Importance of decision support implementation in emergency department vancomycin dosing

INTRODUCTION: The emergency department (ED) plays a critical role in the management of life-threatening infection. Prior data suggest that ED vancomycin dosing is frequently inappropriate. The objective is to assess the impact of an electronic medical record (EMR) intervention designed to improve vancomycin dosing accuracy, on vancomycin dosing and clinical outcomes in critically ill ED patients. METHODS: Retrospective before-after cohort study of all patients (n=278) treated with vancomycin in a 60,000-visit Midwestern academic ED (March 2008 and April 2011) and admitted to an intensive care unit. The primary outcome was the proportion of vancomycin doses defined as “appropriate” based on recorded actual body weight. We also evaluated secondary outcomes of mortality and length of stay. RESULTS: The EMR dose calculation tool was associated with an increase in mean vancomycin dose ([14.1±5.0] vs. [16.5±5.7] mg/kg, p<0.001) and a 10.3% absolute improvement in first-dose appropriateness (34.3% vs. 24.0%, p=0.07). After controlling for age, gender, methicillin-resistant staphylococcus aureus infection, and Acute Physiology and Chronic Health Evaluation II score, 28-day in-hospital mortality (odds ratio OR 1.72; 95% CI [0.76–3.88], p=0.12) was not affected. CONCLUSION: A computerized decision-support tool is associated with an increase in mean vancomycin dose in critically ill ED patients, but not with a statistically significant increase in therapeutic vancomycin doses. The impact of decision-support tools should be further explored to optimize compliance with accepted antibiotic guidelines and to potentially affect clinical outcome

Hardware Design and Implementation of a MAVLink Interface for an FPGA-Based Autonomous UAV Flight Control System

Abstract This paper details the initial design and planning of a Field Programmable Gate Array (FPGA) implemented control system that will enable a path planner to interact with a MAVLink based flight computer. The design is aimed at small Unmanned Aircraft Vehicles (UAV) under autonomous operation which are typically subject to constraints arising from limited on-board processing capabilities, power and size. An FPGA implementation for the design is chosen for its potential to address such limitations through low power and high speed inhardware computation. The MAVLink protocol offers a low bandwidth interface for the FPGA implemented path planner to communicate with an on-board flight computer. A control system plan is presented that is capable of accepting a string of GPS waypoints generated on-board from a previously developed in-hardware Genetic Algorithm (GA) path planner and feeding them to the open source PX4 autopilot, while simultaneously responding with flight status information

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

Neonatal infection with Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis and meningitis in newborns. Recent guidelines have recommended universal screening of all pregnant women to identify those colonized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates. Enriched culture methods are the current standard for prenatal GBS screening; however, the implementation of more sensitive molecular diagnostic tests may be able to further reduce the risk of early-onset GBS infection. We report a clinical evaluation of the Xpert GBS LB assay, a molecular diagnostic test for the identification of GBS from broth-enriched vaginal/rectal specimens obtained during routine prenatal screening. A total of 826 specimens were collected from women undergoing prenatal screening (35 to 37 weeks' gestation) and tested at one of three clinical centers. Each swab specimen was tested directly prior to enrichment using the Xpert GBS assay. Following 18 to 24 h of broth enrichment, each specimen was tested using the Xpert GBS LB assay and the FDA-cleared Smart GBS assay as a molecular diagnostic comparator. Results obtained using all three molecular tests were compared to those for broth-enriched culture as the gold standard. The sensitivity and specificity of the Xpert GBS LB assay were 99.0% and 92.4%, respectively, compared to those for the gold standard culture. The Smart GBS molecular test demonstrated sensitivity and specificity of 96.8% and 95.5%, respectively. The sensitivities of the two broth-enriched molecular methods were superior to those for direct testing of specimens using the Xpert GBS assay, which demonstrated sensitivity and specificity of 85.7% and 96.2%, respectively

