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The primary objective of this study was to examine the impact of an electronic medical record (EMR)–driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed “5 Moments of Antimicrobial Prescribing” metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.
A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.
For the 202 patients, 412 recommendations were made in accordance with the “5 Moments” metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).
The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our “5 Moments of Antimicrobial Prescribing” metric provides a framework for measuring AMS recommendation compliance.
The first ultraviolet photochemical oxidation (UVox) extraction method for marine dissolved organic carbon (DOC) as CO2 gas was established by Armstrong and co-workers in 1966. Subsequent refinement of the UVox technique has co-evolved with the need for high-precision isotopic (Δ14C, δ13C) analysis and smaller sample size requirements for accelerator mass spectrometry radiocarbon (AMS 14C) measurements. The UVox line at UC Irvine was established in 2004 and the system reaction kinetics and efficiency for isolating seawater DOC rigorously tested for quantitative isolation of ∼1 mg C for AMS 14C measurements. Since then, improvements have been made to sampling, storage, and UVox methods to increase overall efficiency. We discuss our progress, and key UVox system parameters for optimizing precision, accuracy, and efficiency, including (1) ocean to reactor: filtration, storage and preparation of DOC samples, (2) cryogenic trap design, efficiency and quantification of CO2 break through, and (3) use of isotopic standards, blanks and small sample graphitization techniques for the correction of DOC concentrations and Fm values with propagated uncertainties. New DOC UVox systems are in use at many institutions. However, rigorous assessment of quantitative UVox DOC yields and blank contributions, DOC concentrations and carbon isotopic values need to be made. We highlight the need for a community-wide inter-comparison study.
We describe the motivation and design details of the ‘Phase II’ upgrade of the Murchison Widefield Array radio telescope. The expansion doubles to 256 the number of antenna tiles deployed in the array. The new antenna tiles enhance the capabilities of the Murchison Widefield Array in several key science areas. Seventy-two of the new tiles are deployed in a regular configuration near the existing array core. These new tiles enhance the surface brightness sensitivity of the array and will improve the ability of the Murchison Widefield Array to estimate the slope of the Epoch of Reionisation power spectrum by a factor of ∼3.5. The remaining 56 tiles are deployed on long baselines, doubling the maximum baseline of the array and improving the array u, v coverage. The improved imaging capabilities will provide an order of magnitude improvement in the noise floor of Murchison Widefield Array continuum images. The upgrade retains all of the features that have underpinned the Murchison Widefield Array’s success (large field of view, snapshot image quality, and pointing agility) and boosts the scientific potential with enhanced imaging capabilities and by enabling new calibration strategies.
We describe the design and performance of the Engineering Development Array, which is a low-frequency radio telescope comprising 256 dual-polarisation dipole antennas working as a phased array. The Engineering Development Array was conceived of, developed, and deployed in just 18 months via re-use of Square Kilometre Array precursor technology and expertise, specifically from the Murchison Widefield Array radio telescope. Using drift scans and a model for the sky brightness temperature at low frequencies, we have derived the Engineering Development Array’s receiver temperature as a function of frequency. The Engineering Development Array is shown to be sky-noise limited over most of the frequency range measured between 60 and 240 MHz. By using the Engineering Development Array in interferometric mode with the Murchison Widefield Array, we used calibrated visibilities to measure the absolute sensitivity of the array. The measured array sensitivity matches very well with a model based on the array layout and measured receiver temperature. The results demonstrate the practicality and feasibility of using Murchison Widefield Array-style precursor technology for Square Kilometre Array-scale stations. The modular architecture of the Engineering Development Array allows upgrades to the array to be rolled out in a staged approach. Future improvements to the Engineering Development Array include replacing the second stage beamformer with a fully digital system, and to transition to using RF-over-fibre for the signal output from first stage beamformers.
