To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Background: Central-line–associated blood stream infections (CLABSIs) are linked with significant morbidity and mortality. A NHSN laboratory-confirmed bloodstream infection (LCBSI) has specific criteria to ascribe an infection to the central line or not. The criteria used to associate the pathogen to another site are restrictive. This objective to better classify CLABSIs using enhanced criteria to gain a comprehensive understanding of the error so that appropriate reduction efforts are utilized. Methods: We conducted a retrospective review of medical records with NHSN-identified CLABSI from July 2017 to December 2018 at 2 geographically proximate hospitals. Trained infectious diseases personnel from tertiary-care academic medical centers, the University of Virginia Health System, a 600-bed medical center in Charlottesville, Virginia, and Virginia Commonwealth University Health System with 865 beds in Richmond, Virginia, reviewed charts. We defined “overcaptured” or O-CLABSI into different categories: O-CLABSI-1 is bacteremia attributable to a primary infectious source; O-CLABSI-2 is bacteremia attributable to neutropenia with gastrointestinal translocation not meeting mucosal barrier injury criteria; O-CLABSI-3 is a positive blood culture attributable to a contaminant; and O-CLABSI-4 is a patient injecting line, though not officially documented. Descriptive analyses were performed using the χ2 and the Fisher exact tests. Results: We found a large number of O-CLABSIs on chart review (79 of 192, 41%). Overall, 56 of 192 (29%) LCBSIs were attributable to a primary infectious source not meeting NHSN definition. O-CLABSI proportions between the 2 hospitals were statistically different; hospital A identified 34 of 59 (58%) of their NHSN-identified CLABSIs as O-CLABSIs, and hospital B identified a 45 of 133 (34%) as O-CLABSIs (P = .0020) (Table 1). When comparing O-CLABSI types, hospital B had a higher percentage of O-CLABSI-1 compared to hospital B: 76% versus 64%. Hospital A had a higher proportion of O-CLABSI-2: 21 versus 7%. Hospitals A and B had similar proportion of O-CLABSI-3: 15% versus 18%. These values were all statistically significant (P < .0001). Discussions: The results of these 2 geographically proximate systems indicate that O-CLABSIs are common. Attribution can vary significantly between institutions, likely depending on differences in incidence of true CLABSI, patient populations, protocols, and protocol compliance. These findings have implications for interfacility comparisons of publicly reported data. Most importantly, erroneous attribution can result in missed opportunity to direct patient safety efforts to the root cause of the bacteremia and could lead to inappropriate treatment.
Disclosures: Michelle Doll, Research Grant from Molnlycke Healthcare
In 1875 the pioneering early authority on Beethoven’s sketches, Gustav Nottebohm, claimed that had the composer completed as many symphonies as were begun in the sketchbooks, then his total output of such works would have exceeded fifty. This essay is the first to scrutinize that claim. A comprehensive study of Beethoven’s sketches from his youth to the last years of his life reveals Nottebohm’s claim to be remarkably accurate. As well as detailed study of the musical evidence the essay presents a thematic catalogue of unfinished – or barely begun – symphonies.
In 1970 Lewis Lockwood published a seminal article drawing attention to the sometimes complex relationship between Beethoven's sketches and his autograph scores. The article demonstrated that any assumption that Beethoven made his sketches for a work and then wrote out the score with no further sketching would be misguided and that autograph scores were sometimes complex documents containing layers of revision. Since then, however, very late changes that Beethoven made in his autograph scores have tended to attract far less attention than those he made earlier in his compositional process during preliminary sketching. This is probably because early changes are generally far more radical, as illustrated by Lockwood's study of the genesis of the Eroica Symphony, which shows plans for a symphony very different from the one that finally emerged. The starting point for a work, as revealed by such sketches, is always of great interest, whereas late changes made at the autograph stage are mostly of small details—textures, figuration, added articulation or dynamics, an added or deleted repeat sign, or occasionally an added or deleted measure. Such changes may seem less significant, but they are of much concern to editors and performers alike. Many are found in the autograph scores themselves, which almost always show changes from their earliest state, sometimes even with whole pages replaced. The text is often altered further in corrected copies or proofs, a famous case being the slow movement of the “Hammerklavier” Sonata, where Beethoven added an extra introductory measure only after the score had been sent to the printers. Nevertheless, the final stage of an autograph score represents a distinctive layer within the compositional process of a work: all earlier changes in sketches, which were made at various stages, and those within the autograph score have been accomplished, while any revisions in corrected copies and proofs are yet to come. The version has its own value, regardless of what changes might be made later.
Several autograph scores have been studied in detail, usually in connection with a published facsimile of the manuscript. Early examples from the Beethoven bicentenary year are Lockwood's discussion of the Cello Sonata, op. 69, and Joel Lester's of the Kyrie of the Missa solemnis.
To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period.
Interrupted time series.
The study was conducted in an 865-bed academic medical center.
Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) “contact plus” isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018).
Environmental cleaning interventions and enhanced “contact plus” isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470).
Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.
We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.
