Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection

Introduction: Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. Whilst the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance evidence of the effect on outcome following severe infection is lacking. Methods: In 2008, Glasgow hospitals introduced a restrictive antibiotic guideline. A retrospective before/after study assessed outcome following gram-negative bacteraemia in the 2-year period around implementation. Results: Introduction of restrictive antibiotic guidelines was associated with a reduction in utilisation of ceftriaxone and co-amoxiclav and an increase in amoxicillin and gentamicin. 1593 episodes of bacteraemia were included in the study. The mortality over 1 year following gram-negative bacteraemia was lower in the period following guideline implementation (RR 0.852, P = 0.045). There was no evidence of a difference in secondary outcomes including ITU admission, length of stay, readmission, recurrence of bacteraemia and need for renal replacement therapy. There was a fall in CDI (RR 0.571, P = 0.014) and a reduction in bacterial resistance to ceftriaxone and co-amoxiclav but no evidence of an increase in gentamicin resistance after guideline implementation. Conclusion: Restrictive antibiotic guidelines were associated with a reduction in CDI and bacterial resistance but no evidence of adverse outcomes following gram-negative bacteraemia. There was a small reduction in one year mortality

Spin gating electrical current

We use an aluminium single electron transistor with a magnetic gate to directly quantify the chemical potential anisotropy of GaMnAs materials. Uniaxial and cubic contributions to the chemical potential anisotropy are determined from field rotation experiments. In performing magnetic field sweeps we observe additional isotropic magnetic field dependence of the chemical potential which shows a non-monotonic behavior. The observed effects are explained by calculations based on the $\mathbf{k}\cdot\mathbf{p}$ kinetic exchange model of ferromagnetism in GaMnAs. Our device inverts the conventional approach for constructing spin transistors: instead of spin-transport controlled by ordinary gates we spin-gate ordinary charge transport.Comment: 5 pages, 4 figure

HUBUNGAN ANTARA SUPERVISI DAN KEAMANAN KERJA DENGAN KINERJA PERAWAT DI RUANG RAWAT INAP RSUD NOONGAN

Supervisi dan Keamanan kerja sangat berpengaruh terhadap kinerja dari perawat. Kinerja perawat sebagai ujung tombak pelayanan kesehatan merupakan masalah yang sangat penting untuk dikaji dalam rangka mempertahankan dan meningkatkan mutu pelayanan kesehatan. Kinerja perawat yang baik merupakan jembatan dalam menjawab jaminan kualitas pelayanan kesehatan yang di berikan terhadap pasien baik yang sakit maupun sehat.Tujuan penelitian I ni untuk mengetahui hubungan antara supervise dan keamanan kerja dengan kinerja perawat di ruang rawat inap RSUD Noongan. Metode penelitian ini adalah survei analitik dengan rancangan cross sectional study (studi potong lintang). Populasi dalam penelitian ini adalah 82 perawat.Alat ukur yang digunakan adalah kuesioner. Hasil penelitian ini menunjukkan terdapat hubungan yang signifikan dari masing-masing variable yaitu supervise dan keamanan kerja dengan kinerja perawat. Kesimpulan terdapat hubungan antara supervise dan keamanan kerja dengan kinerja perawat di ruang rawat inap RSUD Noongan. Disanrankan kepada pihak rumah sakit untuk terus meningkatkan supervise dan keamanan kerja dari perawat dan melaksanakan tugas dang tanggung jawab sesuai prosedur yang ada agar tercipta kinerja yang baik. Kata Kunci: Supervisi, Keamanan Kerja dan Kinerja Perawat ABSTRACTSupervision and job security greatly affect the performance of nurses. The performance of nurses as the spearhead of health services is a very important problem to be studied in order to maintain and improve the quality of health services. A good nurse's performance is a bridge in answering the quality assurance of health services provided to patients both sick and healthy. The purpose of this study was to determine the relationship between supervision and work security with the performance of nurses in the inpatient ward of Noongan Hospital. The method of this study was an analytical survey with a cross sectional study design. The population in this study were 82 nurses. The measuring instrument used is a questionnaire. The results of this study indicate that there is a significant relationship of each variable, namely supervision and job security with nurse performance. Conclusion there is a relationship between supervision and job security with the performance of nurses in the inpatient ward of Noongan Hospital. Disseminated to the hospital to continue to improve supervision and work security of nurses and carry out the duties and responsibilities in accordance with existing procedures in order to create good performance. Keywords: Supervision, Work Security and Nurse Performance

Poisoning with the recreational drug paramethoxyamphetamine ("death")

