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Hospitals are required to have antibiotic stewardship programs (ASPs), but there are few models for implementing ASPs without the support of an infectious disease (ID) specialist, defined as an ID physician and/or ID pharmacist.
In this study, we sought to understand ASP implementation at hospitals that lack on-site ID support within the Veterans’ Health Administration (VHA).
Using a mandatory VHA survey, we identified acute-care hospitals that lacked an on-site ID specialist. We conducted semistructured interviews with personnel involved in ASP activities.
The study was conducted across 7 VHA hospitals.
In total, 42 hospital personnel were enrolled in the study.
The primary responsibility for ASPs fell on the pharmacist champions, who were typically assigned multiple other non-ASP responsibilities. The pharmacist champions were more successful at gaining buy-in when they had established rapport with clinicians, but at some sites, the use of contract physicians and frequent staff turnover were potential barriers. Some sites felt that having access to an off-site ID specialist was important for overcoming institutional barriers and improving the acceptance of their stewardship recommendations. In general, stewardship champions struggled to mobilize institutional resources, which made it difficult to advance their programmatic goals.
In this study of 7 hospitals without on-site ID support, we found that ASPs are largely a pharmacy-driven process. Remote ID support, if available, was seen as helpful for implementing stewardship interventions. These findings may inform the future implementation of ASPs in settings lacking local ID expertise.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
Passive microwave sensors have produced a 35 year record of sea-ice concentration variability and change. Operational analyses combine a variety of remote-sensing inputs and other sources via manual integration to create high-resolution, accurate charts of ice conditions in support of navigation and operational forecast models. One such product is the daily Multisensor Analyzed Sea Ice Extent (MASIE). The higher spatial resolution along with multiple input data and manual analysis potentially provide more precise mapping of the ice edge than passive microwave estimates. However, since MASIE is based on an operational product, estimates may be inconsistent over time due to variations in input data quality and availability. Comparisons indicate that MASIE shows higher Arctic-wide extent values throughout most of the year, largely because of the limitations of passive microwave sensors in some conditions (e.g. surface melt). However, during some parts of the year, MASIE tends to indicate less ice than estimated by passive microwave sensors. These comparisons yield a better understanding of operational and research sea-ice data products; this in turn has important implications for their use in climate and weather models.
Self-harm is a common reason for Emergency Department (ED) attendance. We aimed to develop a clinical tool to help identify patients at higher risk of repeat self-harm, or suicide, within 6 months of an ED self-harm presentation.
The tool, the ReACT Self-Harm Rule, was derived using multicentre data from a prospective cohort study. Binary recursive partitioning was applied to data from two centres, and data from a separate centre were used to test the tool. There were 29 571 self-harm presentations to five hospital EDs between January 2003 and June 2007, involving 18 680 adults aged ⩾16 years. We estimated sensitivity, specificity and positive and negative predictive values to measure the performance of the tool.
A self-harm presentation was classified as higher risk if at least one of the following factors was present: recent self-harm (in the past year), living alone or homelessness, cutting as a method of harm and treatment for a current psychiatric disorder. The rule performed with 95% sensitivity [95% confidence interval (CI) 94–95] and 21% specificity (95% CI 21–22), and had a positive predictive value of 30% (95% CI 30–31) and a negative predictive value of 91% (95% CI 90–92) in the derivation centres; it identified 83/92 of all subsequent suicides.
The ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED. The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation. The use of multicentre data helped to maximize the generalizability of the tool, but we need to further verify its external validity in other localities.
To assess the general health and activity levels of 4- and 5-year-old children after intervention for congenital cardiac disease.
Health behaviour outcomes were assessed in 91 children who had surgery or catheter intervention for congenital cardiac disease. The children were classified into four groups according to severity. The main parameters of classification were the presence of residual symptoms, frequency of visits to general practitioner or the Accident and Emergency Department, and ability to participate in physical activity according to a calculated “activity score”.
Children had very few residual symptoms after “corrective surgery”. Those with complex congenital cardiac disease post-Fontan-type repair still had symptoms on average 18.2 days per month. Surprisingly, the complex group had fewer days “sick” from non-cardiac causes and had fewer visits to general practitioner or Accident and Emergency Departments. Regression analysis indicates that three variables had significant relevance to the general practitioner or Accident and Emergency visits: complex congenital cardiac disease, fewer visits; Townsend score – more deprivation – more visits; and maternal worry – higher maternal worry score – more visits. Regression analysis indicates that lower activity score is significantly related to complex cardiac disease and higher maternal worry score.
The majority of this group of 4- and 5-year-old children had few residual symptoms and had good exercise tolerance. Maternal worry is a significant factor in influencing both activity levels and frequency of unscheduled health service demands – general practitioner or Accident and Emergency visits.
