Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

Summary Background Healthcare associated infections (HAI) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HAI and contain antimicrobial resistance (AMR). Aim To measure the prevalence of HAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HAI was 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most common HAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3% and 13.8% in acute adults, paediatric and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HAI continues to be a public health concern in Scotland. UTI and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings

The Distance to the Cygnus Loop from Hubble Space Telescope Imaging of the Primary Shock Front

We present a Hubble Space Telescope/WFPC2 narrow-band H-alpha image of a region on the northeastern limb of the Cygnus Loop supernova remnant. This location provides a detailed example of where the primary blast wave first encounters the surrounding interstellar medium. The filament structure is seen in exquisite detail in this image, which was obtained primarily as an EARLY ACQuisition image for a follow-up spectroscopic program. We compare the HST image to a digitized version of the POSS-I red plate to measure the proper motion of this filament. By combining this value for the proper motion with previous measurements of the shock velocity at this position we find that the distance to the Cygnus Loop is 440 (+130, -100) pc, considerably smaller than the canonical value of 770 pc. We briefly discuss the ramifications of this new distance estimate for our understanding of this prototypical supernova remnant.Comment: 18 pages, 3 Figures (2 JPEG and one Postscript

Modelling the similarity of pitch collections with expectation tensors

Models of the perceived distance between pairs of pitch collections are a core component of broader models of music cognition. Numerous distance measures have been proposed, including voice-leading [1], psychoacoustic [2–4], and pitch and interval class distances [5]; but, so far, there has been no attempt to bind these different measures into a single mathematical or conceptual framework, nor to incorporate the uncertain or probabilistic nature of pitch perception. This paper embeds pitch collections in expectation tensors and shows how metrics between such tensors can model their perceived dissimilarity. Expectation tensors indicate the expected number of tones, ordered pairs of tones, ordered triples of tones, etc., that are heard as having any given pitch, dyad of pitches, triad of pitches, etc.. The pitches can be either absolute or relative (in which case the tensors are invariant with respect to transposition). Examples are given to show how the metrics accord with musical intuition

Randomised trial of glutamine and selenium supplemented parenteral nutrition for critically ill patients

Background: Mortality rates in the Intensive Care Unit and subsequent hospital mortality rates in the UK remain high. Infections in Intensive Care are associated with a 2–3 times increased risk of death. It is thought that under conditions of severe metabolic stress glutamine becomes "conditionally essential". Selenium is an essential trace element that has antioxidant and anti-inflammatory properties. Approximately 23% of patients in Intensive Care require parenteral nutrition and glutamine and selenium are either absent or present in low amounts. Both glutamine and selenium have the potential to influence the immune system through independent biochemical pathways. Systematic reviews suggest that supplementing parenteral nutrition in critical illness with glutamine or selenium may reduce infections and mortality. Pilot data has shown that more than 50% of participants developed infections, typically resistant organisms. We are powered to show definitively whether supplementation of PN with either glutamine or selenium is effective at reducing new infections in critically ill patients. Methods/design: 2 × 2 factorial, pragmatic, multicentre, double-blind, randomised controlled trial. The trial has an enrolment target of 500 patients. Inclusion criteria include: expected to be in critical care for at least 48 hours, aged 16 years or over, patients who require parenteral nutrition and are expected to have at least half their daily nutritional requirements given by that route. Allocation is to one of four iso-caloric, iso-nitrogenous groups: glutamine, selenium, both glutamine & selenium or no additional glutamine or selenium. Trial supplementation is given for up to seven days on the Intensive Care Unit and subsequent wards if practicable. The primary outcomes are episodes of infection in the 14 days after starting trial nutrition and mortality. Secondary outcomes include antibiotic usage, length of hospital stay, quality of life and cost-effectiveness. Discussion: To date more than 285 patients have been recruited to the trial from 10 sites in Scotland. Recruitment is due to finish in August 2008 with a further six months follow up. We expect to report the results of the trial in summer 2009. Trial registration: This trial is registered with the International Standard Randomised Controlled Trial Number system. ISRCTN87144826Not peer reviewedPublisher PD