Prisoner's Dilemma (PD) games have become a well-established paradigm for studying the mechanisms by which cooperative behavior may evolve in societies consisting of selfish individuals. Recent research has focused on the effect of spatial and connectivity structure in promoting the emergence of cooperation in scenarios where individuals play games with their neighbors, using simple “memoryless” rules to decide their choice of strategy in repeated games. While heterogeneity and structural features such as clustering have been seen to lead to reasonable levels of cooperation in very restricted settings, no conditions on network structure have been established, which robustly ensure the emergence of cooperation in a manner that is not overly sensitive to parameters such as network size, average degree, or the initial proportion of cooperating individuals. Here, we consider a natural random network model, with parameters that allow us to vary the level of “community” structure in the network, as well as the number of high degree hub nodes. We investigate the effect of varying these structural features and show that, for appropriate choices of these parameters, cooperative behavior does now emerge in a truly robust fashion and to a previously unprecedented degree. The implication is that cooperation (as modelled here by PD games) can become the social norm in societal structures divided into smaller communities, and in which hub nodes provide the majority of inter-community connections.
Beethoven's sketch leaves are so numerous and at times so impenetrable that they are bound to throw up the occasional surprise when studied in detail. Around ten thousand such pages survive; they are generally difficult to decipher, and often more than one work appears on a single page. Nevertheless, few surprises will have been as unexpected as the identification of a fragment of a little-known Bach cantata amongst Beethoven's early sketches.
Beethoven’s Grosse Fuge, published in 1827 after being detached from his string quartet Op. 130, appears to be the first work ever to have been allocated rehearsal letters. These were added by Beethoven’s friend Karl Holz at the request of the composer and his publisher Mathias Artaria. The rehearsal letters can be compared with the work’s structure, which is best perceived as dividing into three main ‘movements’, the third being much the longest. A different approach is necessary for analysing each of the three. In the first, reference to medieval rhythmic modes helps to clarify Beethoven’s procedure. The second is essentially a fugue, albeit unusually homophonic. The third is multi-partite but mainly in
, and includes a 32-bar theme that returns intact – the only substantial exact reprise of material. This movement also include two fugal expositions. Thus there are four full fugal expositions altogether, and each is a double fugue in which the exposition is more or less regular. Holz’s letters match up well but not perfectly with the structure of the work.
Alan Turing's short life ran from 1912 to 1954. The inspiration for this volume lay in the centenary of his birth. But Barry Cooper and I, as editors, wanted the word ‘future’ in our title, as well as a reference to the past. We chose the provocative title The Once and Future Turing, alluding to the legend of King Arthur's tomb. We invited a range of distinguished contributors to give us snapshots of scientific work which rest upon Turing's original discoveries, and share the spirit of his thought, but which also give a glimpse of something lying beyond the present. The result is a volume of 15 papers, whose authors responded to our prompting in utterly different ways.
Turing himself was not reticent about advancing visions of the future. Famously, he did so in his classic 1950 paper ‘Computing machinery and intelligence’. He was not always right. Few people would claim that his 50-year prediction for machine intelligence, cautiously phrased as it was, has been fulfilled. On the other hand, he underestimated the potential for fast, cheap, huge-scale computing. His 1948 picture of the future of computer hardware correctly identified the speed of light as the critical constraint governing computing speed. But his assumption of centimetre-scale electronic components overlooked the enormous potential for miniaturisation. Turing's foresight was more strikingly demonstrated by his 1946 observations about the power of the universal machine and the future of what would now be called the software industry; ‘every known process has got to be translated into instruction table form … ’
In 1946 he could speak with the confidence of being the mastermind of the Anglo-American crypto war – with its own legacy for the future of international relations, which, to say the least, has not yet been evaluated. In 1939 he and Gordon Welchman had pulled off the feat of persuading the British authorities to make a huge investment in the untried technology of the Turing Bombe, on the conviction, correct as it turned out, that its logical brilliance would transform British fortunes. This vision was not his alone. To beat Hitler, Bletchley Park seems to have borrowed from the future, scientifically, organisationally and socially, as if the sixties had arrived before the forties.
The world is open for fresh ideas about fundamentals of mind, matter, information, space and time. Turing made just such a plunge in 1936, undeterred by being young and new to the field. Compared with the carefully delineated and trained trajectory expected of modern research students, his d ébut seems amazing. It was extraordinary even then, being without precursor papers or collaborators. But, of course, the young Turing was not alone: Einstein and Eddington, von Neumann and Russell, had spoken volumes to his receptive mind, and he had worked hard through Cambridge mathematics. He was justifiably proud of his breakthrough as a 24-year-old, and correspondingly interested in spotting new youthful talent. His highly unconventional running with young Garner had a parallel: a wish to hand on scientific inspiration to a young person, perhaps in a way quite outside the standard academic framework. This Alan Turing indeed achieved, to some extent, but maybe he has still more to do.
These essays themselves, with their unusual connections and incomplete conclusions, might stimulate new minds with new thoughts. Miguel Walsh, winner of the 2014 Ramanujan Prize, explains how he learned about outstanding problems in mathematics from the Internet, while otherwise isolated in Argentina. We are reminded of how Srinivasa Ramanujan himself emerged from isolation, in the very India where Alan Turing was conceived, through the old mechanism of print and post offices. In the last century, the universal machine has greatly accelerated and amplified such global interaction. Who knows! The history of science depends on the strangest encounters of human brains. The once and future Turing both take their life from the unpredictable and sometimes highly inconvenient magic of human thought.