The evolution of glyphosate resistance in weedy species places an environmentally benign herbicide in peril. The first report of a dicot plant with evolved glyphosate resistance was horseweed, which occurred in 2001. Since then, several species have evolved glyphosate resistance and genomic information about nontarget resistance mechanisms in any of them ranges from none to little. Here, we report a study combining iGentifier transcriptome analysis, cDNA sequencing, and a heterologous microarray analysis to explore potential molecular and transcriptomic mechanisms of nontarget glyphosate resistance of horseweed. The results indicate that similar molecular mechanisms might exist for nontarget herbicide resistance across multiple resistant plants from different locations, even though resistance among these resistant plants likely evolved independently and available evidence suggests resistance has evolved at least four separate times. In addition, both the microarray and sequence analyses identified non–target-site resistance candidate genes for follow-on functional genomics analysis.
An epidemiologic investigation was conducted to characterize and evaluate the possibility of a viral aetiology of an outbreak of acute vertigo in Hot Springs Country, Wyoming, during autumn 1992. Case-finding identified Hot Springs County residents who sought medical attention for new onset vertigo during 1 August, 1992–31 January 1993. Thirty-five case-patients and 61 matched controls were interviewed and serum specimens were obtained during January 1993. Case-patients were more likely than controls to report symptoms (e.g. fatigue, sore throat, fever, diarrhoea) of antecedent acute illness. Case-patients did not have a significantly greater prevalence or mean titre of IgG antibodies to respiratory syncytial virus, parainfluenza viruses, Epstein–Barr virus, and cytomegalovirus than controls. Serologic evidence of recent enterovirus infection (IgM antibodies) was found for 74% of case-patients compared with 54% of controls (P < 0·05), suggesting a possible association between vertigo and enterovirus infection. Future studies are needed to define the role of enteroviruses in inner-ear diseases.
The magnitude and distribution of elastic strain for a nickel alloy 600 (A600) sample that had been subjected to uniaxial tensile stress were measured by micro Laue diffraction (MLD) and neutron diffraction techniques. For a sample that had been dimensionally strained by 1%, both MLD and neutron diffraction data indicated that the global residual elastic strain was on the order of 10−4, however the micro-diffraction data indicated considerable grain-to-grain variability amongst individual components of the residual strain tensor. A more precise comparison was done by finding those grains in the MLD map that had appropriate <hkl> oriented in the specific directions matching those used in the neutron measurements and the strains were found to agree within the uncertainty. Large variations in strain values across the grains were noted during the MLD measurements which are reflected in the uncertainties. This is a possible explanation for the large uncertainty in the average strains measured from multiple grains during neutron diffraction.
After decades of farm specialization, re-integrating crop and livestock farming systems is being reconsidered as a key step toward sustainable agriculture. The relative profitability of Maine farms integrating crops and livestock is compared to non-integrated or conventional farms. Crop and livestock integration in Maine occurs through either diversified on-farm integration or, more commonly, through coupled interactions between specialized crop and livestock producers. Potato and dairy systems coupled for only 2 years (short-term) had greater profitability compared to conventional systems. Profitability increased in the short term in two ways. First, potato farms grew more of their primary cash crop. Secondly, dairy farms expanded cow numbers, increasing profitability assuming increasing returns to scale. Coupled systems integrated for more than 10 years (long-term) had more favorable profitability than short-term couplers since greater manure-nutrient credits were taken for potatoes and silage corn. The advantages of potato–dairy integration were even greater if potato yields increased in the long term, as suggested by long-term rotation plot studies in Maine. Even if coupling is more profitable than non-integrated systems, it requires that farms be in close proximity and for farmers to have adequate working relationships and management skills. Despite these challenges to re-integrating crops and livestock, short- and long-term economic benefits may encourage farmers in appropriate areas to consider coupling with other producers.
A regioregular copolymer of 3–hexylthiophene and 3–(6–hydroxyhexan–1yl)thiophene has been functionalised with biotin hydrazide; binding of avidin to the biotin moieties causes drastic changes to the absorption spectrum of the polymer in solution, and to the electrochemistry and conductivity of the polymer in thin films.
The human pathogen Escherichia coli O157:H7 is thought to be spread by direct or indirect contact with infected animal or human faeces. The present study investigated the effects of the plant coumarin esculin and its aglycone esculetin on the survival of a strain of E. coli O157 under gut conditions. The addition of these compounds to human faecal slurries and in vitro continuous-flow fermenter models simulating conditions in the human colon and rumen caused marked decreases in the survival of an introduced strain of E. coli O157. When four calves were experimentally infected with E. coli O157 and fed esculin, the pathogen was detected in five of twenty-eight (18 %) of faecal samples examined post-inoculation, compared with thirteen of thirty-five (37 %) of faecal samples examined from five control calves not fed esculin. Coumarin compounds that occur naturally in dietary plants or when supplemented in the diet probably inhibit the survival of E. coli O157 in the gut.
