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Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.
Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.
The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).
This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.
Feed represents a substantial proportion of production costs in the dairy industry and is a useful target for improving overall system efficiency and sustainability. The objective of this study was to develop methodology to estimate the economic value for a feed efficiency trait and the associated methane production relevant to Canada. The approach quantifies the level of economic savings achieved by selecting animals that convert consumed feed into product while minimizing the feed energy used for inefficient metabolism, maintenance and digestion. We define a selection criterion trait called Feed Performance (FP) as a 1 kg increase in more efficiently used feed in a first parity lactating cow. The impact of a change in this trait on the total lifetime value of more efficiently used feed via correlated selection responses in other life stages is then quantified. The resulting improved conversion of feed was also applied to determine the resulting reduction in output of emissions (and their relative value based on a national emissions value) under an assumption of constant methane yield, where methane yield is defined as kg methane/kg dry matter intake (DMI). Overall, increasing the FP estimated breeding value by one unit (i.e. 1 kg of more efficiently converted DMI during the cow’s first lactation) translates to a total lifetime saving of 3.23 kg in DMI and 0.055 kg in methane with the economic values of CAD $0.82 and CAD $0.07, respectively. Therefore, the estimated total economic value for FP is CAD $0.89/unit. The proposed model is robust and could also be applied to determine the economic value for feed efficiency traits within a selection index in other production systems and countries.
A post-authorisation safety study was carried out as part of the EU Risk Management Plan to examine the long-term (up to 12 months) use of quetiapine XL as prescribed in general practice in England.
To present a description of the drug utilisation characteristics of quetiapine XL.
An observational, population-based cohort design using the technique of Modified Prescription-Event Monitoring (M-PEM). Patients were identified from dispensed prescriptions issued by general practitioners (GPs) for quetiapine XL between September 2008 and February 2013. Questionnaires were sent to GPs 12 months following the 1st prescription for each individual patient, requesting drug utilisation information. Cohort accrual was extended to recruit additional elderly patients (special population of interest). Summary descriptive statistics were calculated.
The final M-PEM cohort consisted of 13,276 patients; median age 43 years (IQR: 33, 55) and 59.0% females. Indications for prescribing included bipolar disorder (n = 3820), MDD (n = 2844), schizophrenia (n = 2373) and other (non-licensed) indications (n = 3750). Where specified, 59.3% (7869/13,276) were reported to have used quetiapine IR (immediate release formulation) previously at any time. The median start dose was highest for patients with schizophrenia (300 mg/day [IQR 150, 450]). The final elderly cohort consisted of 3127 patients and 28.5% had indications associated with dementia. The median start dose for elderly patients was highest for patients with schizophrenia or BD (both 100 mg/day [IQR 50, 300]).
The prevalence of off-label prescribing in terms of indication and high doses was common, as was use in special populations such as the very elderly. Whilst off-label use may be unavoidable in certain situations, GPs may need to re-evaluate prescribing in circumstances where there may be safety concerns. This study demonstrates the ongoing importance of observational studies such as M-PEM to gather real-world clinical data to support the post-marketing benefit:risk management of new medications, or existing medications for which license extensions have been approved.
A 2009 oceanographic expedition of the Russian Academy of Sciences collected the anterior region of a single acorn worm (phylum Hemichordata, class Enteropneusta) by trawling at a depth of 5560 m in the Romanche Trench (equatorial Atlantic). The specimen was a ripe female with numerous, relatively small oocytes in each ovary. Phylogenetic analysis of rDNA sequences robustly placed the worm in the family Spengelidae. In addition, morphological features of the proboscis, collar, and anterior trunk region indicated that the worm was Glandiceps abyssicola, a species previously represented solely by the holotype, which had been dredged from the equatorial Atlantic in 1873 by the HMS ‘Challenger’ and subsequently sent to Germany for description by Spengel (1893). The holotype was presumably destroyed by World War II bombing; therefore, we here designate the Romanche Trench specimen as the neotype of G. abyssicola and supply an augmented species diagnosis.
