Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome

Background: Sepsis is one of the leading causes of death in the UK. Aims: The aims of this study were to identify the rate of inactive antimicrobial therapy (AMT) in the ICU and whether inactive AMT had an effect on in hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. Additionally, we wanted to identify risk factors for receiving inactive AMT. Methods: This was a retrospective observational study conducted at Glasgow Royal Infirmary ICU between January 2010 and December 2013, with 12,000 blood cultures taken over this time period, of which n=127 were deemed clinically significant. Multivariate logistic regression was used to identify risk factors independently associated with mortality. To identify risk factors for receiving inactive AMT a univariable and a subsequent multivariate analysis was constructed. Results: The rate of inactive AMT was 47% (n =60). Our multivariate analysis showed that receiving antibiotics within the first 24 hours of ICU admission led to a reduced mortality (RR 1.70; 95% CI 1.19-2.44.) Furthermore, it showed that severity of illness (as defined by SIRS criteria sepsis vs septic shock) increased mortality (OR 9.87; 95% CI 1.73-55.5). However, inactive AMT did not increase mortality (OR 1.07; 95% CI 0.47-2.41) or length of hospital stay (53.2 vs 69.1 days p=0.348.) We identified fungal bloodstream infection as a risk factor for receiving inactive AMT (OR 5.10;95% CI 1.29-20.14. Conclusion: Mortality from sepsis is influenced by multiple factors. We were unable to demonstrates that inactive AMT had an effect on mortality in sepsis

Continuous monitoring of aerial bioburden within intensive care isolation rooms and identification of 'high risk' activities

Background: The spread of pathogens via the airborne route is often underestimated and little is known about the extent to which airborne microbial contamination levels vary throughout the day and night in hospital facilities. Aims: This study aims to evaluate variability in airborne contamination levels within ICU isolation rooms over extended time periods to improve understanding of the extent to which ward activities, and consequential increases in airborne bioburden, may contribute to cross-infection of patients. Methods: Environmental air monitoring was conducted within occupied and vacant inpatient isolation rooms. A sieve impactor sampler was used to collect 500 L air samples every 15 minutes over 10-hour (08:00-18:00 h) and 24-hour (08:00-08:00 h) periods. Samples were collected, room activity logged, and the bacterial contamination levels were recorded as cfu/m3 of air. Findings: A high degree of variability in levels of airborne contamination was observed across all scenarios in the studied isolation rooms. Air bioburden increased as room occupancy increased, with air contamination levels highest in rooms occupied for the longest time during the study (10 days) with a mean value of 104.4 cfu/m3 and a range of 12–510 cfu/m3. Counts were lowest in unoccupied rooms, with an average value of 20 cfu/m3 and during the night. Conclusion: Peaks in airborne contamination showed a direct relation to an increase in activity levels. This study provides first clear evidence of the extent of variability in microbial airborne levels over 24-hour periods in ICU isolation rooms and directly correlates microbial load to ward activity

Low-carbon GeoEnergy resource options in the Midland Valley of Scotland, UK

Scotland is committed to be a carbon-neutral society by 2040 and has achieved the important initial step of decarbonising power production. However, more ambitious measures are required to fully decarbonise all of the electricity, transport and heating sectors. We explore the potential to use the low-carbon GeoEnergy resources and bio-energy combined with Carbon Capture and Storage (BECCS) in the Midland Valley area to decarbonise the Scottish economy and society. The Midland Valley has a long history of geological resource extraction, and as a result, the geology of the region is well-characterised. Geothermal energy and subsurface energy storage have the potential to be implemented. Some of them, such as gravity and heat storage, could re-use the redundant mining infrastructure to decrease investment costs. Hydrogen storage could be of particular interest as the Midland Valley offers the required caprock-reservoir assemblages. BECCS is also a promising option to reduce overall CO2 emissions between 1.10-4.40 MtCO2/yr. The Midland Valley has enough space to grow the necessary crops, but CO2 storage will most likely be implemented in North Sea saline aquifers. The studied aspects suggest that the Midland Valley represents a viable option in Scotland for the exploitation of the majority of low-carbon GeoEnergy resources