Calliandra calothyrsus is a tree legume native to Mexico and Central America. The species has attracted considerable attention for its capacity to produce both fuelwood and foliage for either green manure or fodder. Its high content of proanthocyanidins (condensed tannins) and associated low digestibility has, however, limited its use as a feed for ruminants, and there is also a widespread perception that wilting the leaves further reduces their nutritive value. Nevertheless, there has been increasing uptake of calliandra as fodder in certain regions, notably the Central Highlands of Kenya. The present study, conducted in Embu, Kenya, investigated effects of provenance, wilting, cutting frequency and seasonal variation both in the laboratory (in vitro digestibility, crude protein, neutral detergent fibre, extractable and bound proanthocyanidins) and in on-station animal production trials with growing lambs and lactating goats. The local Kenyan landrace of calliandra (Embu) and a closely-related Guatemalan provenance (Patulul) were found to be significantly different, and superior, to a provenance from Nicaragua (San Ramón) in most of the laboratory traits measured, as well as in animal production and feed efficiency. Cutting frequency had no important effect on quality; and although all quality traits displayed seasonal variation there was little discernible pattern to this variation. Wilting had a much less negative effect than expected, and for lambs fed calliandra as a supplement to a low quality basal feed (maize stover), wilting was actually found to give higher live-weight gain and feed efficiency. Conversely, with a high quality basal diet (Napier grass) wilting enhanced intake but not live-weight gain, so feed efficiency was greater for fresh material. The difference between fresh and wilted leaves was not great enough to justify the current widespread recommendation that calliandra should always be fed fresh.
The major muscle systems of the metacercaria of the strigeid trematode, Apatemon cobitidis proterorhini have been examined using phalloidin as a site-specific probe for filamentous actin. Regional differences were evident in the organization of the body wall musculature of the forebody and hindbody, the former comprising outer circular, intermediate longitudinal and inner diagonal fibres, the latter having the inner diagonal fibres replaced with an extra layer of more widely spaced circular muscle. Three orientations of muscle fibres (equatorial, meridional, radial) were discernible in the oral sucker, acetabulum and paired lappets. Large longitudinal extensor and flexor muscles project into the hindbody where they connect to the body wall or end blindly. Innervation to the muscle systems of Apatemon was examined by immunocytochemistry, using antibodies to known myoactive substances: the flatworm FMRFamide-related neuropeptide (FaRP), GYIRFamide, and the biogenic amine, 5-hydroxytryptamine (5-HT). Strong immunostaining for both peptidergic and serotoninergic components was found in the central nervous system and confocal microscopic mapping of the distribution of these neuroactive substances revealed they occupied separate neuronal pathways. In the peripheral nervous system, GYIRFamide-immunoreactivity was extensive and, in particular, associated with the innervation of all attachment structures; serotoninergic fibres, on the other hand, were localized to the oral sucker and pharynx and to regions along the anterior margins of the forebody.
Ribosomal DNA sequences were assessed for their usefulness in distinguishing among Trichoderma isolates and for their robustness in
resolving their phylogenetic relationships. DNA sequences from the D2 region of the 28S rRNA gene were determined for 50
Trichoderma isolates representing seven species. Eight distinct sequence types existed, and were mostly consistent with groupings
based on morphology. Sequence variability within the D2 region alone was not sufficient to provide a reliable phylogeny. Sequences
from the ITS1, 5.8S and ITS2 regions were subsequently determined for 18 of the isolates. Eight distinct ITS sequence types were
detected among these 18 isolates. The ITS sequence types were generally consistent with morphology, ITS1 sequence data
supported the identification of the Th3 T. harzianum group of Muthumeenakshi et al. (1994) as T. atroviride. The data also confirmed
that the biocontrol strains of this study were different from those causing disease problems in the mushroom industry in Europe and
North America. Results from the phylogenetic analysis stress the importance of testing the robustness of data used to predict
phylogenies. Two ITS sequence data sets for the same group of isolates produced significantly different phylogenies. Congruence
analysis detected that T. inhamatum (GJS90-90) was corrupting tree topologies and ‘first order pruning’ was performed by removing
its sequence from the two ITS data sets. Subsequent differences in the topologies of pruned ITS1 and ITS2 trees were attributed to a
lack of phylogenetic information in the ITS2 sequence region. Although ITS sequences successfully differentiated among
morphologically distinct isolates within Trichoderma, it did not provide a sufficient phylogenetic signal to resolve all of their