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Our stewardship team evaluated 19 months of discharge antibiotic prescriptions to determine prescribing appropriateness and to characterize the interventions made. Intervention occurred in 9.7% of patients, with a 58% acceptance rate. Most interventions were educational (antibiotic course was complete at time of intervention). Discharge antibiotic review is a potential stewardship tool.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
The Australian Centre for Advanced Photovoltaics (ACAP) co-ordinates the activities of the six Australian research institutions and a group of industrial partners in the Australia-US Institute for Advanced Photovoltaics (AUSIAPV) to develop the next generations of photovoltaic device technology and to provide a pipeline of opportunities for performance increase and cost reduction. AUSIAPV links ACAP with US-based partners. These national and international research collaborations provide a pathway for highly visible, structured photovoltaic research collaboration between Australian and US researchers, institutes and agencies with significant joint programs based on the clear synergies between the participating organizations. The research program is organized in five collaborative Program Packages (PPs). PP1 deals with silicon wafer-based cells, focusing on three main areas: cells from solar grade silicon, rear contact and silicon-based tandem cells. PP2 involves research into a range of organic solar cells, organic/inorganic hybrid cells, "earth abundant" thin-film materials and "third generation" approaches. PP3 is concerned with optics and characterization. PP4 will deliver a substantiated methodology for assessing manufacturing costs of the different technologies and PP5 involves education, training and outreach. The main research topics, results and plans for the future are presented.
The use of both tablet devices and social media is increasingly popular among the American public. With this in mind, this article discusses our use of the technologies in a course about the 2012 US election campaign. We provided all students in our course with an iPad, created a private Facebook group, and devised a variety of approaches for integrating the technologies into the course. Surveys at the beginning and the end of the course showed that students frequently used their iPad for political and instructional purposes and that their self-confidence in using tablet devices, apps, and social media for political purposes increased during the semester. Open-ended responses and our own observations also suggest that use of the technologies fostered active online conversations about course material. In particular, use of the iPad and the Facebook group in combination during in-class video screenings, guest speakers, and debates facilitated lively, creative interactions among students and between students and instructors.
The aim of this study was to examine if family system dynamics (e.g., parent mental health, marriage quality, conflict, and cohesion) that have often been overlooked when studying Latino families play a more important role in predicting adolescent internalizing symptoms than acculturation processes. Data comes from the Latino Acculturation and Health Project, a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona (Smokowski & Bacallao, 2006, 2010). Researchers conducted in-depth, community-based interviews with 258 Latino adolescents and 258 of their parents in metropolitan, small-town, and rural areas. Interviews were conducted at four time points at intervals of approximately 6 months. Parent and adolescent ratings of the adolescent's internalizing symptoms were used as the dependent variable in a longitudinal hierarchical linear model with a rater effects structure. Results showed that parent–adolescent conflict and parent mental health (fear/avoidance of social situations and humiliation sensitivity) were significant predictors of adolescent internalizing symptoms. Acculturation scales were not significant predictors; however, internalizing symptoms decreased with time spent in the United States. Females and adolescents from lower socioeconomic status families reported more internalizing symptoms, while participants who had been in the United States longer reported fewer internalizing symptoms. Implications were discussed.
Private protected areas (PPAs) are a board category that includes reserves established and managed by non-government entities, including civil society organizations, businesses and private individuals. It was recently suggested that the creation of a system of PPAs in Brazil may act as a useful model for extending protected area systems internationally. While it is clear that RPPNs have an important role to play in the future development of Brazil's protected area system, there are several significant challenges that need to be overcome if they are fulfil their potential: (1) ensuring that RPPNs contribute to coverage and representation; (2) ensuring adequate governance; and (3) increasing the attractiveness of the RPPN model. While it is still too early to determine whether RPPNs constitute a robust PPA model that could (or should) be exported to other countries, they are creating new opportunities for innovation and novel management strategies that might eventually lead to a vibrant and distinctly Brazilian protected area movement.
