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Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol.
To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital.
We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate.
In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015).
AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.
In an intensive care unit, antibiotic heterogeneity led to an increase in antibiotic heterogeneity index (P = .002) and a reduction in carbapenem-resistance Enterobacteriaceae incidence (P = .04). In a general medicine unit with low prevalence of multidrug-resistant organisms, antibiotic heterogeneity index and incidence of multidrug-resistant organisms did not improve.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
The use of the Laser MegaJoule facility within the shock ignition scheme has been considered. In the first part of the study, one-dimensional hydrodynamic calculations were performed for an inertial confinement fusion capsule in the context of the shock ignition scheme providing the energy gain and an estimation of the increase of the peak power due to the reduction of the photon penetration expected during the high-intensity spike pulse. In the second part, we considered a Laser MegaJoule configuration consisting of 176 laser beams that have been grouped providing two different irradiation schemes. In this configuration the maximum available energy and power are 1.3 MJ and 440 TW. Optimization of the laser–capsule parameters that minimize the irradiation non-uniformity during the first few ns of the foot pulse has been performed. The calculations take into account the specific elliptical laser intensity profile provided at the Laser MegaJoule and the expected beam uncertainties. A significant improvement of the illumination uniformity provided by the polar direct drive technique has been demonstrated. Three-dimensional hydrodynamic calculations have been performed in order to analyse the magnitude of the azimuthal component of the irradiation that is neglected in two-dimensional hydrodynamic simulations.
Contemporaries and economic historians have noted several features of medieval and early modern European monetary systems that are hard to analyze using models of centralized exchange. For example, contemporaries complained of recurrent shortages of small change and argued that an abundance/dearth of money had real effects on exchange, especially for the poor. To confront these facts, we build a random-matching monetary model with two indivisible coins with different intrinsic values. The model shows that small change shortages can exist, in the sense that adding small coins to an economy with only large coins is welfare-improving. This effect is amplified by increases in trading opportunities. Further, changes in the quantity of monetary metals affect the real economy and the amount of exchange as well as the optimal denomination size. Finally, the model shows that replacing full-bodied small coins with tokens is not necessarily welfare-improving.
This article describes a newly constructed data set of all U.S. state banks from 1782 to 1861. It contains the names and locations of all banks and branches that went into business and an estimate of when each operated. The compilation is based on reported balance sheets, listings in banknote reporters, and secondary sources. Based on these data, the article presents a count of the number of banks and branches in business by state. I argue that my series are superior to previously existing ones for reasons of consistency, accuracy, and timing. The article contains examples to support this argument.
Before 1789, the individual colonies that would ultimately make up the United States were free to issue their own currencies, and all of them did. The U.S. Constitution, adopted in 1789, took this power away from the individual states. Thus, it might appear that the Constitution left the federal government, which minted gold and silver coins, as the sole creator of currency in the new country.
However, this did not turn out to be the case. Although the Constitution took away the power of states to issue money, it left them with the power to charter and regulate note-issuing banks. All of the states ultimately utilized this power, and some went as far as wholly or partially owning banks. In addition, the federal government chartered the (First) Bank of the United States from 1791 to 1811 and the (Second) Bank of the United States from 1816 to 1836. Virtually all of these banks issued notes, and these notes circulated as currency. Thus, by the early 1800s, there were far more entities issuing currency in the United States than there had ever been before 1789. The regulation of these currency issuers varied from place to place and from time to time.
We have argued elsewhere (Rolnick, Smith, and Weber 1994) that the intention of the framers of the Constitution was to make the United States a monetary union or a uniform currency area.
We establish several facts about medieval monetary debasements: they were followed by unusually large minting volumes and by increased seigniorage; old and new coins circulated concurrently; and, at least some of the time, coins were valued by weight. These facts constitute a puzzle because debasements provide no additional inducements to bring coins to the mint. On theoretical and empirical grounds, we reject explanations based on by-tale circulation, nominal contracts, and sluggish price adjustment. We conclude that debasements pose a challenge to monetary economics.
Since its initial report by the IBM/Purdue University group in 1990, GaAs with As precipitates (GaAs:As) has been shown by this group to exhibit unusual and useful electrical and optical properties. In this paper we review our progress in understanding the fundamental properties of this material. We have shown that both the electrical and optical properties of GaAs:As arc explained by assuming that the GaAs is of good crystalline quality and that the As precipitates act as buried Schottky barriers. This model accounts for its semi-insulating stability against both n- and p-type doping, its high-speed photoconductive behavior, and its ability to detect 1.3 micron light when it forms the “I” layer of a PIN photodiode via the internal photoemission process. Using modulation spectroscopy we clarify the fundamental differences between GaAs:As and unannealed GaAs grown at 200 C. We also show that GaAs:As used as a 1.3 micron detector in the metal-semiconductor-metal device structure format, has a photoconductive bandwidth in excess of 50 GHz.
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