Radio-glaciological parameters from the Moore’s Bay region of the Ross Ice Shelf, Antarctica, have been measured. The thickness of the ice shelf in Moore’s Bay was measured from reflection times of radio-frequency pulses propagating vertically through the shelf and reflecting from the ocean, and is found to be 576 ± 8 m. Introducing a baseline of 543 ± 7m between radio transmitter and receiver allowed the computation of the basal reflection coefficient, R, separately from englacial loss. The depth-averaged attenuation length of the ice column, 〈L〉 is shown to depend linearly on frequency. The best fit (95% confidence level) is 〈L(ν)〉= (460±20) − (180±40)ν m (20 dB km−1), for the frequencies ν = [0.100–0.850] GHz, assuming no reflection loss. The mean electric-field reflection coefficient is (1.7 dB reflection loss) across [0.100–0.850] GHz, and is used to correct the attenuation length. Finally, the reflected power rotated into the orthogonal antenna polarization is <5% below 0.400 GHz, compatible with air propagation. The results imply that Moore’s Bay serves as an appropriate medium for the ARIANNA high-energy neutrino detector.
The star formation rate in the Central Molecular Zone is an order of magnitude lower than in the disk of the Galaxy, given the amount of dense gas there. Understanding why star formation is different in this region is crucial if we are to understand the environmental dependence of star formation. Here, we present the detection of high-mass cores in the CMZ’s ‘dust ridge’ that have been discovered with the Submillimeter Array. These cores range in mass from ~ 50 – 1800 M⊙ within radii of 0.1 – 0.25 pc. All are young (pre-UCHII), meaning that they are prime candidates for representing the initial conditions of high-mass stars and sub-clusters. We compare these with high-mass cores and clouds in the Galactic disk and find that they are very similar in terms of their masses and sizes, despite being subjected to external pressures that are several magnitudes greater (~ 108 K cm−3). The fact that > 80% of these cores do not show any signs of star-forming activity in such a high-pressure environment leads us to conclude that this is further evidence of the critical density for star formation being heightened in the CMZ due to turbulence.
The inner few hundred parsecs of the Milky Way, the Central Molecular Zone (CMZ), is our closest laboratory for understanding star formation in the extreme environments (hot, dense, turbulent gas) that once dominated the universe. We present an update on the first large-area survey to expose the sites of star formation across the CMZ at high-resolution in submillimeter wavelengths: the CMZoom survey with the Submillimeter Array (SMA). We identify the locations of dense cores and search for signatures of embedded star formation. CMZoom is a three-year survey in its final year and is mapping out the highest column density regions of the CMZ in dust continuum and a variety of spectral lines around 1.3 mm. CMZoom combines SMA compact and subcompact configurations with single-dish data from BGPS and the APEX telescope, achieving an angular resolution of about 4″ (0.2 pc) and good image fidelity up to large spatial scales.
Current evidence supports the concept of a preclinical phase of Alzheimer's disease (AD) where pathological and imaging changes are present in asymptomatic individuals. Subjective cognitive impairment (SCI) may represent the earliest point on the continuum of AD. A better understanding of the baseline characteristics of this group of patients that later decline in cognition will enhance our knowledge of the very early disease processes, facilitate preventive strategies, early diagnosis, timely follow-up and treatment.
An observational exploratory study which followed up 62 consecutive patients with SCI presenting to a memory clinic and compared baseline characteristics of SCI patients who declined cognitively with those who did not. Cognitive decline was defined as a progression to a diagnosis of amnestic mild cognitive impairment (aMCI) or dementia at follow-up.
Patients were followed up for a mean of 44 months (range 12–112 months). At the time of follow up, 24% of patients had declined. Patients that declined were significantly older at onset of symptoms and first presentation to memory clinic, and took significantly more medications for physical illnesses. Patients that declined also performed significantly worse on Trail Making Test (TMT) B and Cambridge Cognitive Examination – Revised (CAMCOG-R) at baseline. Survival analysis identified key variables that predicted decline (later age of onset and later age at first assessment).
Patients who present with subjective memory complaints and are over the age of 61 years are at high risk of cognitive decline and warrant an in-depth assessment and follow-up.
