Antibiotic de-escalation experience in the setting of emergency department: A retrospective, observational study

Background: Antimicrobial de-escalation (ADE) is a part of antimicrobial stewardship strategies aiming to minimize unnecessary or inappropriate antibiotic exposure to decrease the rate of antimicrobial resistance. Information regarding the effectiveness and safety of ADE in the setting of emergency medicine wards (EMW) is lacking. Methods: Adult patients admitted to EMW and receiving empiric antimicrobial treatment were retrospectively studied. The primary outcome was the rate and timing of ADE. Secondary outcomes included factors associated with early ADE, length of stay, and in-hospital mortality. Results: A total of 336 patients were studied. An initial regimen combining two agents was prescribed in 54.8%. Ureidopenicillins and carbapenems were the most frequently empiric treatment prescribed (25.1% and 13.6%). The rate of the appropriateness of prescribing was 58.3%. De-escalation was performed in 111 (33%) patients. Patients received a successful de-escalation on day 2 (21%), 3 (23%), and 5 (56%). The overall in-hospital mortality was 21%, and it was significantly lower among the de-escalation group than the continuation group (16% vs 25% p = 0.003). In multivariate analysis, de-escalation strategies as well as appropriate empiric and targeted therapy were associated with reduced mortality. Conclusions: ADE appears safe and effective in the setting of EMWs despite that further research is warranted to confirm these findings

Maps of zeroes of the grand canonical partition function in a statistical model of high energy collisions

Theorems on zeroes of the truncated generating function in the complex plane are reviewed. When examined in the framework of a statistical model of high energy collisions based on the negative binomial (Pascal) multiplicity distribution, these results lead to maps of zeroes of the grand canonical partition function which allow to interpret in a novel way different classes of events in pp collisions at LHC c.m. energies.Comment: 17 pages, figures (ps included); added references, some figures enlarged. To appear in J. Phys.

Selective self-categorization: Meaningful categorization and the in-group persuasion effect

Research stemming from self-categorization theory (Turner et al., 1987) has demonstrated that individuals are typically more persuaded by messages from their in-group than by messages from the out-group. The present research investigated the role of issue relevance in moderating these effects. In particular, it was predicted that in-groups would only be more persuasive when the dimension on which group membership was defined was meaningful or relevant to the attitude issue. In two studies, participants were presented with persuasive arguments from either an in-group source or an out-group source, where the basis of the in-group/out-group distinction was either relevant or irrelevant to the attitude issue. Participants' attitudes toward the issue were then measured. The results supported the predictions: Participants were more persuaded by in-group sources than out-group sources when the basis for defining the group was relevant to the attitude issue. However, when the defining characteristic of the group was irrelevant to the attitude issue, participants were equally persuaded by in-group and out-group sources. These results support the hypothesis that the fit between group membership and domain is an important moderator of self-categorization effects

Coping With Trade-Offs: Psychological Constraints and Political Implications

A thoughtful reader of the psychological literature on judgment and choice might easily walk away with the impression that people are flat-out incapable of reasoning their way through value trade-offs (Kahneman, Slovic, and Tversky 1982). Trade-offs are just too cognitively complex, emotionally stressful, and socially awkward for people to manage them effectively, to avoid entanglement in Tverskian paradoxes, such as intransitivities within choice tasks and preference reversals across choice tasks. But what looks impossible from certain psychological points of view looks utterly unproblematic from a microeconomic perspective. Of course, people can engage in trade-off reasoning. They do it all the time – every time they stroll down the aisle of the supermarket or cast a vote or opt in or out of a marriage (Becker 1981). We expect competent, self-supporting citizens of free market societies to know that they can\u27t always get what they want and to make appropriate adjustments. Trade-off reasoning should be so pervasive and so well rehearsed as to be virtually automatic for the vast majority of the non-institutionalized population. We could just leave it there in a post-positivist spirit of live-and-let-live pluralism. The disciplinary divergence provides just another illustration of how competing theoretical discourses construct reality in their own image. This “resolution” is, however, less than helpful to political scientists who borrow from cognitive psychology or microeconomics in crafting theories of political reasoning. The theoretical choice reduces to a matter of taste, in effect, an unconditional surrender to solipsism

Dendrochronological and geomorphological investigations to assess water erosion and mass wasting processes in the Apennines of Southern Tuscany (Italy)

The Tyrrhenian side of the Central Apennines is located in a lively geological context, in which uplift/denudation dynamics played a key role in landscape evolution. Intense water erosion and gravitational processes led to the development of spectacular badlands on the widespread clayey hillslopes. The Crete d'Arbia badlands (as part of the Crete Senesi of Southern Tuscany) represent one of the most beautiful examples of these landforms developed on Pliocene clays. On the other hand, these rapidly evolving landforms endanger the artistic heritage of the area, as with the Monte Oliveto Maggiore Abbey that was constructed on the top of a badland hillslope and confers additional value to the landscape.In the perspective of monitoring and reconstructing some significant phases of the relief evolution of this area an integrated approach has been used, which is based on dendrogeomorphology and geomorphological monitoring techniques. In particular, the correspondence between the data from dendrogeomorphological indicators and the measured denudation rates on badland hillslopes was tested. The sampling for dendrogeomorphological analysis has been performed in two stages on 45 trees of the Pinus pinea L. species, on hillslopes affected by soil creep and shallow landslides, in order to identify annual ring growth anomalies, compression wood and roots exposure. Trees' local behaviour is not homogeneous but some common trends have been detected on the basis of the anomaly index and compression wood. Since 1993 several monitoring stations at badland denudation "hot spots" have been equipped with erosion pins; quantitative data from monitoring stations, compared to pluviometric series, indicated critical phases of denudation that were supported by dendrochronological data. The integrated approach between dendrogeomorphology and geomorphological monitoring techniques allowed calibration of both tools in order to extend the analysis in the period preceding the field measurements. This kind of approach, capable of implementation in many contexts, could be particularly helpful in order to forecast the relief evolutionary trend

Non-perturbative gluon evolution, squeezing, correlations and chaos in jets

We study evolution of colour gluon states in isolated QCD jet at the non-perturbative stage. Fluctuations of gluons are less than those for coherent states under specific conditions. This fact suggests that there gluon squeezed states can arise. The angular and rapidity dependencies of the normalized second-order correlation function for present gluon states are studied at this stage of jet evolution. It is shown that these new gluon states can have both sub-Poissonian and super-Poissonian statistics corresponding to, respectively, antibunching and bunching of gluons by analogy with squeezed photon states. We investigate the possibility of coexisting both squeezing and chaos using Toda criterion and temporal correlator analysis. It is shown that these effects may coexist under some conditions.Comment: 18 pages, 3 figures, Reported on IPPP Workshop on Multiparticle Production in QCD Jets (University of Durham, Durham, UK, 12-15 December 2001