We present an update of the ‘key points’ from the Antarctic Climate Change and the Environment (ACCE) report that was published by the Scientific Committee on Antarctic Research (SCAR) in 2009. We summarise subsequent advances in knowledge concerning how the climates of the Antarctic and Southern Ocean have changed in the past, how they might change in the future, and examine the associated impacts on the marine and terrestrial biota. We also incorporate relevant material presented by SCAR to the Antarctic Treaty Consultative Meetings, and make use of emerging results that will form part of the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report.
Children with spina bifida myelomeningocele (SBM) are more likely to display a pattern of good-decoding/poor comprehension than their neurologically intact peers. The goals of the current study were to (1) examine the cognitive origins of one of the component skills of comprehension, bridging inferences, from a developmental perspective and (2) to test the effects of those relations on reading comprehension achievement. Data from a sample of children with SBM and a control group (n = 78) who participated in a longitudinal study were taken from age 36-month and 9.5-year time points. A multiple mediation model provided evidence that three preschool cognitive abilities (working memory/inhibitory control, oral comprehension, narrative recall), could partially explain the relation between group and bridging inference skill. A second mediation model supported that each of the 36-month abilities had an indirect effect on reading comprehension through bridging inference skill. Findings contribute to an understanding of both typical and atypical comprehension development, blending theories from the developmental, cognitive, and neuropsychological literature. (JINS, 2013, 19, 1–10)
J. David Singer, a globally recognized scholar of international politics, died Monday, December 28, 2009, in Ann Arbor, Michigan. He was involved in an auto accident on September 22 and had been hospitalized since. At the time of his death, Singer was Professor Emeritus at the University of Michigan, where he'd been on the faculty from 1958 until retiring in 2002. He was 84 years old.
Pseudoprogression (psPD) is now recognised following radiotherapy with concurrent temozolomide (RT/TMZ) for glioblastoma multiforme (GBM). The aim of this study was to determine the incidence of psPD following RT/TMZ and the effect of psPD on prognosis.
All patients receiving RT/TMZ for newly diagnosed GBM were identified from a prospective database. Clinical and radiographic data were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within eight weeks of completing RT/TMZ. Pseudoprogression was defined as early progression with subsequent disease stabilization, without salvage therapy, for at least six months from completion of RT/TMZ. The primary outcome was overall survival (Kaplan-Meier) and log rank analysis was used to compare groups.
Out of 111 patients analyzed, 104 were evaluable for radiological response. Median age was 58 years and median follow-up 55 weeks. Early progression was confirmed in 26% and within this group 32% had psPD. Median survival for the whole cohort was 56.7 weeks [95% CI (51.0, 71.3)]. Median survival for patients with psPD was significantly higher than for patients with true early progression (124.9 weeks versus 36.0 weeks, p=0.0286).
Approximately one third of patients with early progression were found to have psPD which was associated with a favourable prognosis. Maintenance TMZ should not be abandoned on the basis of seemingly discouraging imaging features identified within the first three months after RT/TMZ.
The Hispaniolan solenodon Solenodon paradoxus, one of only two surviving native Hispaniolan land mammals, has declined drastically in Haiti and has only been recorded from the Duchity region of the Massif de la Hotte in recent decades. Previous studies have been pessimistic about the probability of even short-term survival of this relict population, predicting its likely extinction by the start of the 21st century because of a range of anthropogenic threats. However, new surveys (sign surveys and interviews with villagers and subsistence farmers) and the discovery of three dead solenodons confirm the continued survival of the species in the Duchity region, apparently across a greater geographic area than previously recognized. This may reflect a cull on dogs around the Duchity region. Given the lack of any targeted mammal conservation research in Haiti for almost 2 decades, immediate further investigation is required into solenodon distribution, habitat utilization, density, and interaction with introduced predators across the region. The solenodons of the Massif de la Hotte may represent a distinct taxon, making the establishment of an effective research and conservation programme for this population an urgent priority.