Investigating the variability of airborne bacteria in a hospital Intensive Care Unit over a 24 hour period

Current knowledge of the clinical microflora is limited, however it is currently estimated that 10-33% of nosocomial infections are transmitted via air. This study aims to assess the variability and dynamics of airborne contamination in a hospital setting, and contribute to an improved understanding of the airborne bioburden in clinical environments. Environmental air monitoring, using a sieve-impactor air sampler, was conducted in an Intensive Care Unit, with 500L air samples collected every 15-min over 24-h periods (08:00-08:00h). Room activity was logged and bacterial contamination levels were recorded as CFU/m3 of air. A cascade impactor and aerosol spectrometer were also used to separate particles into size fractions correlating to human lung deposition. A high degree of variability in airborne contamination was observed over the course of a 24-h period in the hospital ICU. Contamination counts ranged from 12-510 CFU/m3 over 24-h in an isolation room occupied for 10 days by a patient with C. difficile infection. Levels were lowest during the night and in unoccupied rooms, with an average value of 20 CFU/m3. Peaks in airborne contamination showed a direct relation to an increase in room activity, such as bed changes and visiting times. This study demonstrates the variation and degree of airborne contamination that can occur in an ICU over a 24-h period. Numerous factors contributed to increasing microbial air contamination and consideration should be given to potential improved infection control strategies and decontamination technologies to reduce airborne contamination, with the ultimate aim of reducing healthcare-associated infections from environmental sources

Large-angle production of charged pions by 3 GeV/c - 12.9 GeV/c protons on beryllium, aluminium and lead targets

Measurements of the double-differential $\pi^{\pm}$ production cross-section in the range of momentum 100 \MeVc \leq p < 800 \MeVc and angle 0.35 \rad \leq \theta < 2.15 \rad in proton--beryllium, proton--aluminium and proton--lead collisions are presented. The data were taken with the HARP detector in the T9 beam line of the CERN PS. The pions were produced by proton beams in a momentum range from 3 \GeVc to 12.9 \GeVc hitting a target with a thickness of 5% of a nuclear interaction length. The tracking and identification of the produced particles was performed using a small-radius cylindrical time projection chamber (TPC) placed inside a solenoidal magnet. Incident particles were identified by an elaborate system of beam detectors. Results are obtained for the double-differential cross-sections at six incident proton beam momenta (3 \GeVc, 5 \GeVc, 8 \GeVc, 8.9 \GeVc (Be only), 12 \GeVc and 12.9 \GeVc (Al only)) and compared to previously available data

The local adsorption geometry of benzenethiolate on Cu(1 0 0)

The local adsorption geometry of benzenethiolate in the ordered c(2 × 6) phase on Cu(1 0 0) has been investigated by a combination of S K-edge near-edge X-ray absorption fine structure (NEXAFS), normal incidence X-ray standing waves (NIXSW) and S 1s scanned-energy mode photoelectron diffraction (PhD). NEXAFS and PhD show that the molecular plane is tilted from the surface normal by 20 ± 15°, while NIXSW clearly identifies the S head-group as occupying the four-fold coordinated hollow sites. PhD shows the S atoms lies 1.34 ± 0.04 Å above the outermost Cu atomic layer, leading to a Cu–S bondlength of 2.25 ± 0.02 Å. The combination of the PhD and NIXSW results shows the Cu surface layer has an outward relaxation of 0.15 ± 0.06 Å. Possible origins for this large adsorbate-induced relaxation are discussed

