Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum -lactamase (ESBL)- producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens

Robust tracking of objects with dynamic topology

In many instances of the object tracking problem the topological properties of objects can change over time. Such changes include the splitting of an object into multiple objects or merging of multiple objects into a single object. We propose a novel tracking model which is robust to such changes. This model is formulated terms of homology theory whereby 0-dimensional homology classes, which correspond to path-connected components, are tracked. A generalisation of this model for tracking spatially close objects lying in an ambient metric space is also proposed. This generalisation is particularly suitable for tracking spatial-temporal phenomena such as weather phenomena. The utility of the proposed model is demonstrated with respect to tracking rain clouds in radar imagery

Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

PURPOSE: Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix. METHODS: Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm. RESULTS: The proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only. CONCLUSIONS: No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication

Potential advantage of student-run clinics for diversifying a medical school class

The purpose of this study was to evaluate the influence of a student-run clinic on the diversification of a medical student class. We distributed a two-page, 20-item, paper survey to students of the University of Missouri School of Medicine (MU SOM) class of 2015 in July of 2011. The survey gathered information on general demographics, opinions on the importance of medical education opportunities, and opinions on the importance of medical school characteristics in applying to and attending MU SOM. A total of 104 students responded to the survey. A majority of the students identified the MedZou Community Health Clinic, a student-run, free health clinic affiliated with MU SOM, and simulated-patient encounters as important educational experiences (81% and 94%, respectively). More than half of the self-identified "non-white" students reported MedZou as an important factor in their choice to apply to (60%; 95% confidence interval [CI], 32 to 88) and attend (71%; 95% CI, 44 to 98) MU SOM, over half of the females reported MedZou as important in their choice to apply (59%; 95% CI, 43 to 76) and attend (57%; 95% CI, 40 to 74), and over half of non-Missouri residents reported MedZou as important in their choice to apply (64%; 95% CI, 36 to 93) and attend (71%; 95% CI, 44 to 98). According to the above results, it can be said that students clearly value both MedZou and simulated-patient encounters as important educational experiences. Women, minorities, and non-Missouri residents value MedZou more highly than their peers who are First Year Medical Students who are Missouri residents, suggesting that MedZou may provide a promising opportunity to advance diversity within MU SOM. These results highlight the need for additional research to further explore MedZou's potential to enhance the recruitment of a diverse medical student class

Effects of systematic shortening of noncovalent C8 side chain on the cytotoxicity and NF-κB inhibitory capacity of pyrrolobenzodiazepines (PBDs)

The systematic shortening of the noncovalent element of a C8-linked pyrrolobenzodiazepine (PBD) conjugate (13) led to the synthesis of a 19-member library of C8-PBD monomers. The critical elements of 13, which were required to render the molecule cytotoxic, were elucidated by an annexin V assay. The effects of shortening the noncovalent element of the molecule on transcription factor inhibitory capacity were also explored through an enzyme-linked immunosorbent assay-based measurement of nuclear NF-κB upon exposure of JJN-3 cells to the synthesized molecules. Although shortening the noncovalent interactive element of 13 had a less than expected effect upon compound cytotoxicity due to reduced DNA interaction, the transcription factor inhibitory capacity of the molecule was notably altered. This study suggests that a relatively short noncovalent side chain at the C8 position of PBD is sufficient to confer cytotoxicity. The shortened PBD monomers provide a new ADC payload scaffold because of their potent cytotoxicity and druglike properties

Monte Carlo Simulations of Coupled Transient Seepage Flow and Compressive Stress in Levees