The objective of this study was to assess the prevalence of Ureaplasma urealyticum and Mycoplasma hominis infections and to investigate associations between their presence in the lower female genital tract and lifestyle characteristics. The study was performed on a population of 3115 women, comparing the demographic and behavioural characteristics of 872 women with U. urealyticum infection and 142 women with M. hominis with uninfected women, using univariate and multiple logistic regression analysis. The prevalence of infection with U. urealyticum was 28% and M. hominis was 4·6%. In multivariate logistic regression analysis, intrauterine device, number of sexual partners and age (<35 years) were significantly associated with U. urealyticum while previous induced abortion, condom use and young age at first intercourse (<16 years) were associated with M. hominis infection. U. urealyticum infection presents the same demographic and behavioural characteristics of a sexually transmitted disease. The unprotective role of condom use suggests a non-sexual mode of transmission of M. hominis infection.
Cochlear implantation has been used to rehabilitate profoundly deafened adults for more than 25 years. However, surgical labyrinthectomy is often considered a contraindication to cochlear implantation, especially if there is a significant delay between the two procedures. As the role of cochlear implantation continues to expand, this idea requires reconsideration.
A 59-year-old woman presented to our clinic after undergoing bilateral surgical labyrinthectomies for intractable Ménière's disease 21 years prior. Despite the significant time delay, she underwent cochlear implantation with a good audiological outcome and improved quality of life.
Changes to the cochlea and vestibule following surgical labyrinthectomy include cochlear ossification and obliteration of the vestibule. These issues have been thought to limit the potential for cochlear implantation, especially when there is a significant delay between the two procedures. However, delayed cochlear implantation, even decades after labyrinthectomy, remains a viable treatment option which can benefit selected patients.
The executed body is never merely a body, and the method of its execution is never simply a method. Each conspires to construct the other, and together, they participate in the constitution of an executable subject. At some times, and in some places, that subject can become an agent of ethical import, however circumscribed that agency may be, and so a thing that is recognizable as a human being. In other places, at other times, that subject can become an object, and so something that frustrates efforts to recall that this, too, may once have been a being who was human.
One way to chart the difference between these two executable subjects is to ask whether – and if so, how – the category of dignity is employed in characterizing each. The intelligibility of this category turns not on whether the subject in question does or does not possess some antecedent or essential quality that can be accurately represented via this terminology. Instead, the meaningfulness of the category of dignity turns on the existence and exercise of historically contingent as well as fragile practices that regulate bodies in certain ways as opposed to others. Given one set of practices, a body may appear as an agent who can affirm a meaningful claim to dignity as well as the forms of treatment to which an ethical subject is entitled.
Punishment and Political Order. By Keally McBride. Ann Arbor: University of Michigan Press, 2007. 194p. $55.00 cloth, $19.95 paper.
What part does punishment play in the constitution of political order, and under what circumstances does punishment reinforce or undermine that order? In recent decades, suggests Keally McBride, this question has too often been ceded by students of political science to sociologists, legal scholars, and criminologists. In this discerning collection of essays, McBride seeks to reclaim this turf by asking, first, how certain pathbreaking texts have responded to the dilemmas generated when political orders, real or imagined, inflict suffering in response to misdeeds and, second, how we might make, specifically, political sense of controversies engendered by contemporary practices of punishment, especially but not exclusively in the United States.
Human-wildlife conflict has negative implications for wildlife conservation, and current crop protection methods are not sufficient to address the problem. Alternative livelihood strategies may provide the ultimate solution to this conflict but they are not always feasible in the short-term. We test the viability of using chilli Capsicum spp. as an unpalatable cash crop to reduce human-wildlife conflict. Our trials indicate that chilli is less vulnerable to wildlife than other crops and is also economically viable.
