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Hand hygiene compliance rates were estimated using direct observations. An AHHMS, installed on 4 nursing units in a sequential manner, determined hand hygiene performance rates, expressed as the number of hand hygiene events performed upon entering and exiting patient rooms divided by the number of room entries and exits. Additional strategies implemented to improve hand hygiene included goal setting, hospital leadership support, feeding AHHMS data back to healthcare personnel, and use of Toyota Kata performance improvement methods. HAIs were defined using National Healthcare Safety Network criteria.
Hand hygiene compliance rates generated by direct observation were substantially higher than performance rates generated by the AHHMS. Installation of the AHHMS without supplementary activities did not yield sustained improvement in hand hygiene performance rates. Implementing several supplementary strategies resulted in a statistically significant 85% increase in hand hygiene performance rates (P < .0001). The incidence density of non–Clostridioies difficile HAIs decreased by 56% (P = .0841), while C. difficile infections increased by 60% (P = .0533) driven by 2 of the 4 study units.
Implementation of an AHHMS, when combined with several supplementary strategies as part of a multimodal program, resulted in significantly improved hand hygiene performance rates. Reductions in non–C. difficile HAIs occurred but were not statistically significant.
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
The origins of agriculture in South-west Asia is a topic of continued archaeological debate. Of particular interest is how agricultural populations and practices spread inter-regionally. Was the Arabian Neolithic, for example, spread through the movement of pastoral groups, or did ideas perhaps develop independently? Here, the authors report on recent excavations at Alshabah, one of the first Neolithic sites discovered in Northern Arabia. The site’s material culture, environmental context and chronology provide evidence suggesting that well-adapted, seasonally mobile, pastoralist groups played a key role in the Neolithisation of the Arabian Peninsula.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Stonehenge is a site that continues to yield surprises. Excavation in 2009 added a new and unexpected feature: a smaller, dismantled stone circle on the banks of the River Avon, connected to Stonehenge itself by the Avenue. This new structure has been labelled ‘Bluestonehenge’ from the evidence that it once held a circle of bluestones that were later removed to Stonehenge. Investigation of the Avenue closer to Stonehenge revealed deep periglacial fissures within it. Their alignment on Stonehenge's solstitial axis (midwinter sunset–midsummer sunrise) raises questions about the early origins of this ritual landscape.
Clover inclusion may increase the sustainability of certain low-maintenance turfgrasses. However, selective weed control within mixed turfgrass–clover swards proves problematic because of clover susceptibility to herbicides. Research was conducted to identify common turf herbicides that are tolerated by three Trifolium species, including white clover, ball clover, and small hop clover, within low-maintenance turfgrass. Leaf and flower density, as well as plant height, were measured 4 wk after treatment as indicators of clover response to 14 herbicides. The three Trifolium spp. were moderately tolerant of bentazon (< 35% decrease in leaf density, height, or flowering). Simazine was well tolerated by white clover (< 5% decrease in all response variables), yet moderate injury to ball clover and small hop clover was observed (> 32% decrease in leaf density and > 27% decrease in flower density). Pronamide was well tolerated by white and ball clovers, with no effect on measured response variables; however, pronamide decreased small hop clover height and flower density (38 and 42%, respectively). Imazethapyr and imazamox were moderately well tolerated by white clover and small hop clover (< 39% decrease by all response variables), yet ball clover may be more susceptible to these herbicides than was anticipated based on previously reported tolerance. The herbicides 2,4-DB, halosulfuron, and metribuzin were well tolerated by white clover, with no effect on measured response variables; however, results suggest ball and small hop clovers were less tolerant. Clopyralid, 2,4-D, glyphosate, imazaquin, metsulfuron-methyl, and nicosulfuron resulted in varying degrees of injury across clover species and response variables, but, in general, these herbicides may not be viable options when attempting to maintain any of the three clover species tested. Further research is needed to quantify long-term effects of herbicide application on sward composition and clover succession.
