Laboratory data as a quality indicator of health-care-associated infections in England.

Routine diagnostic laboratory results, e.g. numbers of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias, have been used as health-care-associated infection quality indicators for decades. The English health-care-associated infection quality indicator system was one of the earliest in the world to mandate the collection and public reporting of such data and has been associated with a reduction of MRSA bacteraemias and Clostridium difficile infections but has shown mixed results for other infections. Diagnostic laboratory data vary greatly between hospitals depending not only on the underlying frequency of the infection of interest, but on the case mix, numbers of samples processed and laboratory factors, which limits benchmarking. Further, over-reliance on laboratory reports has led to unintended negative consequences in England. So, while acknowledging the successes of the English system, the authors believe that it should be appraised in light of the goals of quality of care, patient safety, fairness and providing meaningful data, and alternative healthcare-associated infection quality indicator measurements considered

On the low speed longitudinal stability of hypersonic waveriders

The development of hypersonic civilian transport aircraft requires solutions to a number of challenging problems in the areas of aerothermodynamics, control, aeroelasticity, propulsion and others encountered at high Mach number flight. The desire for good aerodynamic performance at high Mach numbers results in slender vehicle designs called waveriders. The stability and handling of waverider shapes at the low speeds at the take-off and landing phases of flight is not well studied. This thesis covers static and dynamic CFD simulations of the Hexafly-Int glider which have been used to obtain longitudinal stability derivatives at low speeds. Complementary static and free-to-pitch dynamic wind tunnel testing, are used to validate the CFD computations. A final chapter on the optimisation of waverider designs including low speed longitudinal stability is presented to show the impacts of this additional requirement on the hypersonic design space. The static wind tunnel testing has identified stability issues relating to the location of the centre of gravity. The design centre of gravity which is suitable for the Hexafly-Int vehicle at Mach 7.2 is found to be too far aft which results in instability at low speeds. In addition, the dynamic testing in the wind tunnel shows that the pitch damping is inadequate at low speeds. The CFD simulations agree well with the wind tunnel test results validating the use of CFD tools for determining dynamic stability derivatives of this class of slender vehicle in the design process. To alleviate the low speed stability issue of hypersonic vehicles, a waverider shape optimisation study has been carried out to understand what shapes will produce better low speed stability behaviour. These shapes are found to produce lower aerodynamic efficiency at high speeds which suggests that a design compromise between low speed stability and high speed performance is required at the outset of hypersonic waverider design

A New Operational Snow Retrieval Algorithm Applied to Historical AMSR-E Brightness Temperatures

Snow is a key element of the water and energy cycles and the knowledge of spatio-temporal distribution of snow depth and snow water equivalent (SWE) is fundamental for hydrological and climatological applications. SWE and snow depth estimates can be obtained from spaceborne microwave brightness temperatures at global scale and high temporal resolution (daily). In this regard, the data recorded by the Advanced Microwave Scanning Radiometer—Earth Orbiting System (EOS) (AMSR-E) onboard the National Aeronautics and Space Administration’s (NASA) AQUA spacecraft have been used to generate operational estimates of SWE and snow depth, complementing estimates generated with other microwave sensors flying on other platforms. In this study, we report the results concerning the development and assessment of a new operational algorithm applied to historical AMSR-E data. The new algorithm here proposed makes use of climatological data, electromagnetic modeling and artificial neural networks for estimating snow depth as well as a spatio-temporal dynamic density scheme to convert snow depth to SWE. The outputs of the new algorithm are compared with those of the current AMSR-E operational algorithm as well as in-situ measurements and other operational snow products, specifically the Canadian Meteorological Center (CMC) and GlobSnow datasets. Our results show that the AMSR-E algorithm here proposed generally performs better than the operational one and addresses some major issues identified in the spatial distribution of snow depth fields associated with the evolution of effective grain size

Mechanism of Microwave Assisted Hydrodistillation Studied Through Heat Analysis

In this study, the efficiency of heating mechanism of microwave assisted hydrodistillation (MAHD) in the extraction of cinnamon bark oil was investigated. The optimum conditions used to analyse the heating performance were 8:1 ratio of water to cinnamon bark powder and fixed 250 W of irradiation power. The increasing temperature in the cinnamon bark matrix was dependent on the solvent, physical, dielectric and heating properties of the cinnamon matrix. Due to the high dielectric properties of water it accelerated the process of extraction. However, after the cinnamon matrix reached the boiling point, the density of solvent decreased which led to decrease in the dielectric properties. Volume rate of heat generation and penetration depth of microwave was also evaluated. The rate of volume heat generation reduced when the exposure time increase which is related to the reducing dielectric properties of cinnamon matrix. The penetration depth was calculated to support the data of dielectric properties. This study therefore produced an in depth justification necessary to understand the heating mechanism of MAHD in extraction of cinnamon bark essential oil