The Murchison Widefield Array is a Square Kilometre Array Precursor. The telescope is located at the Murchison Radio–astronomy Observatory in Western Australia. The MWA consists of 4 096 dipoles arranged into 128 dual polarisation aperture arrays forming a connected element interferometer that cross-correlates signals from all 256 inputs. A hybrid approach to the correlation task is employed, with some processing stages being performed by bespoke hardware, based on Field Programmable Gate Arrays, and others by Graphics Processing Units housed in general purpose rack mounted servers. The correlation capability required is approximately 8 tera floating point operations per second. The MWA has commenced operations and the correlator is generating 8.3 TB day−1 of correlation products, that are subsequently transferred 700 km from the MRO to Perth (WA) in real-time for storage and offline processing. In this paper, we outline the correlator design, signal path, and processing elements and present the data format for the internal and external interfaces.
We present the results of an approximately 6 100 deg2 104–196 MHz radio sky survey performed with the Murchison Widefield Array during instrument commissioning between 2012 September and 2012 December: the MWACS. The data were taken as meridian drift scans with two different 32-antenna sub-arrays that were available during the commissioning period. The survey covers approximately 20.5 h < RA < 8.5 h, − 58° < Dec < −14°over three frequency bands centred on 119, 150 and 180 MHz, with image resolutions of 6–3 arcmin. The catalogue has 3 arcmin angular resolution and a typical noise level of 40 mJy beam− 1, with reduced sensitivity near the field boundaries and bright sources. We describe the data reduction strategy, based upon mosaicked snapshots, flux density calibration, and source-finding method. We present a catalogue of flux density and spectral index measurements for 14 110 sources, extracted from the mosaic, 1 247 of which are sub-components of complexes of sources.
The Australian Square Kilometre Array Pathfinder (ASKAP) will give us an unprecedented opportunity to investigate the transient sky at radio wavelengths. In this paper we present VAST, an ASKAP survey for Variables and Slow Transients. VAST will exploit the wide-field survey capabilities of ASKAP to enable the discovery and investigation of variable and transient phenomena from the local to the cosmological, including flare stars, intermittent pulsars, X-ray binaries, magnetars, extreme scattering events, interstellar scintillation, radio supernovae, and orphan afterglows of gamma-ray bursts. In addition, it will allow us to probe unexplored regions of parameter space where new classes of transient sources may be detected. In this paper we review the known radio transient and variable populations and the current results from blind radio surveys. We outline a comprehensive program based on a multi-tiered survey strategy to characterise the radio transient sky through detection and monitoring of transient and variable sources on the ASKAP imaging timescales of 5 s and greater. We also present an analysis of the expected source populations that we will be able to detect with VAST.
Ruthenium complexes with tridentate terpyridine type ligands have many structural advantages over the complexes with bipyridine ligands. Polynuclear ruthenium complexes prepared using these terpyridine ligands bridged with phenylene rings are potential candidates for photosensitization in dye-sensitized photovoltaic cells. In this study, we have carried out synthesis, characterization and theoretical modeling of rigid, rod-like homometallic dinuclear ruthenium complexes using terpyridine and bipyridine ligands. The photophysical and photovoltaic properties have been investigated. These supramolecular dyes are found to be efficient photosensitizers in dye-sensitized photovoltaic cells when a liquid electrolyte is employed.
Nuclear magnetic resonance (NMR) has provided essential information on the local atomic bonding and microstructure of hydrogen in hydrogenated amorphous silicon (a-Si:H). Here we describe results from NMR and Raman spectroscopy on the hydrogen distribution and bonding in a-Si:H prepared by remote hydrogen plasma (RHP) deposition and contrast the results with those from a-Si:H prepared by conventional glow discharge (GD) deposition. The films prepared by the two techniques have similar H bonding except for the presence in the RHP sample of about 1 atomic % molecular hydrogen, a factor of ten higher than in GD material. For RHP samples prepared from a deuterium plasma rather than a hydrogen plasma, substantial differences in the hydrogen NMR spectra, hydrogen spin lattice relaxation time and Raman spectra are observed. The hydrogen which necessarily originates from the silane has a dramatically altered spectra.
Gas-phase chemical reactions of interest for the deposition of amorphous silicon carbide in a remote hydrogen plasma reactor have been quantitatively characterized with electron spin resonance, and the deposition of a-SiC:H from silane and acetylene is demonstrated.