The fundamental pro-groupoid of an affine 2-scheme

A natural question in the theory of Tannakian categories is: What if you don't remember \Forget? Working over an arbitrary commutative ring $R$, we prove that an answer to this question is given by the functor represented by the \'etale fundamental groupoid \pi_1(\spec(R)), i.e.\ the separable absolute Galois group of $R$ when it is a field. This gives a new definition for \'etale \pi_1(\spec(R)) in terms of the category of $R$-modules rather than the category of \'etale covers. More generally, we introduce a new notion of "commutative 2-ring" that includes both Grothendieck topoi and symmetric monoidal categories of modules, and define a notion of $\pi_1$ for the corresponding "affine 2-schemes." These results help to simplify and clarify some of the peculiarities of the \'etale fundamental group. For example, \'etale fundamental groups are not "true" groups but only profinite groups, and one cannot hope to recover more: the "Tannakian" functor represented by the \'etale fundamental group of a scheme preserves finite products but not all products.Comment: 46 pages + bibliography. Diagrams drawn in Tik

Methods for the sampling and analysis of marine aerosols: results from the 2008 GEOTRACES aerosol intercalibration experiment

Atmospheric deposition of trace elements and isotopes (TEI) is an important source of trace metals to the open ocean, impacting TEI budgets and distributions, stimulating oceanic primary productivity, and influencing biological community structure and function. Thus, accurate sampling of aerosol TEIs is a vital component of ongoing GEOTRACES cruises, and standardized aerosol TEI sampling and analysis procedures allow the comparison of data from different sites and investigators. Here, we report the results of an aerosol analysis intercalibration study by seventeen laboratories for select GEOTRACES-relevant aerosol species (Al, Fe, Ti, V, Zn, Pb, Hg, NO3-, and SO42-) for samples collected in September 2008. The collection equipment and filter substrates are appropriate for the GEOTRACES program, as evidenced by low blanks and detection limits relative to analyte concentrations. Analysis of bulk aerosol sample replicates were in better agreement when the processing protocol was constrained (+/- 9% RSD or better on replicate analyses by a single lab, n = 7) than when it was not (generally 20% RSD or worse among laboratories using different methodologies), suggesting that the observed variability was mainly due to methodological differences rather than sample heterogeneity. Much greater variability was observed for fractional solubility of aerosol trace elements and major anions, due to differing extraction methods. Accuracy is difficult to establish without an SRM representative of aerosols, and we are developing an SRM for this purpose. Based on these findings, we provide recommendations for the GEOTRACES program to and macro-nutrients to the open ocean (Okin et al. 2011) and is a key component of the international GEOTRACES program (GEOTRACES Planning Group 2006). A priority of the GEOTRACES program is to quantify both major and trace elements (e. g., Al, Fe, Ti, V, Zn, Pb, and Hg) and species such as nitrate and sulfate in marine aerosols. Therefore, marine aerosol samples collected during GEOTRACES cruises must follow sampling protocols that permit the collection and analysis of as many elements and compounds as possible, while meeting the constraints associated with basin-wide oceanographic cruises (e. g., space limitations, high-frequency sampling, etc.)

Small molecule activators of SIRT1 replicate signaling pathways triggered by calorie restriction in vivo

<p>Abstract</p> <p>Background</p> <p>Calorie restriction (CR) produces a number of health benefits and ameliorates diseases of aging such as type 2 diabetes. The components of the pathways downstream of CR may provide intervention points for developing therapeutics for treating diseases of aging. The NAD⁺-dependent protein deacetylase SIRT1 has been implicated as one of the key downstream regulators of CR in yeast, rodents, and humans. Small molecule activators of SIRT1 have been identified that exhibit efficacy in animal models of diseases typically associated with aging including type 2 diabetes. To identify molecular processes induced in the liver of mice treated with two structurally distinct SIRT1 activators, SIRT501 (formulated resveratrol) and SRT1720, for three days, we utilized a systems biology approach and applied Causal Network Modeling (CNM) on gene expression data to elucidate downstream effects of SIRT1 activation.</p> <p>Results</p> <p>Here we demonstrate that SIRT1 activators recapitulate many of the molecular events downstream of CR <it>in vivo</it>, such as enhancing mitochondrial biogenesis, improving metabolic signaling pathways, and blunting pro-inflammatory pathways in mice fed a high fat, high calorie diet.</p> <p>Conclusion</p> <p>CNM of gene expression data from mice treated with SRT501 or SRT1720 in combination with supporting <it>in vitro </it>and <it>in vivo </it>data demonstrates that SRT501 and SRT1720 produce a signaling profile that mirrors CR, improves glucose and insulin homeostasis, and acts via SIRT1 activation <it>in vivo</it>. Taken together these results are encouraging regarding the use of small molecule activators of SIRT1 for therapeutic intervention into type 2 diabetes, a strategy which is currently being investigated in multiple clinical trials.</p