The purpose of this research is to compare the results from two different computer programs of flow analyses of two levees at Port Arthur, Texas where rising water of a flood from Hurricane Ike occurred on the levees. The first program (Program 1) is a two-dimensional (2-D) transient finite element program that couples the conservation of mass flow equation with accompanying hydraulic boundary conditions with the conservation of force equations with accompanying x and y displacement and force boundary conditions, thus yielding total head, x displacement, and y displacement as unknowns at each finite element node. The second program (Program 2) is a 2-D transient finite element program that considers only the conservation of mass flow equation with its accompanying hydraulic boundary conditions, yielding only total head as the unknown at each finite element node. Compressive stresses can be computed at the centroid of each finite element when using the coupled program. Programs 1 and 2 were parallelized for high performance computing to consider thousands of realisations of the material properties. Since a single realisation requires as much as one hour of computer time for certain levees, the large realisation computation is made possible by utilising HPC. This Monte Carlo type analysis was used to compute the probability of unsatisfactory performance for under seepage, through seepage, and uplift for the two levees. Respective hydrographs from the flood resulting from Hurricane Ike were applied to each levee. When comparing the computations from the two programs, the most significant result was the two programs yielded significantly different values in the computed results in the two clay levees considered in this research

Generalised analysis of compensating balancing sleeves with experimental results from a scaled industrial turbine coupling shaft

The paper furthers the analysis of a recently proposed balancing methodology for high-speed, flexible shafts. This mechanism imparts corrective balancing moments, having the effect of\ud simulating the fixing moments of equivalent double or single encastre mounted shafts. This is shown to theoretically eliminate/nullify the 1st lateral critical speed (LCS), and thereby facilitate safe operation with reduced LCS margins. The paper extends previously reported research to encompass a more generalised case of multiple, concentrated, residual imbalances, thereby facilitating analysis of any imbalance distribution along the shaft. Solutions provide greater insight of the behaviour of the balancing sleeve concept, and the beneficial implications for engineering design. Specifically: 1) a series of concentrated imbalances can be regarded as an equivalent level of uniform eccentricity, and balance sleeve compensation is equally applicable to a generalised unbalanced distribution, 2) compensation depends on the sum of the applied balancing sleeve moments and can therefore be achieved using a single balancing sleeve (thereby simulating a single encastre shaft), 3) compensation of the 2nd critical speed, and to a lesser extent higher orders, is possible by use of two balancing sleeves, positioned at shaft ends, 4) the concept facilitates on-site commissioning of trim balance which requires a means of adjustment at only one end of the shaft, 5) the Reaction Ratio, RR, (simply supported/ encastre), is independent of residual eccentricity, so that the implied benefits resulting from the ratio (possible reductions in the equivalent level of eccentricity) are additional to any balancing procedures undertaken prior to encastre simulation. Analysis shows that equivalent reductions in the order of 1/25th, are possible. Experimental measurements from a scaled model of a typical drive coupling employed on an industrial gas turbine package, loaded asymmetrically with a concentrated point of imbalance, are used to support the analysis and conclusions

Interpreting MMSE Performance in Highly Proficient Bilingual Spanish-English and Asian Indian-English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures

Purpose: Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance. Method: Sixty independent community-dwelling monolingual and bilingual adults were recruited from Eastern and Western regions of the United States in this cross-sectional group study. Independent sample t-tests were used to compare two bilingual groups (Spanish-English and Asian Indian-English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers. Results: Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups. Conclusions: Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population

Interpreting MMSE Performance in Highly Proficient Bilingual Spanish-English and Asian Indian-English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures

Purpose: Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance. Method: Sixty independent community-dwelling monolingual and bilingual adults were recruited from Eastern and Western regions of the United States in this cross-sectional group study. Independent sample t-tests were used to compare two bilingual groups (Spanish-English and Asian Indian-English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers. Results: Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups. Conclusions: Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population

Controlling Light to Make the Most Energy From the Sun

Representing the Light-Material Interactions in Energy Conversion (LMI), this document is one of the entries in the Ten Hundred and One Word Challenge. As part of the challenge, the 46 Energy Frontier Research Centers were invited to represent their science in images, cartoons, photos, words and original paintings, but any descriptions or words could only use the 1000 most commonly used words in the English language, with the addition of one word important to each of the EFRCs and the mission of DOE energy. The mission of LMI to tailor the morphology, complex dielectric structure, and electronic properties of matter so as to sculpt the flow of sunlight and heat, enabling light conversion to electrical and chemical energy with unprecedented efficiency