The structure of Onsala 1 star forming region

We present new high-sensitivity high-resolution mm-wave observations of the Onsala 1 ultra-compact HII region that bring to light the internal structure of this massive star forming cloud. The 1.2 mm continuum map obtained with the IRAM 30-m radiotelescope (~11" resolution) shows a centrally peaked condensation of 1' size (~0.5 pc at the assumed distance of 1.8 kpc) which has been further investigated at higher resolution in the 3 mm continuum and in the emission lines of H13CO+ J=1--0 and SiO J=2--1 with the IRAM Plateau de Bure interferometer. The 3 mm data, with a resolution of ~5" X 4", displays a unresolved continuum source at the peak of the extended 1.2 mm emission and closely associated with the ultra-compact HII region. The H13CO+ map traces the central condensation in good agreement with previous NH_3 maps of Zheng et al. (1985). However, the velocity field of this central condensation, which was previously thought to arise in a rapidly rotating structure, is better explained in terms of the dense and compact component of a bipolar outflow. This interpretation is confirmed by SiO and CO observations of the full region. In fact, our new SiO data unveils the presence of multiple (at least 4) outflows in the region. In particular, there is an important center of outflow activity in the region at about 1' north of the UCHII region. Indeed the different outflows are related to different members of the Onsala 1 cluster. The data presented here support a scenario in which the phases of massive star formation begin much later in the evolution of a cluster and/or UCHII region last for much longer than 10^5 yrs.Comment: 6 pages and 3 figure

G6b-B Inhibits Constitutive and Agonist-induced Signaling by Glycoprotein VI and CLEC-2

Platelets play an essential role in wound healing by forming thrombi that plug holes in the walls of damaged blood vessels. To achieve this, platelets express a diverse array of cell surface receptors and signaling proteins that induce rapid platelet activation. In this study we show that two platelet glycoprotein receptors that signal via an immunoreceptor tyrosine-based activation motif (ITAM) or an ITAM-like domain, namely the collagen receptor complex glycoprotein VI (GPVI)-FcR γ-chain and the C-type lectin-like receptor 2 (CLEC-2), respectively, support constitutive (i.e. agonist-independent) signaling in a cell line model using a nuclear factor of activated T-cells (NFAT) transcriptional reporter assay that can detect low level activation of phospholipase Cγ (PLCγ). Constitutive and agonist signaling by both receptors is dependent on Src and Syk family kinases, and is inhibited by G6b-B, a platelet immunoglobulin receptor that has two immunoreceptor tyrosine-based inhibitory motifs in its cytosolic tail. Mutation of the conserved tyrosines in the two immunoreceptor tyrosine-based inhibitory motifs prevents the inhibitory action of G6b-B. Interestingly, the inhibitory activity of G6b-B is independent of the Src homology 2 (SH2)-domain containing tyrosine phosphatases, SHP1 and SHP2, and the inositol 5′-phosphatase, SHIP. Constitutive signaling via Src and Syk tyrosine kinases is observed in platelets and is associated with tyrosine phosphorylation of GPVI-FcR γ-chain and CLEC-2. We speculate that inhibition of constitutive signaling through Src and Syk tyrosine kinases by G6b-B may help to prevent unwanted platelet activation

A survey of SiO 5-4 emission towards outflows from massive young stellar objects

Results are presented of a survey of SiO 5-4 emission observed with the James Clerk Maxwell Telescope (JCMT) towards a sample of outflows from massive young stellar objects. The sample is drawn from a single-distance study by Ridge & Moore. In a sample of 12 sources, the 5-4 line was detected in 5, a detection rate of 42 per cent. This detection rate is higher than that found for a sample of low-luminosity outflow sources, although for sources of comparable luminosity, it is in good agreement with the results of a previous survey of high luminosity sources. For most of the detected sources, the 5-4 emission is compact or slightly extended along the direction of the outflow. NGC6334I shows a clear bipolar flow in the 5-4 line. Additional data were obtained for W3-IRS5, AFGL5142 and W75N for the 2-1 transition of SiO using the Berkeley-Illinois-Maryland Association (BIMA) millimetre interferometer. There is broad agreement between the appearance of the SiO emission in both lines, though there are some minor differences. The 2-1 emission in AFGL5142 is resolved into two outflow lobes which are spatially coincident on the sky, in good agreement with previous observations. In general the SiO emission is clearly associated with the outflow. The primary indicator of SiO 5-4 detectability is the outflow velocity, i.e. the presence of SiO is an indicator of a high velocity outflow. This result is consistent with the existence of a critical shock velocity required to disrupt dust grains and subsequent SiO formation in post-shock gas. There is also weak evidence that higher luminosity sources and denser outflows are more likely to be detected.Comment: Accepted for publication in MNRA

