Results from the Scottish national HAI prevalence survey

A national point prevalence survey was undertaken over the period of one calendar year in Scotland from October 2005 to October 2006. The prevalence of healthcare-associated infection (HAI) was 9.5% in acute hospitals and 7.3% in non-acute hospitals. The highest prevalence of HAI in acute hospital inpatients was found in the following specialties: care of the elderly (11.9%), surgery (11.2%), medicine (9.6%) and orthopaedics (9.2%). The lowest prevalence was found in obstetrics (0.9%). The most common types of HAI in acute hospital inpatients were: urinary tract infections (17.9% of all HAI), surgical site infections (15.9%) and gastrointestinal infections (15.4%). In non-acute hospitals one in ten inpatients in two specialties (combined) medicine (11.4%) and care of the elderly (7.8%) was found to have HAI, and one in 20 inpatients in psychiatry (5.0%) had HAI. In non-acute hospital patients, urinary tract infections were frequent (28.1% of all HAI) and similarly skin and soft tissue infection (26.8% of all HAI). When combined, these two HAI types affected 4% of all the inpatients in non-acute hospitals. This is the first survey of its kind in Scotland and describes the burden of HAI at a national level

Management of hypoxaemia in the critically ill patient.

Hypoxaemia is a common presentation in critically ill patients, with the potential for severe harm if not addressed appropriately. This review provides a framework to guide the management of any hypoxaemic patient, regardless of the clinical setting. Key steps in managing such patients include ascertaining the severity of hypoxaemia, the underlying diagnosis and implementing the most appropriate treatment. Oxygen therapy can be delivered by variable or fixed rate devices, and non-invasive ventilation; if patients deteriorate they may require tracheal intubation and mechanical ventilation. Early critical care team involvement is a key part of this pathway. Specialist treatments for severe hypoxaemia can only be undertaken on an intensive care unit and this field is developing rapidly as trial results become available. It is important that each new scenario is approached in a structured manner with an open diagnostic mind and a clear escalation plan

Roadmap for a competency-based educational curriculum in epileptology: report of the Epilepsy Education Task Force of the International League Against Epilepsy

Teaching competency in the diagnosis and clinical management of epilepsy is of utmost importance for the ILAE. To achieve this mission, the Task Force for Epilepsy Education (EpiEd) developed a competency-based curriculum for epileptology, covering the spectrum of skills and knowledge for best medical practice. The curriculum encompasses seven domains, 42 competencies, and 124 learning objectives, divided into three levels: entry (Level 1), proficiency (Level 2), and advanced proficiency (Level 3). A survey of the currently existing ILAE-endorsed teaching activities identified a significant gap in education of basic knowledge of epileptology (Level 1). To bridge this gap, a web-based educational tool is being developed. A virtual campus will be constructed around the curriculum, integrating the various educational activities of the ILAE. This paper describes the development of the curriculum and future tasks necessary to achieve the educational goal of the ILAE

Sustainable economics for a digital planet: ensuring long-term access to digital information. Final report of the Blue Ribbon Task Force on Sustainable Digital Preservation and Access.

Digital information is a vital resource in our knowledge economy, valuable for research and education, science and the humanities, creative and cultural activities, and public policy. But digital information is inherently fragile and often at risk of loss. Access to valuable digital materials tomorrow depends upon preservation actions taken today; and, over time, access depends on ongoing and efficient allocation of resources to preservation. Ensuring that valuable digital assets will be available for future use is not simply a matter of finding sufficient funds. It is about mobilizing resources—human, technical, and financial—across a spectrum of stakeholders diffuse over both space and time. But questions remain about what digital information we should preserve, who is responsible for preserving, and who will pay. The Blue Ribbon Task Force on Sustainable Digital Preservation and Access investigated these questions from an economic perspective. In this report, we identify problems intrinsic to all preserved digital materials, and propose actions that stakeholders can take to meet these challenges to sustainability. We developed action agendas that are targeted to major stakeholder groups and to domain-specific preservation strategies. The Task Force focused its inquiry on materials that are of long-term public interest, looking at four content domains with diverse preservation profiles: Scholarly discourse: the published output of scholarly inquiry. Research data: the primary inputs into research, as well as the first-order results of that research. Commercially owned cultural content: culturally significant digital content that is owned by a private entity and is under copyright protection; and Collectively produced Web content: Web content that is created interactively, the result of collaboration and contributions by consumers