Measurement of the production of charged pions by protons on a tantalum target

A measurement of the double-differential cross-section for the production of charged pions in proton--tantalum collisions emitted at large angles from the incoming beam direction is presented. The data were taken in 2002 with the HARP detector in the T9 beam line of the CERN PS. The pions were produced by proton beams in a momentum range from 3 \GeVc to 12 \GeVc hitting a tantalum target with a thickness of 5% of a nuclear interaction length. The angular and momentum range covered by the experiment (100 \MeVc \le p < 800 \MeVc and 0.35 \rad \le \theta <2.15 \rad) is of particular importance for the design of a neutrino factory. The produced particles were detected using a small-radius cylindrical time projection chamber (TPC) placed in a solenoidal magnet. Track recognition, momentum determination and particle identification were all performed based on the measurements made with the TPC. An elaborate system of detectors in the beam line ensured the identification of the incident particles. Results are shown for the double-differential cross-sections ${{\mathrm{d}^2 \sigma}} / {{\mathrm{d}p\mathrm{d}\theta}}$ at four incident proton beam momenta (3 \GeVc, 5 \GeVc, 8 \GeVc and 12 \GeVc). In addition, the pion yields within the acceptance of typical neutrino factory designs are shown as a function of beam momentum. The measurement of these yields within a single experiment eliminates most systematic errors in the comparison between rates at different beam momenta and between positive and negative pion production.Comment: 49 pages, 31 figures. Version accepted for publication on Eur. Phys. J.

Measurement of the production cross-section of positive pions in the collision of 8.9 GeV/c protons on beryllium

The double-differential production cross-section of positive pions, $d^2\sigma^{\pi^{+}}/dpd\Omega$, measured in the HARP experiment is presented. The incident particles are 8.9 GeV/c protons directed onto a beryllium target with a nominal thickness of 5% of a nuclear interaction length. The measured cross-section has a direct impact on the prediction of neutrino fluxes for the MiniBooNE and SciBooNE experiments at Fermilab. After cuts, 13 million protons on target produced about 96,000 reconstructed secondary tracks which were used in this analysis. Cross-section results are presented in the kinematic range 0.75 GeV/c < $p_{\pi}$ < 6.5 GeV/c and 30 mrad < $\theta_{\pi}$ < 210 mrad in the laboratory frame.Comment: 39 pages, 21 figures. Version accepted for publication by Eur. Phys. J.

Effective Lagrangian Approach to the Theory of Eta Photoproduction in the N∗(1535)N^{*}(1535) Region

We investigate eta photoproduction in the $N^{*}(1535)$ resonance region within the effective Lagrangian approach (ELA), wherein leading contributions to the amplitude at the tree level are taken into account. These include the nucleon Born terms and the leading $t$-channel vector meson exchanges as the non-resonant pieces. In addition, we consider five resonance contributions in the $s$- and $u$- channel; besides the dominant $N^{*}(1535)$, these are: $N^{*}(1440),N^{*}(1520),N^{*}(1650)$ and $N^{*}(1710)$. The amplitudes for the $\pi^\circ$ and the $\eta$ photoproduction near threshold have significant differences, even as they share common contributions, such as those of the nucleon Born terms. Among these differences, the contribution to the $\eta$ photoproduction of the $s$-channel excitation of the $N^{*}(1535)$ is the most significant. We find the off-shell properties of the spin-3/2 resonances to be important in determining the background contributions. Fitting our effective amplitude to the available data base allows us to extract the quantity $\sqrt{\chi \Gamma_\eta} A_{1/2}/\Gamma_T$, characteristic of the photoexcitation of the $N^{*}(1535)$ resonance and its decay into the $\eta$-nucleon channel, of interest to precise tests of hadron models. At the photon point, we determine it to be $(2.2\pm 0.2)\times 10^{-1} GeV^{-1}$ from the old data base, and $(2.2\pm 0.1) \times 10^{-1} GeV^{-1}$ from a combination of old data base and new Bates data. We obtain the helicity amplitude for $N^{*}(1535)\rightarrow \gamma p$ to be $A_{1/2}=(97\pm 7)\times 10^{-3} GeV^{-1/2}$ from the old data base, and $A_{1/2}=(97\pm 6)\times 10^{-3} GeV^{-1/2}$ from the combination of the old data base and new Bates data, compared with the results of the analysis of pion photoproduction yielding $74\pm 11$, in the same units.Comment: 43 pages, RevTeX, 9 figures available upon request, to appear in Phys. Rev.