We aimed to study the fate of fat during digestion. For this purpose, we validated and investigated the non-invasive quantification of gastric and duodenal fat emptying and emulsion processing (creaming and phase separation) using the MRI method iterative decomposition with echo asymmetry and least squares estimation (IDEAL). In total, twelve healthy subjects were studied on two separate visits in a single-blind, randomised, cross-over design study. IDEAL was utilised to repeatedly acquire quantitative fat fraction maps of the gastrointestinal tract after infusion of one of two fat emulsions: E1 (acid stable, droplet size 0·33 mm) and E4 (acid unstable, 0·38 mm). In vitro and in vivo validation was carried out using diluted emulsion and gastric content samples, respectively, and resulted in Lin’s concordance correlation coefficients of 1·00 (95 % CI 0·98, 1·00) and 0·91 (95 % CI 0·87, 0·94), respectively. Fat fraction maps and intragastric emulsion profiles enabled the identification of features of intraluminal phase separation and creaming that were not visible in conventional MRI. Gastric fat emptying was faster for E4 compared with E1 with a difference of 2·5 (95 % CI 1·9, 3·1) ml/h. Duodenal content volumes were larger for E1 than for E4 with a difference of 4·9 (95 % CI 3·9, 8·5) ml. This study demonstrated that with IDEAL it was possible (1) to visualise the intragastric and duodenal fat distribution and (2) to quantify the differences in emptying, phase separation and creaming of an acid-stable and an acid-unstable emulsion. This method has potential to bridge the gap between current in vitro digestive models and in vivo behaviour and to be applied in the development of effective functional foods.
Aminocyclopyrachlor (AMCP) is a synthetic auxin herbicide used for broadleaf
weed control in pasture and rangeland. The tolerance and fate of AMCP within
pertinent grass species is not well understood. Research was conducted to
establish the tolerance of four grass species to AMCP application and
observe their absorption, translocation, and metabolism. Results indicate
that tall fescue is the most tolerant of AMCP at rates required for weed
control. Bahiagrass and bermudagrass are marginally tolerant, and cogongrass
is the most sensitive. Tall fescue and bahiagrass absorbed more AMCP than
bermudagrass and cogongrass, but cogongrass absorption is the most rapid and
complete within 2 days after treatment (DAT). Cogongrass and bermudagrass
translocated the least amount out of the target area, whereas bahiagrass and
tall fescue translocated the most. Radioisotope imaging revealed that tall
fescue may sequester absorbed AMCP in leaf tips. This sequestering may be
the basis of the greater tolerance to AMCP by tall fescue relative to the
other species evaluated. No metabolism of AMCP was detected in any grass
species out to 42 DAT.
Antimicrobial stewardship programs are increasingly recognized as critical in optimizing the use of antimicrobials. Consequently, more physicians, pharmacists, and other healthcare providers are developing and implementing such programs in a variety of healthcare settings. The purpose of this guidance document is to outline the knowledge and skills that are needed to lead an antimicrobial stewardship program. It was developed by antimicrobial stewardship experts from organizations that are engaged in advancing the field of antimicrobial stewardship.
Infect Control Hosp Epidemiol 2014;35(12):1444–1451
Successful outcome from surgery does not come about because of a surgeon’s encyclopaedic knowledge of surgical conditions, nor from his or her masterly ability as a technical operator, although both of these components surely contribute. Good outcome is the result of multiple factors within a team framework, all contributing to the end result of surgery. Implicit within these constituents is the close relationship between the surgeon and the anaesthetist and the understanding each has of the complexities and difficulties with which the other might have to contend throughout the period of an operation, which includes the pre- and post-operative phases.
This book serves to inform surgeons of the intricacies and minutiae of anaesthesia in all aspects, ranging from day care local anaesthesia to cardiac bypass techniques. It is comprehensive and yet eminently readable and informative. The early chapters on basic physiology, combined with later chapters on fluids and commonly used drugs and dosages are fundamental to any trainee or practising surgeon and are beautifully composed. To miss these gems would be akin to ignoring the basic science lectures that are so important in the understanding of all medicine and surgery.
Subsequent chapters relate to specialty specific surgical fields and are particularly interesting and suitably detailed. In addition, there are chapters on associated subjects such as enhanced recovery, post-operative cognitive dysfunction and medico-legal aspects of consent. The editors have gone to considerable trouble to find authors with the specific knowledge and interests to produce a concise and yet wide-ranging book, which leaves the surgical reader admirably informed about his or her colleague’s armamentarium of anaesthetic approaches, potential pitfalls and rescue strategies.
We present new results of our wide-field redshift survey of galaxies in a 182 square degree region of the Shapley Supercluster (SSC) based on observations with the FLAIR-II spectrograph on the UK Schmidt Telescope (UKST). In this paper we present new measurements to give a total sample of redshifts for 710 bright (R ≤ 16.6) galaxies, of which 464 are members of the SSC (8000 < v < 18 000 km s–1). Our data reveal that the main plane of the SSC (v ≈ 14 500 km s–1) extends further than previously realised, filling the whole extent of our survey region of 10 degrees by 20 degrees on the sky (35 Mpc by 70 Mpc, for H0 = 75 km s–1 Mpc–1). There is also a significant structure associated with the slightly nearer Abell 3571 cluster complex (v ≈ 12 000 km s–1) with a caustic structure evident out to a radius of 6 Mpc. These galaxies seem to link two previously identified sheets of galaxies and establish a connection with a third one at V (V) = 15 000 km s–1 near RA = 13h. They also tend to fill the gap of galaxies between the foreground Hydra-Centaurus region and the more distant SSC. We calculate galaxy overdensities of 5.0 ± 0.1 over the 182 square degree region surveyed and 3.3 ± 0.1 in a 159 square degree region excluding rich clusters. Over the large region of our survey the inter-cluster galaxies make up 46 per cent of all galaxies in the SSC region and may contribute a similar amount of mass to the cluster galaxies.
