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Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes.
A multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015–2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes.
Of 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n = 558), rhinosinusitis (n = 715), bronchitis (n = 1,155), URI-NOS (n = 1,475), or mixed diagnoses (>1 ARI diagnosis) (n = 402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P < .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P = .22).
Antibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations.
We carried out a high contrast imaging search for (sub)stellar companions of young pre-main sequence stars in the Lupus star forming region. For this project we utilized NACO/ESO-VLT, operated at the Paranal observatory. On this poster, we presented the results of this survey. In several observing campaigns we could obtain diffraction limited deep IR imaging data and detected faint co-moving companions around our targets, whose astro- and photometry was determined in all observing epochs. The co-moving companions found in our survey exhibit angular separations in the range between about 0.1 and a few arcsecs, i.e. projected separations between about 10 and a few hundreds of au, at the average distance of our targets of about 140 pc. Beside several new binary and triple star systems, whose multiplicity was revealed in this survey, also faint co-moving companions in the substellar mass regime could be identified close to some of our targets.
In order to determine the true impact of stellar multiplicity on the formation and evolution of planets, we initiated direct imaging surveys to search for (sub)stellar companions of exoplanet host stars on close orbits, as their gravitational impact on the planet bearing disk at first and on formed planets afterwards is expected to be maximal. According to theory these are the most challenging environments for planet formation and evolution but might occur quite frequently in the milky way, due to the large number of multiple stars within our galaxy. On this poster we showed results, obtained so far in the course of our AO and Lucky-imaging campaigns of exoplanet host stars, conducted with NACO/ESO-VLT for southern and with AstraLux/CAHA2.2m for northern targets, respectively. In addition, we introduced our new high contrast imaging survey with SPHERE/ESO-VLT to search for close companions of southern exoplanet host stars, and presented some first results.
Practical Implementation of an Antibiotic Stewardship Program provides an essential resource for healthcare providers in acute care, long-term care, and ambulatory care settings looking either to begin or to strengthen existing antibiotic stewardship programs. Each chapter is written by both physician and pharmacist leaders in the stewardship field and incorporates both practical knowledge as well as evidence-based guidance. This book will also serve as a useful resource for medical students, pharmacy students, residents, and infectious diseases fellows looking to learn more about the field of antibiotic stewardship.
To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program.
The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities.
Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities.
Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection.
The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs.
Many neutron stars (NSs) and runaway stars apparently come from the same regions on the sky. This suggests that they share the same birth places, namely associations and clusters of young massive stars. To identify NS birth places, we attempt to find NS-runaway pairs that could be former companions that were disrupted in a supernova (SN). The remains of recent (<few Myr) nearby (<150 pc) SNe should still be identifiable by observing the emission of rare radioisotopes such as 26Al and 60Fe that can also be used as additional indicators to confirm a possible SN event. We investigated the origin of the isolated NS RX J1605.3+3249 and found that it was probably born ≈ 100 pc far from Earth 0.45 Myr ago in the extended Corona Australis or Octans associations, or in Sco OB4 ≈ 1 kpc 3.5 Myr ago. A SN in Octans is supported by the identification of one to two possible former companions—the runaway stars HIP 68228 and HIP 89394—as well as the appearance of a feature in the γ-ray emission from 26Al decay at the predicted SN place. Both, the progenitor masses estimated by comparison with theoretical 26Al yields as well as derived from the lifetime of the progenitor star, are found to be ≈ 11M⊙.
To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.
A retrospective analysis of bar code medication administration (BCMA) data.
Acute care wards of 128 VA hospitals throughout the United States.
Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route.
Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).
Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a “low-hanging fruit” to increase awareness of appropriate antibiotic use.
