Contributors: H.F. Doherty, Kathryn Dutton, Kirsten Fenton, Paul Fouracre, Herbert Kessler, Ryan Lavelle, Thomas J.H. McCarthy, Lisa Wolverton, Simon Yarrow.
A survey of management practices in 309 Irish dairy herds was used to identify risk factors for the presence of antibodies to Salmonella, Neospora caninum and Leptospira interrogans serovar hardjo in extensively managed unvaccinated dairy herds. A previous study documented a herd-level seroprevalence in bulk milk of 49%, 19% and 86% for Salmonella, Neospora caninum and leptospira interrogans serovar hardjo, respectively in the unvaccinated proportion of these 309 herds in 2009. Association analyses in the present study were carried out using multiple logistic regression models. Herds where cattle were purchased or introduced had a greater likelihood of being positive to leptospira interrogans serovar hardjo (P<0.01) and Salmonella (P<0.01). Larger herds had a greater likelihood of recording a positive bulk milk antibody result to leptospira interrogans serovar hardjo (P<0.05). Herds that practiced year round calving were more likely to be positive to Neospora caninum (P<0.05) compared to herds with a spring-calving season, with no difference in risk between herds that practiced split calving compared to herds that practiced spring calving. No association was found between presence of dogs on farms and prevalence of Neospora caninum possibly due to limited access of dogs to infected materials including afterbirths. The information from this study will assist in the design of suitable control programmes for the diseases under investigation in pasture-based livestock systems.