We present new imaging data and archival multiwavelength observations of the little-studied emission nebula K 1-6 and its central star. Narrow-band images inHα (+[N II]) and [O III] taken with the Faulkes Telescope North reveal a stratified, asymmetric, elliptical nebula surrounding a central star which has the colours of a late G or early K-type subgiant or giant. GALEX ultraviolet images reveal a very hot subdwarf or white dwarf coincident in position with this star. The cooler, optically dominant star is strongly variable with a period of 21.312± 0.008 days, and is possibly a high-amplitude member of the RS CVn class, although an FK Com classification is also possible. Archival ROSAT data provide good evidence that the cool star has an active corona. We conclude that K 1-6 is most likely an old bona fide planetary nebula at a distance of ∼1.0 kpc, interacting with the interstellar medium, and containing a binary or ternary central star. The observations and data analyses reported in this paper were conducted in conjunction with Year 11 high school students as part of an Australian Research Council Linkage Grant science education project, denoted Space To Grow, conducted jointly by professional astronomers, educational researchers, teachers, and high-school students.
Recent Hα surveys such as SHS and IPHAS have improved the completeness of the Galactic planetary nebula (PN) census. We now know of ∼3000 PNe in the Galaxy, but this is far short of most estimates, typically ~25 000 or more for the total population. The size of the Galactic PN population is required to derive an accurate estimate of the chemical enrichment rates of nitrogen, carbon, and helium. In addition, a high PN count (>20 000) is strong evidence that most main-sequence stars of mass 1–8 M⊙ will go through a PN phase, while a low count (<10 000) argues that special conditions (e.g. close binary interactions) are required to form a PN. We describe a technique for finding hundreds more PNe using the existing data collections of the digital sky surveys, thereby improving the census of Galactic PNe.
Although Much has been published on giant Magnetoresistance (GMR) in co-deposited thin films [1–4], only little  has been published on the structure-property relationships limiting the effect. Here, we report the results of microstructural characterization of NiFeAg thin films that exhibit a GMR effect. The as-deposited films show a sizeable GMR effect. The Maximum GMR effect observed was 6.4% with -4k0e FWHM of the 6P/P peak. Upon annealing these films, the GMR at first increases, and then decreases. We present microstructural evidence from TEM and XRD, amongst other techniques, which shows that this is a consequence of the initial NiFeAg thin film agglomerating into NiFe grains in a predominantly Ag segregant Matrix. Upon extended annealing, excessive grain growth leads to a decrease in the GMR as predicted by the model of Berkowitz, et al. .
A new sequence of Holocene landscape change has been discovered through an investigation of sediment sequences, palaeosols, pollen and molluscan data discovered during the Stonehenge Riverside Project. The early post-glacial vegetational succession in the Avon valley at Durrington Walls was apparently slow and partial, with intermittent woodland modification and the opening-up of this landscape in the later Mesolithic and earlier Neolithic, though a strong element of pine lingered into the third millennium bc. There appears to have been a major hiatus around 2900 cal bc, coincident with the beginnings of demonstrable human activities at Durrington Walls, but slightly after activity started at Stonehenge. This was reflected in episodic increases in channel sedimentation and tree and shrub clearance, leading to a more open downland, with greater indications of anthropogenic activity, and an increasingly wet floodplain with sedges and alder along the river's edge. Nonetheless, a localized woodland cover remained in the vicinity of Durrington Walls throughout the third and second millennia bc, perhaps on the higher parts of the downs, while stable grassland, with rendzina soils, predominated on the downland slopes, and alder–hazel carr woodland and sedges continued to fringe the wet floodplain. This evidence is strongly indicative of a stable and managed landscape in Neolithic and Bronze Age times. It is not until c 800–500 cal bc that this landscape was completely cleared, except for the marshy-sedge fringe of the floodplain, and that colluvial sedimentation began in earnest associated with increased arable agriculture, a situation that continued through Roman and historic times.