One of the handful of known PMS eclipsing binaries is a component of the spectroscopic triple TY CrA. Its secondary component is particularly interesting since it is a star of relatively high mass (1.64 M⊙) which is still on the pre-main sequence. The eclipsing binary was analyzed in the optical wavelength range ~10 years ago, however, the crucial secondary eclipse minimum is very shallow. Therefore, we are obtaining new photometry in both optical and near-IR bands. We present first observations in (BVRI) which show that the secondary eclipse depth increases to about 0.1 mag in the I band. The increased eclipse depth with respect to other bands will help to better determine the colours and dimensions of the system. Furthermore, we show and discuss first near-IR observations of the primary eclipse. In addition to the light curves we are obtaining radial velocities in order to pin down the orbital parameters of the triple. Our first observations agree with the orbital parameters derived ~10 years ago.
Body fat mass (FM) adds to the variance in resting energy expenditure (REE). However, the nature and extent of this relationship remains unclear. Using a database of 1306 women and a linear regression model, we systematically analysed the contribution of FM to the total variance in REE at different grades of adiposity (ranges of body %FM). After adjusting for age, the relative contribution of FM on REE variance increased from low ( ≤ 10 %FM) to normal (>10– ≤ 30 %FM) and moderately elevated (>30– ≤ 40 %FM) grades of adiposity but decreased sharply at high (>40– ≤ 50 %FM) and very high (>50 %FM) grades of adiposity according to the ratio between regression coefficients. These data suggest that the specific metabolic rate of fat tissue is reduced at high adiposity. This should be considered when REE is normalized for FM in obesity.
We have started high precision photometric monitoring observations at the AIU Jena observatory in Großschwabhausen near Jena in fall 2006. We used a 25.4cm Cassegrain telescope equipped with a CCD-camera mounted piggyback on a 90cm telescope. To test the attainable photometric precision, we observed stars with known transiting planets. We could recover all planetary transits observed by us.
We observed the parent star of the transiting planet TrES-2 over a longer period in Großschwabhausen. Between March and November 2007 seven different transits and almost a complete orbital period were analyzed. Overall, in 31 nights of observation 3423 exposures (in total 57.05h of observation) of the TrES-2 parent star were taken. Here, we present our methods and the resulting light curves. Using our observations we could improve the orbital parameters of the system.
We report on observations of transit events of the transiting planets XO-1b and TrES-1 with the AIU Jena telescope in Großschwabhausen. Based on our (IR) photometry (in March 2007) and available transit timings (SuperWASP, XO and TLC-project-data) we improved the orbital period of XO-1b (P = 3.941497 ± 0.000006) and TrES-1 (P = 3.0300737 ± 0.000006), respectively. The new ephemeris for the both systems are presented.
TWA 5B is a brown dwarf companion of H=12 mag, 2″ off the ~5 mag brighter triple star CoD-33° 7795 (=TWA 5), a member of the TW Hydrae association of T Tauri stars at ~55 pc. This object is the first brown dwarf around a pre-main-sequence star (confirmed by common proper motion) ever found. In the last year we have newly reduced VLT NaCo data originally taken in 2003 and combined it with all the available astrometric data of the system to investigate possibly detectable orbital motion of the system. Indeed we were able to find linear orbital motion of the system combining data from HST, VLT and Gemini-North.
Two different types of metallic glasses, a metal-metal-based and a metal-metalloid-based one, in both bulk and ribbon form (i.e., produced with very different quenching rates) are compared with respect to their structural relaxation behavior during continuous heating (2 K/min) in a vibrating-reed set-up (frequencies 0.2–5 kHz). The variation of damping as a function of temperature, time, and strain amplitude is shown as a measure of the content of structural relaxation centers, whose nature is studied by means of artificially introduced irregularities into the amorphous structure (i.e., by cold rolling and by hydrogen charging). The results indicate that the hydrogen damping peak, which is only observed in the Zr-based glass, is more probably due to hydrogen reorientation jumps than due to reorientation of hydrogen-related, dislocation-like distortion fields although the latter cannot be ruled out. A pronounced deformation damping peak could not be found in contrast to earlier results in the literature, probably owing to the selected degrees of deformation.