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Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.
Observational study of acute-care hospitals in Ontario, Canada
A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.
Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.
Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.
The Gaia astrometric reference catalogue will provide star proper motions with an accuracy of one mas one century ago for stars of magnitude 14 or brighter. Our project is to re-reduced the old observations with the new catalogue allowing to have an astrometric accuracy only limited by the observational biases and not by reference stars. Then, we plan to get an accuracy of 50 mas where the old reductions were not better than 500 mas!
For our purpose, we will digitize old photographic plates with a sub-micrometric scanner. Tests were made using the UCAC catalogue showing that old photographic plates have an intrinsect accuracy of 30 to 60 mas.
Commission 8 has regularly published triennial reports in the past and the current OC therefore voted to adopt a traditional format also for this special Legacy issue of the IAU Transactions. The outgoing President is grateful for the support of many Commission members who contributed to this report. Our contribution consists of 3 parts: 1) this introduction, providing a general overview and highlights of recent research in astrometry, 2) a summary of the astrometry business & science meeting at the 2015 IAU General Assembly, and 3) the activity report of our Commisson covering the mid-2012 to mid-2015 period.
Reception and administrative employees may be particularly vulnerable to patient aggression in mental health services. This study examined whether satisfaction with social support and primary aggression training moderated the effects of perceived aggression on psychological distress and somatic symptoms in a sample of 101 employees. The biophysical model of threat and challenge, the stressor-stress-strain model, and the stress-buffering hypothesis served as theoretical frameworks. Results showed perceived aggression correlated positively with psychological distress, but not with somatic symptoms. Significant interactions were found for social support (buffering effect) and training (interaction effect) for somatic symptoms, but not for psychological distress. It is suggested that, for somatic symptoms, the moderation effects of social support and training on perceived aggression involve similar mechanisms (increased knowledge, self-esteem, perceived control, coping capacity). These findings provide support for the benefits of staff training and the incorporation of knowledge-based components in training programs.
In the quest for ever smaller, lighter weight, and conformal components and devices for radar and communication applications, researchers in the RF community have increasingly turned to artificially engineered, composite structures (or “metamaterials”) in order to exploit the extraordinary electromagnetic response these materials offer. One particularly promising class of metamaterials that has recently received a great deal of attention are “left-handed” or negative index materials. Because these metamaterials exhibit the unique ability to bend and focus light in ways no other conventional materials can, they hold great potential for enabling a number of innovative lens and antenna structures for a broad range of commercial and DoD relevant applications. Exploring the possible implementation of negative index materials for such applications will require significant enhancements in the properties of existing Negative Index Materials (NIM) (bandwidth, loss, operational frequency, etc.), as well as improved understanding of the physics of their electromagnetic transport properties. For this reason the Defense Advanced Research Project Agency (DARPA) has initiated a program that seeks to further develop and demonstrate NIM for future DoD missions including, but not limited to, the following: 1) lightweight, compact lenses with improved optics; 2) sub wavelength/high resolution imaging across the electromagnetic spectrum; 3) novel approaches to beam steering for radar, RF, and/or optical communications; and 4) novel approaches for integrating optics with semiconductor electronics. A brief overview of the salient properties of NIM will be presented as well as a general discussion of a few of their potential applications.
Mycobacterium simiae is found primarily in the southwestern United States, Israel, and Cuba, with tap water as its suspected reservoir. Our institution saw an increase in M. simiae isolates in 2001. An investigation into possible contaminated water sources was undertaken.
Environmental cultures were performed from water taps in the microbiology laboratory, patient rooms, points in the flow of water to the hospital, and patients' homes. Patient and environmental M. simiae were compared by PFGE.
Military treatment facility in San Antonio, Texas.
All patients with cultures positive for M. simiae between January 2001 and April 2002. Medical records were reviewed.
M. simiae was recovered from water samples from the hospital, patients' home showers, and a well supplying the hospital. A single PFGE clone was predominant among water isolates (9 of 10) and available patient isolates (14 of 19). There was an association between exposure to hospital water and pulmonary samples positive for the clonal M. simiae strain (P = .0018). Only 3 of 22 culture-positive patients met criteria for M. simiae pulmonary disease. Of them, two had indistinguishable M. simiae strains from tap water to which they were routinely exposed.
This represents an outbreak of M. simiae colonization with one nosocomial infection. It is only the second time that M. simiae has been recovered from hospital tap water and its first presentation in municipal water. This study raises issues about the need and feasibility of eliminating or avoiding exposure to M. simiae from tap water.
Ecological succession is a pivotal process in ecology, since it occurs in all dynamic systems. It is therefore hardly surprising that its study is still a major preoccupation of ecologists, though as one combs the past scientific literature there are clear fashions in areas of interest and the approach adopted. Thus, from early descriptions of specific successional patterns of the vegetation, attention turned to a consideration of the mechanisms underpinning succession and ways in which successional trajectories could be modeled.
The study of succession has traditionally been dominated by plant ecologists. Even though plant–animal and, to a lesser extent, plant–microbial interactions have been in vogue for much of the time span of successional studies, relatively few workers have considered these in the context of succession. Of course, one notable exception is in the practical management of plant succession by the larger herbivores, which has also attracted scientific rigor (e.g., Gibson and Brown, 1992). Successional interactions with other less conspicuous organisms, namely invertebrates and microorganisms, have been given far lower priority by ecologists. Once these interactions become more complex, by involving other organisms or trophic levels, priority has fallen even further. In the few studies that do exist, interest has focused on the interactions that can be seen, namely those between organisms associated with above-ground plant structures. Include soil organisms and there is a gaping void in our knowledge!
The recent years of poor pay, increasing workload and lack of a proper career structure have led to many staff feeling undervalued and demoralised. More are turning to agency work as a way of 'topping up' wages or even working for agencies as the sole employer to achieve flexibility in working patterns. Balfor Recruitment Group deals with staff with a variety of skills, finding anything from an occasional shift to full time work. I know that this includes some of you. However, I doubt you know much about my side of the work so I have been asked to tell you about it. I look forward to hearing whether you find it interesting and whether you learnt anything new!
This commentary centres around the system of human visual
attention. Although generally supportive of the position advocated in
the target article, we suggest that the detailed account overestimates
the capacities of active human vision. Limitations of peripheral
search and saccadic accuracy are discussed in relation to the division
of labour between covert and overt attentional processes.
Intuitively, termites would seem to be a very suitable group to illustrate effects of ecosystem fragmentation. Being detritivores, they do not control directly the rate at which their resources are available, nor do they restrict the ability of the resources to regenerate. Consequently, termites do not mask the ecosystem depletion caused by fragmentation. With this in mind, we compared the communities of termites in undisturbed Amazonian forest with those of two isolated fragments nearby, aiming to show that the differences observed may have resulted from habitat fragmentation. Dissimilarities between communities in the undisturbed forest suggest natural patchiness in their distribution, which could lead to misinterpretation of the effects of fragmentation. Continuous forest had higher species richness and fewer rare species than the fragments. Guild structure in the forest was biased towards soil-feeding termites, which are subterranean and soft bodied, and therefore more sensitive to variation in microclimate. In the fragments, litterfeeders and species intermediate between soil-feeding and wood-feeding types were numerically more important. Habitats in the forest were more equally used than in the fragments, suggesting habitat unsuitability increased with fragmentation. It is suggested that the community composition of the fragments is a result of the intrinsic patchiness of the original forest and deterministic and stochastic extinctions caused by fragmentation. The need for manipulative experiments to test such ideas is discussed.
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