Ejecta, Dust, and Synchrotron Radiation in B0540-69.3: A More Crab-Like Remnant than the Crab

We present near and mid-infrared observations of the pulsar-wind nebula (PWN) B0540-69.3 and its associated supernova remnant made with the {\it Spitzer Space Telescope}. We report detections of the PWN with all four IRAC bands, the 24 $\mu$m band of MIPS, and the Infrared Spectrograph (IRS). We find no evidence of IR emission from the X-ray/radio shell surrounding the PWN resulting from the forward shock of the supernova blast wave. The flux of the PWN itself is dominated by synchrotron emission at shorter (IRAC) wavelengths, with a warm dust component longward of 20 $\mu$m. We show that this dust continuum can be explained by a small amount (\sim 1-3 \times 10^{-3} \msun) of dust at a temperature of $\sim 50-65$ K, heated by the shock wave generated by the PWN being driven into the inner edge of the ejecta. This is evidently dust synthesized in the supernova. We also report the detection of several lines in the spectrum of the PWN, and present kinematic information about the PWN as determined from these lines. Kinematics are consistent with previous optical studies of this object. Line strengths are also broadly consistent with what one expects from optical line strengths. We find that lines arise from slow ($\sim 20$ km s$^{-1}$) shocks driven into oxygen-rich clumps in the shell swept-up by an iron-nickel bubble, which have a density contrast of $\sim 100-200$ relative to the bulk of the ejecta, and that faster shocks ($\sim 250$ km s$^{-1}$) in the hydrogen envelope are required to heat dust grains to observed temperatures. We infer from estimates of heavy-element ejecta abundances that the progenitor star was likely in the range of 20-25 $M_\odot$.Comment: 46 pages, 10 figures, accepted for publication in Ap

Ibrutinib for Relapsed / Refractory CLL: A UK and Ireland Analysis of Outcomes in 315 patients

In 2014, ibrutinib was made available for relapsed/refractory chronic lymphocytic leukaemia (CLL) patients. The UK CLL Forum collected data from UK/Ireland patients with a minimum of 1 year follow-up with pre-planned primary endpoints; the number of patients still on therapy at 1 year (Discontinuation Free Survival; DFS) and 1 year overall survival (OS). With a median 16 months follow-up, data on 315 patients demonstrated 1 year DFS of 73.7% and 1 year OS of 83.8%. Patients with better pre-treatment performance status (PS 0/1 vs 2+) had superior DFS (77.5% vs 61.3%;p14 days and had OS of 89.7%, while 26% of patients had dose reductions and 13% had temporary treatment breaks >14 days. We could not demonstrate a detrimental effect of dose reductions alone (1 year OS: 91.7%), but patients who had first year treatment breaks > 14 days, particularly permanent cessation of ibrutinib had both reduced 1 year OS (68.5%) and also a statistically significant excess mortality rate beyond one year. Although outcomes appear inferior to the RESONATE trial (1 year OS;90%: PFS;84%), this may partly reflect the inclusion of PS 2+ patients and that 17.5% of patients permanently discontinued ibrutinib due to an event other than disease progression

Singularity image method for electrical impedance tomography of bubbly flows

A singularity image method is applied to the electrical impedance tomography of gas–liquid flows in a two-dimensional circular domain. Algorithms that use analytic complex functions, dipoles and the Milne-Thomson circle theorem are described. Numerical experiments are provided to demonstrate the robustness of this technique. Numerical results show excellent reconstruction properties.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49106/2/ip3409.pd