Understanding the scale and nature of outcome change in area-regeneration programmes: evidence from the New Deal for Communities Programme in England

The New Deal for Communities (NDC) Programme is one of the most intensive area-based initiatives (ABIs) launched in England. Between 1998 and 2010, 39 NDC Partnerships were charged with improving conditions in relation to six outcomes within deprived neighbourhoods, each accommodating around 9,800 people. Data point to only modest change, much of which reflected improving attitudes towards the area and the environment. There are problems in identifying positive people-based outcomes because relatively few individuals benefit from relevant initiatives. Few positive benefits leak out of NDC areas. Transformational change was always unlikely bearing in mind the limited nature of additional resources, and because only a minority of individuals directly engage with NDC projects. This evidence supports perspectives of ABIs rooted in 'local-managerialism'

Searching for Galactic White Dwarf Binaries in Mock LISA Data using an F-Statistic Template Bank

We describe an F-statistic search for continuous gravitational waves from galactic white-dwarf binaries in simulated LISA Data. Our search method employs a hierarchical template-grid based exploration of the parameter space. In the first stage, candidate sources are identified in searches using different simulated laser signal combinations (known as TDI variables). Since each source generates a primary maximum near its true "Doppler parameters" (intrinsic frequency and sky position) as well as numerous secondary maxima of the F-statistic in Doppler parameter space, a search for multiple sources needs to distinguish between true signals and secondary maxima associated with other, "louder" signals. Our method does this by applying a coincidence test to reject candidates which are not found at nearby parameter space positions in searches using each of the three TDI variables. For signals surviving the coincidence test, we perform a fully coherent search over a refined parameter grid to provide an accurate parameter estimation for the final candidates. Suitably tuned, the pipeline is able to extract 1989 true signals with only 5 false alarms. The use of the rigid adiabatic approximation allows recovery of signal parameters with errors comparable to statistical expectations, although there is still some systematic excess with respect to statistical errors expected from Gaussian noise. An experimental iterative pipeline with seven rounds of signal subtraction and re-analysis of the residuals allows us to increase the number of signals recovered to a total of 3419 with 29 false alarms.Comment: 29 pages, 11 figures; submitted to Classical and Quantum Gravit

Quantifying the relative importance of riverine and open-ocean nitrogen sources for hypoxia formation in the northern Gulf of Mexico

The Mississippi and Atchafalaya River System discharges large amounts of freshwater and nutrients into the northern Gulf of Mexico (NGoM). These lead to increased stratification and elevate primary production in the outflow region. Consequently, hypoxia (oxygen <62.5 mmol/m3), extending over an area of roughly 15,000 km2, forms every summer in bottom waters. High‐resolution models have significantly improved our understanding of the processes controlling hypoxia formation in the NGoM and have strongly implicated riverine nutrients as the dominant nutrient source. However, the relative importance of different nutrient sources (i.e., the Mississippi and Atchafalaya Rivers and offshore) has not been assessed before now. Here, we combine a high‐resolution model with an element tracing method to directly quantify the relative contributions of nitrogen from the two rivers and the open ocean to primary production and sediment oxygen consumption, which is the main oxygen sink contributing to hypoxia in the NGoM. Our results indicate that, averaged over 2001–2011, Mississippi and Atchafalaya nitrogen support 51 ± 9% and 33 ± 9% of summer sediment oxygen consumption, respectively, while open‐ocean nitrogen supports 16 ± 2%. The higher relative impact of Mississippi inputs results from longer transit times compared to those of Atchafalaya inputs. We also analyze the effect of riverine nitrogen load reductions and a larger diversion of discharge to the Atchafalaya River. These scenario simulations show that nutrient load reductions are most effective in mitigating hypoxia