Crop-raiding by wildlife is neither a new phenomenon nor a rare one. Farmers throughout the world are faced with trying to reduce or eradicate the impact of crop damage by wildlife to their standing crops. Insects, birds, rodents and ungulates are perhaps the most common sources of such conflict and there is a growing literature that details various strategies for reducing crop losses (Fiedler 1988; Giles 1989; Adesina et al. 1994); describes factors that increase farmer tolerance to losses (Decker and Purdy 1988; Messmer 2000); and discusses the introduction of systems for compensating farmers for losses incurred (Rollins and Briggs 1996; Nyhus et al. 2003). For example, wild ungulates and rodents cause an estimated $60-million-worth of damage to forest plantations annually and bird damage to agricultural crops is a multi-million-dollar problem in the USA (Dolbeer et al. 1994). Perhaps not surprisingly, then, rodents, invertebrates and birds receive the greatest attention within the literature on pest management. However, other animals – some of them threatened species – may also pose a considerable threat to farmers' livelihoods. Two types of mammal pests, elephants and primates, exemplify the complexities of managing intelligent and potentially dangerous crop pests, which are also of conservation concern. The problem may be chronic or sporadic, predictable or sometimes unpredictable (at least at the level of the individual); whatever the pattern, crop damage threatens the livelihood security of farmers living near wildlife.
Tracheostomy remains the primary method of treatment of acute airway obstruction due to malignant invasion and compression of the trachea. However, the development of tracheal stents has provided an alternative effective treatment modality. This case report and literature review highlights the benefits of intra-luminal stenting, including resolution of distressing obstructive symptoms, and subsequent improvement in quality of life.
We have developed platinum (Pt) deposition and chlorine-based Reactive Ion
Etch (RIE) processes that are needed to deposit, pattern and embed
electrodes deep within a MEMS process flow. Various combinations of
chlorinebased gases were tested to find the optimum gas mixture for RIE. A
1: 0.4 mixture ratio of pure chlorine to argon and 100-150 Watts of RF
microwave power were found to be optimum conditions for the RIE of platinum
metal. The addition of argon gas to chlorine was found to contribute to the
anisotropic etching of platinum, obtaining vertical shaped sidewall
patterns. A simple model of the platinum etching mechanism is proposed.
Following the plasma enhanced formation of platinum and chlorine ions,
volatile products of platinum chlorides were formed and driven away at
elevated temperature. As a demonstration of our RIE process, micron-sized
platinum patterns with vertical sidewalls were fabricated. Etch chemistry
was investigated using ToF SIMS analysis. This etch technique will be useful
to device developers intending to use the unique properties of platinum
metal as an electrode that is deeply embedded within a MEMS process
Multiwavelength observations of polars are essential for developing the big picture of these systems, particularly to gain understanding of the relevant accretion-induced heating and cooling processes. Eclipsing polars are prime targets for such studies since different radiation processes can be disentangled by observations with high-time resolution. We present a preliminary combined analysis of space-based observations (XMM-Newton, ROSAT, HST) with ground-based high-speed photometry (MCCP, OPTIMA, ULTRACAM) of DP Leo, HU Aqr and UZ For. We determine the location and extent of different emission components and find secular and short-term changes in the accretion geometries. We find displaced optical and X-ray emission regions in DP Leo and HU Aqr as well as mini-bursts and accretion arcs of variable size in HU Aqr. We report marked changes in the X-ray eclipse length of UZ For between high and low states.
We have used sputtered ZnTe:N and ZnO:Al as transparent electrodes for CdTe based solar cells. ZnTe:N is reactively sputtered with 3% N2 in the sputter gas. The ZnTe:N films typically have transmission near 85% above 750 nm and resistivity as low as 10 ohm-cm with fine grains of approximately 30 nm diameter. ZnO:Al is sputtered from a ZnO:Al2O3 (2%) target. The ZnO:Al films have resistivity as low as 4 × 10-4 ohm-cm with 80-95% transmission over the visible spectrum. To test the stability of the films, ZnTe:N films were annealed in argon, dry air and nitrogen at a range of temperatures from 200°C to 500°C. Annealing decreased the resistivity for temperatures up to 350°C and increased for temperatures greater than 350°C. ZnO:Al films were annealed in dry air at temperatures from 300°C to 550°C. Though the resistivity increased at higher annealing temperatures, there was no change in the transmission. Important to the function of a tandem solar cell is a transparent contact, like ZnTe:N/ZnO:Al, to replace the traditional metal contact to the CdS/CdTe solar cell. We investigate the ZnTe:N/ ZnO:Al bilayer as a possible recombination junction. The rf sputtered ZnTe:N and ZnO:Al films were characterized by AFM, STM, XRD, transmission, 4-point probe, and Hall measurements.