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Objective: To describe the clinical features of paramethoxyamphetamine (PMA; "death") poisoning and to compare these with those of people with self-reported "ecstasy" poisoning. Design: Retrospective casenote review. Participants and setting: 22 patients who presented to the Emergency Department of the Royal Adelaide Hospital (RAH), a major metropolitan teaching hospital, between 1 January 1996 and 31 December 1998 with PMA poisoning identified through urine drug screens; and 61 patients with self-reported ecstasy poisoning between 1 September 1997 and 31 December 1998 found through the hospital databases. Results: Patients with PMA poisoning presented with tachycardia (64%), hyperthermia (temperature > 37.5ºC; 36%), coma (41%), seizures (32%), arrhythmias (23%), and QRS intervals 100 ms (50%) with greater frequency and often greater severity than those with self-reported ecstasy poisoning. Two patients with PMA poisoning presented with severe hypoglycaemia (blood glucose level, 7.5 mmol/L). Conclusions: At our hospital, PMA poisonings accounted for most of the severe reactions among people who believed they had taken ecstasy. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. PMA toxicity should be suspected with severe or atypical reactions to "ecstasy", and confirmed by chromatographic urine drug screens.Liang Han Ling, Colin Marchant, Nicholas A. Buckley, Michael Prior and Rod J. Irvin

Reconfigurable Boolean Logic using Magnetic Single-Electron Transistors

We propose a novel hybrid single-electron device for reprogrammable low-power logic operations, the magnetic single-electron transistor (MSET). The device consists of an aluminium single-electron transistors with a GaMnAs magnetic back-gate. Changing between different logic gate functions is realized by reorienting the magnetic moments of the magnetic layer which induce a voltage shift on the Coulomb blockade oscillations of the MSET. We show that we can arbitrarily reprogram the function of the device from an n-type SET for in-plane magnetization of the GaMnAs layer to p-type SET for out-of-plane magnetization orientation. Moreover, we demonstrate a set of reprogrammable Boolean gates and its logical complement at the single device level. Finally, we propose two sets of reconfigurable binary gates using combinations of two MSETs in a pull-down network

Composition and Distribution of Extracellular Polymeric Substances in Aerobic Flocs and Granular Sludge

Extracellular polymeric substances (EPS) were quantified in flocculent and aerobic granular sludge developed in two sequencing batch reactors with the same shear force but different settling times. Several EPS extraction methods were compared to investigate how different methods affect EPS chemical characterization, and fluorescent stains were used to visualize EPS in intact samples and 20-µm cryosections. Reactor 1 (operated with a 10-min settle) enriched predominantly flocculent sludge with a sludge volume index (SVI) of 120 ± 12 ml g–1, and reactor 2 (2-min settle time) formed compact aerobic granules with an SVI of 50 ± 2 ml g–1. EPS extraction by using a cation-exchange resin showed that proteins were more dominant than polysaccharides in all samples, and the protein content was 50% more in granular EPS than flocculent EPS. NaOH and heat extraction produced a higher protein and polysaccharide content from cell lysis. In situ EPS staining of granules showed that cells and polysaccharides were localized to the outer edge of granules, whereas the center was comprised mostly of proteins. These observations confirm the chemical extraction data and indicate that granule formation and stability are dependent on a noncellular, protein core. The comparison of EPS methods explains how significant cell lysis and contamination by dead biomass leads to different and opposing conclusions

Projected free energies for polydisperse phase equilibria

A `polydisperse' system has an infinite number of conserved densities. We give a rational procedure for projecting its infinite-dimensional free energy surface onto a subspace comprising a finite number of linear combinations of densities (`moments'), in which the phase behavior is then found as usual. If the excess free energy of the system depends only on the moments used, exact cloud, shadow and spinodal curves result; two- and multi-phase regions are approximate, but refinable indefinitely by adding extra moments. The approach is computationally robust and gives new geometrical insights into the thermodynamics of polydispersity.Comment: 4 pages, REVTeX, uses multicol.sty and epsf.sty, 1 postscript figure include

Biodegradation of 3-chlorophenol in a sequencing batch reactor

The present paper shows the results obtained through a study on the biodegradation of 3-chlorophenol (3-CP) in a Sequencing Batch Reactor (SBR). To such a purpose a lab-scale SBR was fed a synthetic wastewater containing 3-CP and nutrients (nitrogen and phosphorus) diluted in tap water. The operating strategy, in terms of both the duration of either the cycle or the react phase, was changed throughout the experimental activity in order to find out the optimal one allowing to ensure constant and high removal efficiency despite the increasing 3-chlorophenol concentration in the feed. Biomass collected from a full-scale continuous flow activated sludge facility treating domestic wastewater was used as seed, after being acclimated to 3-CP by means of several batch tests. The results showed that a periodically operated activated sludge system can be successfully used for the biodegradation of chlorophenol compounds, after the needed members of the microbiological consortium are selected and enriched

Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database

Objective To determine whether varenicline, a recently licensed smoking cessation product, is associated with an increased risk of suicide and suicidal behaviour compared with alternative treatments bupropion and nicotine replacement therapy