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 firstname.lastname@example.org
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.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
Recreational saltwater anglers from the mid-Atlantic through the Gulf of Mexico commonly target red drum. Due to concerns about overharvesting within South Carolina coupled with regional management actions, South Carolina explored the technical feasibility of stocking hatchery-produced juvenile red drum as a technique to augment the abundance of South Carolina stock. In order to assess a continued program, in 2005 a mail survey was used to collect data for estimating the economic benefits with the contingent valuation method. The theoretical validity of willingness to pay was assessed by comparison to the value of a change in red drum fishing trips that would result from the program. Benefits were compared to estimated, explicit stocking costs. We illustrate how a certainty recode approach can be used in sensitivity analysis. The net present values (NPVs) for the stocking program are positive suggesting that the program would have been economically efficient relative to no program.
Benchmarking strategies are needed to promote the appropriate use of antibiotics. We have adapted a simple regressive method in Microsoft Excel that is easily implementable and creates predictive indices. This method trends consumption over time and can identify periods of over- and underuse at the hospital level.
Exposure to otolaryngology is currently minimal in the UK undergraduate medical curriculum. This may lead to difficulties in attracting graduates into higher ENT surgical training and in ensuring a reasonable standard of ENT knowledge amongst primary care practitioners.
A recent innovation, of which many ENT units may be unaware, is the introduction to the undergraduate curriculum of ‘student-selected components’. Like the traditional elective, this allows students to undertake an attachment to a speciality and department of their choice. Units which do not regularly teach medical students but which have a welcoming and enthusiastic approach to undergraduate training may well be ideal hosts.
This paper introduces the concepts underlying student-selected components, outlines the preparation required and offers a template for such an attachment, for which ENT is ideally suited.
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
The commissioning and operation of apparatus for neutron diffraction at simultaneous high temperatures and pressures is reported. The basic design is based on the Paris-Edinburgh cell using opposed anvils, with internal heating. Temperature is measured using neutron radiography. The apparatus has been shown in both on-line and off-line tests to operate to a pressure of 7 GPa and temperature of 1700°C. The apparatus has been used in a neutron diffraction study of the crystal structure of deuterated brucite, and results for 520°C and 5.15 GPa are presented. The diffraction data that can be obtained from the apparatus are of comparable quality to previous high-pressure studies at ambient temperatures, and are clearly good enough for Rietveld refinement analysis to give structural data of reasonable quality.
We report the initial results of one year of continuous observations of the Sun‘s internal structure from the Michelson Doppler Imager (MDI) on board SOHO. The results have been obtained by inverting frequencies of p and f modes determined with two different methods of averaging over split multiplets. Small systematic differences between the two frequency sets depend primarily on mode frequencies, and, thus, did not significantly affect the inversions. A preliminary study of the systematic effects resulting from asymmetry of oscillation power peaks has also shown no significant influence on the inversion results. The inferred sound-speed profile is in general agreement with the previous data from MDI and ground-based networks. In the energy-generating core, the resolution is substantially improved, and the inversion results indicate a sharp negative perturbation of the sound speed in the core, tending to a positive value near the center. High-precision measurements of the f-mode frequencies have been used to determine the seismic radius of the Sun. The global asphericity estimated from frequency variation across the split mode multiplets has been found to be small, and is consistent with the asphericity during the previous activity minimum. Variations of the solar frequencies during the first year of MDI observations have also been detected.
We present a mathematical model which is used to interpret the
dynamics of the immunological response of a mouse host
to infection with the filarial worm Onchocerca lienalis. The
model mimics changes in worm burden over time post-infection
and after reinfection and its behaviour provides a good description of
experimental results. Measured production of T-cells and eosinophils
is also compared with the predictions of the model. Our results show
that the immune response
mechanism proposed on the basis of experimental results, involving
CD4+ T-cells and eosinophil destruction of the
parasite, is supported by the insights gained from the mathematical
model. Also, using the parameters estimated to describe
the primary infection dynamics, the degree of acquired immunity to
secondary infection is also well described by the
model. Our analysis highlights the importance of obtaining
quantitative measures of the many rate parameters involved
in even the simplest interpretations of immunological responses to
The unprecedented combination of spatial resolution and stability achieved by the Solar Oscillations Investigation/Michelson Doppler Imager on SOHO has opened up new opportunities for the analysis of solar surface oscillations of high spatial frequencies. In this regime the oscillations are essentially plane waves, amenable to the techniques of ring-diagram analysis of their three-dimensional power spectra. This approach holds the promise of measuring fluid motions and possibly magnetic fields in spatially-resolved structures within the uppermost levels of the convective envelope, a region unresolved by the global modes. Atmospheric g-modes trapped above the photosphere may also be detectable. We review the first results of plane-wave analysis of various types of SOI data and comparisons with the analyses of comparable ground-based datasets.