Management of Mevalonate Kinase Deficiency: A Pediatric Perspective

Background: Mevalonate kinase deficiency (MKD) is an inborn error of metabolism leading to a syndrome characterized by recurrent inflammation. This clinically manifests itself as fever and can be accompanied by gastrointestinal symptoms, oral ulcers, cervical lymphadenopathy, and skin rash. Methods: We searched Pubmed, Embase, Cochrane, and CINAHL for relevant articles. All articles were screened by both authors. Relevant articles were included in this review. Results: The interleukin-1 antagonist canakinumab is the only well-studied and effective treatment for MKD patients with 35% of patients reaching complete remission in a large randomized controlled trial. Other therapeutic options include glucocorticoids and the IL-1 antagonist anakinra, although the level of evidence for these treatments is weaker. If patients fail to these treatments, the biologicals etanercept or tocilizumab can be used. Mildly affected patients might benefit from cheaper, less invasive treatments such as paracetamol and NSAIDs. Conclusion: Canakinumab is the only evidence-based treatment for mevalonate kinase deficiency. However, the costs limit availability for many patients. Cheaper and more readily available options include glucocorticoids, anakinra, etanercept, and tocilizumab, although there is limited evidence supporting these treatments

The darkening of the Greenland ice sheet: trends, drivers, and projections (1981–2100)

The surface energy balance and meltwater production of the Greenland ice sheet (GrIS) are modulated by snow and ice albedo through the amount of absorbed solar radiation. Here we show, using space-borne multispectral data collected during the 3 decades from 1981 to 2012, that summertime surface albedo over the GrIS decreased at a statistically significant (99 %) rate of 0.02 decade−1 between 1996 and 2012. Over the same period, albedo modelled by the Modèle Atmosphérique Régionale (MAR) also shows a decrease, though at a lower rate ( ∼ −0.01 decade−1) than that obtained from space-borne data. We suggest that the discrepancy between modelled and measured albedo trends can be explained by the absence in the model of processes associated with the presence of light-absorbing impurities. The negative trend in observed albedo is confined to the regions of the GrIS that undergo melting in summer, with the dry-snow zone showing no trend. The period 1981–1996 also showed no statistically significant trend over the whole GrIS. Analysis of MAR outputs indicates that the observed albedo decrease is attributable to the combined effects of increased near-surface air temperatures, which enhanced melt and promoted growth in snow grain size and the expansion of bare ice areas, and to trends in light-absorbing impurities (LAI) on the snow and ice surfaces. Neither aerosol models nor in situ and remote sensing observations indicate increasing trends in LAI in the atmosphere over Greenland. Similarly, an analysis of the number of fires and BC emissions from fires points to the absence of trends for such quantities. This suggests that the apparent increase of LAI in snow and ice might be related to the exposure of a "dark band" of dirty ice and to increased consolidation of LAI at the surface with melt, not to increased aerosol deposition. Albedo projections through to the end of the century under different warming scenarios consistently point to continued darkening, with albedo anomalies averaged over the whole ice sheet lower by 0.08 in 2100 than in 2000, driven solely by a warming climate. Future darkening is likely underestimated because of known underestimates in modelled melting (as seen in hindcasts) and because the model albedo scheme does not currently include the effects of LAI, which have a positive feedback on albedo decline through increased melting, grain growth, and darkening

Wie Reiche denken und lenken : Reichtum in der Schweiz: Geschichte, Fakten, Gespräche

Geld Schweiz Geld Gesellschaft Die Schweiz ist ein kleines Land. Doch jeder zehnte Milliardär der Welt wohnt in der Schweiz. Drei Prozent der hier wohnhaften privaten ­Steuerpflichtigen haben gleich viel Nettovermögen wie die restlichen 97 Prozent. Die Vermögen der 300 Reichsten stiegen in den letzten ­zwanzig Jahren von 86 Milliarden auf 459 Milliarden Franken. Wer sind diese Menschen? Wo und wie leben sie? Die Autoren dieses Buchs zeigen auf, wie dieser Reichtum entstanden und verteilt ist, wie er sich erneuert, wie Reiche denken und lenken, wie sie soziale Gegensätze wahrnehmen und wie Medien über Reiche berichten. Diese Studie knüpft an die frühere Untersuchung über den Reichtum in der Schweiz (Mäder/Streuli 2002) an und erweitert den Kontext. Der Blick richtet sich auf soziale Ungleichheiten, auf Kontinuitäten und Wandel, auf die Selbst- und Fremdwahrnehmung von Reichen, besonders auch im Zusammenhang mit der globalen Finanzkrise. Als Grundlage dienen statistische Auswertungen aktueller Daten, ethnografische ­Zugänge im Feld der Reichen, Auswertungen von Medienberichten sowie zahlreiche Gespräche mit Reichen

HEXAFLY-INT: An Overview of Waverider Subsonic Investigations

Hypersonic waveriders have the potential to significantly reduce travel times on long haul civilian transport routes. The design of hypersonic aircraft is heavily influenced by the aerodynamic efficiency at the cruise Mach number, resulting in less than ideal geometries for subsonic flight. Waverider aerodynamics and stability in the low speed regime is rarely investigated and not well understood, but is crucial for horizontal take-offs and landings. This paper gives an overview of all work completed within the HEXAFLY-INT project with respect to subsonic investigations. It covers a wide range of static and dynamic wind tunnel tests in the longitudinal and lateral-directional planes. The experimental investigations are complemented by in depth numerical computations which validate the experimental data. It was found that flow separation, non-linear vortex lift and subsequent bursting at high angles of attack govern the aircraft stability derivaties. This is due to the low aspect ratio, highly swept delta wings which are present on the vehicle, as well as sharp edges which give rise to high pressure gradients at moderate angles of attack