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To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI.
Design:
Cluster randomized controlled trial.
Setting:
Nursing homes in rural Alberta, Canada.
Participants:
The study included 42 nursing homes ranging from 8 to 112 beds.
Methods/interventions:
Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention.
Results:
Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (−2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], −2.5 to −1.7; P < .001) and antimicrobial prescribing for UTIs (−0.7 prescriptions per 1,000 RD; 95% CI, −1.0 to −0.4; P < .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, −0.4 to 0.3; P = .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, −0.5 to −0.1; P = .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases.
Conclusion:
A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.
We present very detailed images of the photosphere of an AGB star obtained with the PIONIER instrument, installed at the Very Large Telescope Interferometer (VLTI). The images show a well defined stellar disc populated by a few convective patterns. Thanks to the high precision of the observations we are able to derive the contrast and granulation horizontal scale of the convective pattern for the first time in a direct way. Such quantities are then compared with scaling relations between granule size, effective temperature, and surface gravity that are predicted by simulations of stellar surface convection.
The lesser date moth (LDM) Batrachedra amydraula is a significant pest of date palm fruits. Previously, detection and monitoring of the pest was inaccurate due to high costs of sampling with lifting machines. We report a practical system for detection and monitoring of LDM based on pheromone traps and relevant models. Dose–response experiments with LDM pheromone traps indicated a 1 mg lure is optimal for monitoring. Delta traps with adhesive covering their entire inner surface gave the highest captures while trap colour was unimportant. Sampling pheromone traps throughout the night indicated male flight began at 1:00–2:00 and reached a peak 2 h before sunrise. Monitoring traps exposed all year long in Israel revealed three generations with different abundance. Trapping transects in a date plantation indicated interference from a monitoring trap became minimal at distances >27 m away. Inter-trap distances closer than this may lower efficiency of monitoring and mass trapping in control programs. Our estimate of the circular effective attraction radius (EARc) of a 1 mg delta trap for LDM (3.43 m) shows this bait is among the most attractive compared with baits for other insects. We developed encounter-rate equations with the pheromone trap EARc to model the interplay between population levels, trap density and captures that are useful for detection of invasive LDM and its control by mass trapping. The integrated methodologies are applicable to many pest species.
The flow development above and within homogeneous and heterogeneous canopies was experimentally studied using particle image velocimetry in a refractive-index-matching channel. The experiments were designed to gain insight into the effect of height heterogeneity on the structure and spatial distribution of the turbulence. The homogeneous model (base case) is constituted of elements of height $h$ arranged in a staggered configuration; whereas the heterogeneous canopy resembled a row canopy and consisted of elements of two heights $h_{1}=h+(1/3)h$ and $h_{2}=h-(1/3)h$ alternated every two rows. Both canopies had the same density, element geometry and mean height. The flow was studied under three submergences $H/h=2$, 3 and 4, where $H$ denotes the flow depth. The experiments were performed at Reynolds number $Re_{H}\simeq 6500$, 11 300 and 12 300 and nearly constant Froude number $Fr\simeq 0.1$. Turbulence statistics complemented with quadrant analysis and proper orthogonal decomposition reveal richer flow dynamics induced by height heterogeneity. Topography-induced spatially periodic mean flows are observed for the heterogeneous canopy. Furthermore, and in contrast to the homogeneous case, non-vanishing vertical velocity is maintained across the entire length of the heterogeneous canopy with increased levels at lower submergence depths. Further alternations were induced in the magnitude and distribution of the turbulent kinetic energy, Reynolds shear stress and characteristics of the canopy mixing layer, evidencing enhanced mixing and turbulent transport for the heterogeneous canopy especially at lower submergence depths. Overall, the results indicate that heterogeneous canopies exhibit greater vertical turbulent exchange at the canopy interface, suggesting a potential for greater scalar exchange and a greater impact on channel hydraulic resistance than a homogeneous canopy of similar roughness density.
A laboratory investigation was performed to study distinctive features of the laminar-to-turbulent transition over distributed roughness characterized by two-dimensional (2D) and three-dimensional (3D) periodic, low-order topographies at roughness Reynolds number $Re_{k}\approx 300$. Systematic experiments were performed using high-spatial-resolution planar particle image velocimetry (PIV) in a refractive-index-matching (RIM) channel, where the roughness covered the entire length of the test section. The results show that the flow over the 2D roughness becomes turbulent much sooner than its 3D counterpart ($Re_{x}=50\,000$ versus 120 000). This is attributed to the presence of a velocity inflection point resulting from flow separation within the troughs of the 2D roughness. In the transitional region, unsteady disturbances above the two roughnesses appear upstream of near-roughness disturbances. The above-roughness disturbances are associated with the inflection point in the vertically displaced boundary layer for the 2D case, and with the mean velocity deficit resulting from the interaction of the wakes of upstream elements for the 3D case. The near-roughness fluctuations are associated with the shear layer present behind the crests of both roughnesses. The transitional region is characterized by the interaction between above- and near-roughness disturbances, which merge, leading to a rapid vertical growth of the turbulent fluctuations.
