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Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
The CHIME telescope (the Canadian Hydrogen Intensity Mapping Experiment) recently built in Penticton, Canada, is currently being commissioned. Originally designed as a cosmology experiment, it was soon recognized that CHIME has the potential to simultaneously serve as an incredibly useful radio telescope for pulsar science. CHIME operates across a wide bandwidth of 400–800 MHz and will have a collecting area and sensitivity comparable to that of the 100-m class radio telescopes. CHIME has a huge field of view of ~250 square degrees. It will be capable of observing 10 pulsars simultaneously, 24-hours per day, every day, while still accomplishing its missions to study Baryon Acoustic Oscillations and Fast Radio Bursts. It will carry out daily monitoring of roughly half of all pulsars in the northern hemisphere, including all NANOGrav pulsars employed in the Pulsar Timing Array project. It will cycle through all pulsars in the northern hemisphere with a range of cadence of no more than 10 days.
Soviet plans to divert water from rivers flowing into the Arctic Ocean have led to research into the impact of a reduction in discharge on Arctic sea ice. We consider the mechanisms by which discharge reductions might affect sea-ice cover and then test various hypotheses related to these mechanisms. We find several large areas over which sea-ice concentration correlates significantly with variations in river discharge, supporting two particular hypotheses. The first hypothesis concerns the area where the initial impacts are likely to which is the Kara Sea. Reduced riverflow is associated occur, with decreased sea-ice concentration in October, at the time of ice formation. This is believed to be the result of decreased freshening of the surface layer. The second hypothesis concerns possible effects on the large-scale current system of the Arctic Ocean and, in particular, on the inflow of Atlantic and Pacific water. These effects occur as a result of changes in the strength of northward-flowing gradient currents associated with variations in river discharge. Although it is still not certain that substantial transfers of riverflow will take place, it is concluded that the possibility of significant cryospheric effects and, hence, large-scale climate impact should not be neglected.
A radiochemical 71Ga−71 Ge experiment to determine the integral flux of neutrinos from the sun has been constructed at the Baksan Neutrino Observatory in the USSR. Measurements have begun with 30 tonnes of gallium. The experiment is being expanded with the addition of another 30 tonnes. The motivation, experimental procedures, and present status of this experiment are presented.
Most individuals with dementia live in the community, receiving care from family or lay carers. Carers’ wellbeing, and the quality of the care they provide, depends on their resilience in the face of the challenges associated with caring for someone with dementia. However, factors associated with carers’ resilience are not yet fully understood. The aim of this review is to present a narrative synthesis of factors, materials and resources associated with carers’ resilience. Electronic and hand searches identified relevant published literature, which was narratively synthesized. A framework consisting of three inter-related domains of factors influencing carers’ resilience emerged, encompassing: social and cultural factors; properties of the care relationship; and carers’ psychological factors. Holistic assessment based on this framework can help practitioners to identify vulnerable carers and to target help on factors that help to make them vulnerable but that are amenable to change.
Two tests are described for detecting antibody to the type-specific opacity factor (OF) of group A streptococci. This antibody was detected among patients convalescent from streptococcal sore throat in two communities in which out-breaks due to opacity factor-producing strains of group A streptococci occurred.
In an outbreak due to streptococci of M-type 22 there was a close correspondence between the distribution of anti-OF and of bactericidal M-antibody for the type. In a smaller outbreak due to M-type 58 streptococci, however, M-antibody was detected more often than antibody of OF.
The alarm vocalizations of the whistling rats Parotomys brantsii and P. littledalei were investigated at the Goegap Nature Reserve in the Northern Cape, South Africa, where they occur sympatrically. Parotomys brantsii's call is a single note vocalization, characterized by an upward frequency sweep and high frequency plateau with a dominant frequency of 10.0 ± 0.3 kHz and duration of 164 ± 11 ms. The alarm whistle of P. littledalei has three overlapping components and is both shorter (53 ± 5 ms) and lower in dominant frequency (7.7 ± 0.1 kHz) than that of P. brantsii. The frequency bandwidth of P. littledalei calls (10.2 ± 0.7 kHz) is significantly higher than that of P. brantsii (6.8 ± 0.4 kHz). These significant distinctions are attributed to habitat preferences of the two species. Our data support the acoustic adaptation hypothesis in that P. littledalei, which inhabits a more closed habitat, has calls which are lower in frequency than P. brantsii calls, but contrary to the hypothesis, P. brantsii calls do not show greater frequency modulation than those of P. littledalei. Despite these differences, the alarm calls of the two species are both high-pitched, and may have converged in structure to be difficult for predators to locate.
Patients undergoing cancer treatments, including radiotherapy, frequently report fatigue during their treatment. Recent research indicates that structured exercise programmes can alleviate fatigue and, in light of this research, many centres are now advocating activity as part of the strategy with which to combat fatigue. The aim of this investigation was to see how well this strategy would be received by patients and what effect it would have on fatigue levels. Of the 147 patients who agreed to take part in the study 123 completed all the questionnaires. Fiftyfour of the patients received the standard advice whilst 69 received the modified advice. Fatigue was measured at four time points using the MFI scale. Fatigue scores at the end of treatment were significantly higher than at the start of treatment but there was no difference in fatigue scores between the two groups of patients receiving the different advice. Activity levels between the two groups were comparable, as was their change in activity level compared to normal, indicating a reluctance to use this strategy.
Measurements of fluctuating pressure and velocity, together with instantaneous smoke-flow visualizations, are presented in order to reveal the unsteady structure of a separated and reattaching flow. It is shown that throughout the separation bubble a low-frequency motion can be detected which appears to be similar to that found in other studies of separation. This effect is most significant close to separation, where it leads to a weak flapping of the shear layer. Lateral correlation scales of this low-frequency motion are less than the reattachment length, however; it appears that its timescale is about equal to the characteristic timescale for the shear layer and bubble to change between various shedding phases. These phases were defined by the following observations: shedding of pseudoperiodic trains of vortical structures from the reattachment zone, with a characteristic spacing between structures of typically 60% to 80% of the bubble length; a large-scale but irregular shedding of vorticity; and a relatively quiescent phase with the absence of any large-scale shedding structures and a significant ‘necking’ of the shear layer downstream of reattachment.
Spanwise correlations of velocity in the shear layer show on average an almost linear growth of spanwise scale up to reattachment. It appears that the shear layer reaches a fully three-dimensional state soon after separation. The reattachment process does not itself appear to impose an immediate extra three-dimensionalizing effect upon the large-scale structures.
The provenance of vessels of the Marine Style of LMIB from Crete and LHIIA from the Mainland remains an important unsolved problem. This article describes an attempt to discriminate between selected Mainland and Cretan specimens by multivariate analysis of the compositions of their fabrics determined by optical emission spectroscopy with the aim of determining whether the Mainland Marine Style pieces were indeed made on the Mainland, perhaps locally at their find spots, or were imported from Crete or the islands. Accordingly Marine Style sherds have been sampled from seven Mainland, two island, and two Cretan sites, together with a large number of definitively local sherds from each site to serve as a control over the characteristics of the local clays. A distribution map, Fig. 1, and a corpus, as complete as possible, defining and describing the motifs and shapes used in the Marine Style from the Mainland, Crete, and the islands as a whole is included below in order to provide an overview of the available information.
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