The Medium-l Program of the Michelson Doppler Imager (MDI) instrument on board SOHO provides continuous observations of oscillation modes of angular degree, l, from 0 to ∼ 300. The initial results show that the noise in the Medium-l oscillation power spectrum is substantially lower than in ground-based measurements. This enables us to detect lower amplitude modes and, thus, to extend the range of measured mode frequencies. The MDI observations also reveal the asymmetry of oscillation spectral lines. The line asymmetries agree with the theory of mode excitation by acoustic sources localized in the upper convective boundary layer. The sound-speed profile inferred from the mean frequencies gives evidence for a sharp variation at the edge of the energy-generating core. In a thin layer just beneath the convection zone, helium appears to be less abundant than predicted by theory. Inverting the multiplet frequency splittings from MDI, we detect significant rotational shear in this thin layer.
This paper presents scaling equations relating suspension-feeding rates to body size for articulate brachiopods and bivalve molluscs, two classes which represent a significant component of the fossil record of marine benthic communities. Clearance (feeding) rates of five species of living articulate brachiopods and three species of epifaunal suspension-feeding bivalve molluscs collected from mid-latitude fjords of Newfoundland and New Zealand were measured in similar experimental conditions. In comparisons within and between the two classes, we found that both plectolophous and spirolophous brachiopods had significantly lower feeding rates than mytilids, which are filibranchs, but that a sympatric primitive eulamellibranch veneroid bivalve had rates comparable to the brachiopods. Articulate brachiopods do not appear to feed effectively at the high algal concentrations which bivalves can exploit. The data on comparative suspension-feeding rates support the hypothesis that past changes in diversity and distribution of bivalves and brachiopods may be related to an overall increase in energy flux and escalation of metabolic rates during the Phanerozoic.
The production of titanium aluminide intermetallic compound foil represents a significant manufacturing challenge. Cold rolling, which imparts excellent thickness uniformity and surface finish characteristics that are of benefit in composite fabrication, is especially difficult with these alloys. However, recent modifications in Ti aluminide alloy compositions and advances in thermomechanical processing have made it possible to produce foil of thickness less than 100 μm, having the microstructure and mechanical property characteristics required for composite fabrication and improved performance. This paper describes the properties of a new Ti aluminide alloy, of nominal composition Ti-22AI-23Nb (at.%), comprising a three phase microstructure of α2 (Ti3Al), an ordered orthorhombic phase (Ti2AINb) and an ordered beta phase. The discussion emphasizes the processing of this alloy through cold rolling to foil, and the associated microstructures and mechanical property characteristics that are relevant to the use of this foil to form a composite matrix.
study was undertaken to examine the attributes of utilizing a high niobiumcontaining titanium aluminide (orthorhombic) composition, specifically Ti-22AI-23Nb (a%), for use as a matrix for a continuously reinforced metal matrix composite. Both unreinforced “neat” panels and 35v% 4-ply unidirectional (4) SiC (SCS-6) panels were fabricated by HIP'ing using a foil / fiber / foil approach. The microstructure of these panels were examined via optical, scanning electron and transmission electron microscopy. Reaction zone kinetics including both the primary reaction product and any beta-depleted zone growth were determined at 982°C. Analytical electron microscopy was employed to identify fiber / matrix interfacial compounds as well as local phases and their associated chemistries. Preliminary mechanical properties were obtained which included: longitudinal and transverse tensile, matrix thermal stability, thermal fatigue, thermal mechanical fatigue and transverse composite creep. The results were compared with panels fabricated from the baseline matrix composition, Ti-24AI-11 Nb.
Among the more serious problems arising from the use of SiC as a reinforcement for titanium aluminides are chemical instability and thermal expansion mismatch. In this work, metallic layers (Pd + W or Pt + W) have been included in the interface between SCS6 type SiC reinforcing fibers and Ti-48A1-1V (gamma TiA1) matrix to reduce interdiffusion and to retard crack propagation. Pd reacted with the SCS layer on the SiC fibers as well as with the titanium aluminide matrix by diffusion through the W layer. Cracks were found in the resulting Pd-Ti-Al reaction product. Pt did not react with the SCS layer, and reacted with the titanium matrix only in those regions where the W layer was fractured. No cracks were present where the W layer successfully protected the matrix from the Pt. Ti and Pt reacted extensively with the underlying SiC fiber in those areas where the SCS layer was fractured.