Recent studies suggest that sand can serve as a vehicle for exposure of humans to pathogens at beach sites, resulting in increased health risks. Sampling for microorganisms in sand should therefore be considered for inclusion in regulatory programmes aimed at protecting recreational beach users from infectious disease. Here, we review the literature on pathogen levels in beach sand, and their potential for affecting human health. In an effort to provide specific recommendations for sand sampling programmes, we outline published guidelines for beach monitoring programmes, which are currently focused exclusively on measuring microbial levels in water. We also provide background on spatial distribution and temporal characteristics of microbes in sand, as these factors influence sampling programmes. First steps toward establishing a sand sampling programme include identifying appropriate beach sites and use of initial sanitary assessments to refine site selection. A tiered approach is recommended for monitoring. This approach would include the analysis of samples from many sites for faecal indicator organisms and other conventional analytes, while testing for specific pathogens and unconventional indicators is reserved for high-risk sites. Given the diversity of microbes found in sand, studies are urgently needed to identify the most significant aetiological agent of disease and to relate microbial measurements in sand to human health risk.
In the past decade, various astrobiological studies on different lichen species investigated the impairment of viability and photosynthetic activity by exposure to simulated or real space parameters (as vacuum, polychromatic ultraviolet (UV)-radiation and monochromatic UVC) and consistently found high post-exposure viability as well as low rates of photosynthetic impairment (de Vera et al. 2003, 2004a; 2004b; de la Torre et al. 2010; Onofri et al. 2012; Sánchez et al. 2012, 2014; Brandt et al. 2014). To achieve a better understanding of the basic mechanisms of resistance, the present study subdued isolated and metabolically active photobionts of two astrobiologically relevant lichens to UVC254 nm, examined its effect on photosynthetic activity by chlorophyll a fluorescence and characterized the UVC-induced damages by quantum yield reduction and measurements of non-photochemical quenching. The results indicate a strong impairment of photosynthetic activity, photoprotective mechanisms and overall photobiont vitality when being irradiated in the isolated and metabolically active state. In conclusion, the present study stresses the higher susceptibility of photobionts towards extreme environmental conditions as UVC-exposure, a stressor that does not occur on the Earth. By comparison with previous studies, the present results highlight the importance of protective mechanisms in lichens, such as morphological–anatomical traits (Meeßen et al. 2013), secondary lichen compounds (Meeßen et al. 2014) and the symbiont's pivotal ability to pass into anhydrobiosis when desiccating.
Human genomic structural variation (SV) is significant factor in genome complexity, and thus has substantial implications to the cause, development and progression of genetic diseases. These SVs, ranging in size of 1kbp-1Mbp, are challenging to assess with current technologies. As such, we have developed a commercial system (nanoAnalyzer® 1000) for the rapid linear analysis of genomes at single-molecule level.
The core of our system is a nanofluidic chip consisting of an array of channels with a diameter less than 100 nm, nanofabricated on the surface of a silicon substrate. Thousands of unamplified genomic DNA molecules of 100’s kbps to several Mbps can be isolated and linearly streamed into the array for analysis in a parallel fashion. Fluorescently labeled sequence-specific signatures can then be identified and aligned to reference patterns at high resolution with custom software. This automated, multi-color imaging platform will enable a wide range of applications, such as accurate sequencing assembly, discovering genome structural variations, and uncovering epigenomic content. Nanochannel arrays promise to substantially lower the barriers of entry for single-molecule DNA analysis for scientists and clinicians, greatly impacting the advancement of molecular diagnostics, personalized medicine, and biomedical research.
A method of plasma containment by means of spherical multipole (SM) magnetic fields has been developed. The analysis of the confining field geometry has proved that the high-order SM-configurations constitute minimum-B traps with a given number of point cusps instead of linear loss gaps which occur in a standard minimum-B geometry. Injection and trapping of a gun-produced plasma in the SM magnetic trap have been investigated and compared with those in a spindle-cusp trap.
The thermal emission rate of dominant traps in molecular beam
epitaxial n- and p-type AlGaAs subjected to Ar-ion beam etching
has been studied by deep level transient spectroscopy. Emission
signatures were determined and compared with results obtained
by other authors for irradiation induced and grown-in defects
in GaAs and AlGaAs. The most significant result of this study
is the observation that the process-induced defects in n- as
well as p-type AlGaAs exhibit emission signatures, which are
characteristic of native defects found in GaAs. The effect is
discussed in terms of a compensation effect and related band
bending.
