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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.
A superconductor of paired protons is thought to form in the core of neutron stars soon after their birth. Minimum energy conditions suggest that magnetic flux is expelled from the superconducting region due to the Meissner effect, such that the neutron star core retains or is largely devoid of magnetic fields for some nuclear equation of state and proton pairing models. We show via neutron star cooling simulations that the superconducting region expands faster than flux is expected to be expelled because cooling timescales are much shorter than timescales of magnetic field diffusion. Thus magnetic fields remain in the bulk of the neutron star core for at least 106 − 107yr. We estimate the size of flux free regions at 107yr to be ≲ 100m for a magnetic field of 1011G and possibly smaller for stronger field strengths.
Data on gender-specific profiles of cognitive functions in patients with Parkinson's disease (PD) are rare and inconsistent, and possible disease-confounding factors have been insufficiently considered.
The LANDSCAPE study on cognition in PD enrolled 656 PD patients (267 without cognitive impairment, 66% male; 292 with mild cognitive impairment, 69% male; 97 with PD dementia, 69% male). Raw values and age-, education-, and gender-corrected Z scores of a neuropsychological test battery (CERAD-Plus) were compared between genders. Motor symptoms, disease duration, l-dopa equivalent daily dose, depression - and additionally age and education for the raw value analysis - were taken as covariates.
Raw-score analysis replicated results of previous studies in that female PD patients were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.03), while men outperformed women in visuoconstruction (p = 0.002) and figural memory (p = 0.005). In contrast, gender-corrected Z scores showed that men were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.02; recognition, p = 0.04), while no difference was found for visuospatial tests. This picture could be observed both in the overall analysis of PD patients as well as in a differentiated group analysis.
Normative data corrected for gender and other sociodemographic variables are relevant, since they may elucidate a markedly different cognitive profile compared to raw scores. Our study also suggests that verbal memory decline is stronger in women than in men with PD. Future studies are needed to replicate these findings, examine the progression of gender-specific cognitive decline in PD and define different underlying mechanisms of this dysfunction.
Proteins often deform, dehydrate or otherwise denature when adsorbed or patterned directly onto an inorganic substrate, thus losing specificity and biofunctionality. One method used to maintain function is to pattern the protein of interest directly onto another underlying protein or polypeptide that acts as a buffer layer between the substrate and the desired protein. We have used microcontact printing (μcp) to cross-stamp orthogonal linear arrays of two different proteins (e.g., IgG, poly-lysine, protein A) onto glass substrates. This created three separate types of protein-substrate microenvironments, including crossover structures of protein one on protein two. We report preliminary fluorescent microscopy and scanning force microscopy characterization of these structures, including commonly encountered structural defects.