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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Many important oxidative reactions, such as CO oxidation, take place on metal surfaces at high temperatures and partial pressures. Understanding the atomic processes involved in these catalyzed reactions are of great importance and may be achievable by observations of the adsorbate-induced surface structure under temperatures and pressures relevant to working catalysts. Many of the prior studies, however, have only considered quenched-in structures with no dynamic interaction between the metal surface and the gas phase. This presentation describes in-situ synchrotron x-ray studies of the Cu (001) surface as a function of pO2, the oxygen partial pressure, and temperature. We utilize a controlled-flow reaction chamber specially constructed to mount onto an eight-circle diffractometer at the Advanced Photon Source. The chamber allows the flow of oxygen, hydrogen, and argon mixtures with pO2 ranging from 760 to 1×10-12 Torr and sample temperatures variable from 25 to 1000 °C. After reaching a critical pO2, oxygen adsorbs onto the initially clean Cu (001) surface, resulting in the rapid nucleation and growth of c(2×2)-O domains. Domain formation is concurrent with a small in-plane surface contraction and a large out-of-plane surface expansion associated with a compressive adsorbate-induced surface stress. The often reported (2√2×√2)R45 reconstruction is observed only below ~ 150 °C. Relationships between the different surface structures, subsurface oxygen, surface stress, and surface reactivity will be discussed.
Although food from grazed animals is increasingly sought by consumers because of perceived animal welfare advantages, grazing systems provide the farmer and the animal with unique challenges. The system is dependent almost daily on the climate for feed supply, with the importation of large amounts of feed from off farm, and associated labour and mechanisation costs, sometimes reducing economic viability. Furthermore, the cow may have to walk long distances and be able to harvest feed efficiently in a highly competitive environment because of the need for high levels of pasture utilisation. She must, also, be: (1) highly fertile, with a requirement for pregnancy within ~80 days post-calving; (2) ‘easy care’, because of the need for the management of large herds with limited labour; (3) able to walk long distances; and (4) robust to changes in feed supply and quality, so that short-term nutritional insults do not unduly influence her production and reproduction cycles. These are very different and are in addition to demands placed on cows in housed systems offered pre-made mixed rations. Furthermore, additional demands in environmental sustainability and animal welfare, in conjunction with the need for greater system-level biological efficiency (i.e. ‘sustainable intensification’), will add to the ‘robustness’ requirements of cows in the future. Increasingly, there is evidence that certain genotypes of cows perform better or worse in grazing systems, indicating a genotype×environment interaction. This has led to the development of tailored breeding objectives within countries for important heritable traits to maximise the profitability and sustainability of their production system. To date, these breeding objectives have focussed on the more easily measured traits and those of highest relative economic importance. In the future, there will be greater emphasis on more difficult to measure traits that are important to the quality of life of the animal in each production system and to reduce the system’s environmental footprint.