Electronic structure of Mn/ZnO system has been investigated by synchrotron radiation photoemission. Manganese vacuum deposition was done at room temperature onto a ZnO(0001) single crystal for coverage ΘMn < 4 ML. Photoemission spectra taken near Mn3p-Mn3d absorption edge after each deposition step show resonant enhancement of Mn3d states within 10 eV of the Fermi level. The experimentally deduced partial Mn3d density of states for Θ > 1.2 ML shows at least three features: a major Mn3d structure at 3.8–4.5 eV below the Fermi energy, a valence structure at lower binding energy (1–3 eV) and a broad satellite in the 5.5 – 9 eV range. The branching ratio of satellite/main structure increases with deposition from 0.33 for 0.4 ML to 0.65 for 4 ML. After annealing up to 500 C the satellite/main ratio decreases to 0.43 indicating a high degree of hybridization between the Mn3d states and valence band of ZnO. After annealing no manganese cap layer was found at the crystal surface as was confirmed by the lack of metallic Fermi edge in photoemission spectra and by scanning Auger spectroscopy experiment. The photoemission Mn3p core level spectra taken after annealing consist of two components separated by about 4eV. It is evidence that at least two manganese states are observed in the Mn-ZnO interface region.
Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children.
Aims
To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change.
Method
A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6–14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored.
Results
Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).
Conclusions
The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.
Carbonized buffer layers were formed on Si (100) nominally oriented substrates with propane diluted in palladium purified hydrogen in a cold wall vertical reactor. Subsequent SiC layers were grown using silane and propane at atmospheric pressure. The growth temperature was ranging from 1150°C to 1350°C. The layers obtained were characterized by LT photoluminescence, IR reflectivity, X-ray diffraction, micro-Raman on cleaved edges, AFM imaging, and optical microscopy. Drastic influence on the layer surface morphology was evidenced depending on the transition step between the carbonization and the SiC epitaxial growth. As a result, we have developed a carbonization process leading to very high quality 3CSiC films grown at 1250°C.
Far infrared magnetooptical investigations of shallow donors in epitaxial MOCVD GaN layers show two types of shallow donors. In relaxed layers, a donor with an ionization energy of 35 meV was found. In strained, undoped and Si doped samples, a donor with ionization energy 32.5 meV was observed. From the p state splitting in magnetic field, the cyclotron effective mass for conduction electrons was found to be m*=0.222 m0.
By
P. Calvani, Laboratoire pour l'Utilization de Rayonnement Electromagnétique, Université Paris-Sud, 91405 Orsay, France,
S. Lupi, Laboratoire pour l'Utilization de Rayonnement Electromagnétique, Université Paris-Sud, 91405 Orsay, France,
P. Roy, Laboratoire pour l'Utilization de Rayonnement Electromagnétique, Université Paris-Sud, 91405 Orsay, France,
M. Capizzi, Dipartimento di Fisica, Universita di Roma ‘La Sapienza’, Piazzale A. Moro 2, 1-00185 Roma, Italy,
P. Maselli, Dipartimento di Fisica, Universita di Roma ‘La Sapienza’, Piazzale A. Moro 2, 1-00185 Roma, Italy,
A. Paolone, Dipartimento di Fisica, Universita di Roma ‘La Sapienza’, Piazzale A. Moro 2, 1-00185 Roma, Italy,
W. Sadowski, Faculty of Applied Physics and Mathematics, Technical University of Gdańsk, G. Narutowicza 11/12, 80-592 Gdańsk, Poland,
S.-W. Cheong, AT&T Bell Laboratories, Murray Hill, New Jersey 07974, USA
The far- and mid-infrared reflectivity R(ω) of e-doped single crystals belonging to the family M2−xCexCuO4−y(M = Pr, Nd, Gd; 0<x<0.15; 0<y<0.04) has been studied between 300 and 20 K. In addition to the phonons predicted for the T' structure, R(ω) shows local modes in the far infrared as well as a broad infrared absorption centered at about 0.1 eV (d or J band). These features depend strongly on both T and y. We have resolved the d band at low T, in samples doped by oxygen vacancies. We demonstrate its polaronic origin by showing that it is made up of intense overtones of the local modes observed in the far infrared. We also find that Ce-doped superconductors (x> 0.12,y = 0.03) have the same polaronic structure as the semiconducting ones, partially superimposed on a weak Drude term.
Introduction
Since the discovery of high-Tc superconductors (HTSC), infrared reflectivity measurements have been largely employed to investigate both electronic and transport properties of these cuprates [1]. Early spectra already showed several intriguing features common to all HTSC families, which were then attributed to the peculiar properties of the Cu–O plane. Those features are well reproducible and could be studied in greater detail as soon as large single crystals became available. However, their interpretation is still being debated. In the insulating parent compounds of HTSC, one observes phonon modes in the far infrared, and a broad band at high frequencies (from about 1.5 to 2.5 eV). This latter has been unanimously assigned to charge-transfer (CT) transitions between O 2p and Cu 3d orbitals.