The effect of Sc and Yb microalloying additions and aged-hardening heat treatment on corrosion behavior of Al-Mg alloys

Sc-containing Al alloys are potentially applied in saline environment. However, the corrosion behavior and its mechanisms of Sc-containing Al alloys have not been paid much attention. In this research, the corrosion behavior of Al-4Mg, Al-4Mg-0.3Sc, and Al-4Mg-0.24Sc-0.06Yb alloys was investigated in 3.5wt% NaCl solution by immersion and potentiodynamic polarization analysis. Scanning electron microscope (SEM), transmission electron microscopy (TEM) and high-resolution TEM were used to characterize intermetallic phases and localized corrosion. The results showed that the Fe-containing intermetallic particles are cathodic with respect to the matrix and can lead to localized corrosion, whereas the high content of Mg makes the Fe-containing intermetallic particle less noble to the matrix. Yb-containing intermetallic particles did not show any dissolution of the matrix at the periphery of these particles. The results indicated that active dissolution and localized corrosion were the dominant corrosion mechanisms for Al-4Mg alloy. However the polarization curves of Al-4Mg-0.3Sc and Al-4Mg-0.24Sc-0.06Yb alloys showed spontaneous passivation followed by pitting corrosion. Results suggested that age-hardening heat treatment improved the stability of the passive film on Al-4Mg-0.3Sc and Al-4Mg-0.24Sc-0.06Yb alloys.This research was supported by The Project Bridging The Gap, funded by the Erasmus Mundus External Cooperation Window Program. Acknowledgements also to the University of Minho, for the provision of research facilities.info:eu-repo/semantics/publishedVersio

The first ALMA view of IRAS 16293-2422: Direct detection of infall onto source B and high-resolution kinematics of source A

Aims: We focus on the kinematical properties of a proto-binary to study the infall and rotation of gas towards its two protostellar components. Methods: We present ALMA Science Verification observations with high-spectral resolution of IRAS 16293-2422 at 220.2 GHz. The wealth of molecular lines in this source and the very high spectral resolution offered by ALMA allow us to study the gas kinematics with unprecedented detail. Results: We present the first detection of an inverse P-Cygni profile towards source B in the three brightest lines. The line profiles are fitted with a simple two-layer model to derive an infall rate of 4.5x10^-5 Msun/yr. This infall detection would rule-out the previously suggested possibility that source B is a T Tauri star. A position velocity diagram for source A shows evidence for rotation with an axis close to the line-of-sight.Comment: Accepted by A&A Letters. 4 pages, 3 figures, 3 appendices (one for Tables, one for additional figures). This second version includes small language modifications and changes to keep the letter within the 4 page limi

Sustainability motivations and practices in small tourism enterprises in European protected areas

A survey of around 900 tourism enterprises in 57 European protected areas shows that small firms are more involved in taking responsibility for being sustainable than previously expected, including eco-savings related operational practices but also reporting a wide range of social and economic responsibility actions. Two-step cluster analysis was used to group the firms in three groups based on their motivations to be sustainable. Business driven firms implement primarily eco-savings activities and are commercially oriented. Legitimization driven firms respond to perceived stakeholder pressure and report a broad spectrum of activities. Lifestyle and value driven firms report the greatest number of environmental, social and economic activities. No profile has a higher business performance than average. The study has implications for policy programmes promoting sustainability behaviour change based primarily on a business case argument