Clostridium difficile infection in the United States: A national study assessing preventive practices used and perceptions of practice evidence

We surveyed 571 US hospitals about practices used to prevent Clostridium difficile infection (CDI). Most hospitals reported regularly using key CDI prevention practices, and perceived their strength of evidence as high. The largest discrepancy between regular use and perceived evidence strength occurred with antimicrobial stewardship programs.Infect. Control Hosp. Epidemiol. 2015;36(8):969–971</jats:p

Controlled electrochemical growth of ultra-long gold nanoribbons

Citation: Basnet, G., Panta, K. R., Thapa, P. S., & Flanders, B. N. (2017). Controlled electrochemical growth of ultra-long gold nanoribbons. Applied Physics Letters, 110(7), 5. doi:10.1063/1.4976027This paper describes the electrochemical growth of branchless gold nanoribbons with similar to 40 nm x similar to 300 nm cross sections and >100 mu m lengths (giving length-to-thickness aspect ratios of > 10(3)). These structures are useful for opto-electronic studies and as nanoscale electrodes. The 0.75-1.0V voltage amplitude range is optimal for branchless ribbon growth. Reduced amplitudes induce no growth, possibly due to reversible redox chemistry of gold at reduced amplitudes, whereas elevated amplitudes, or excess electrical noise, induce significant side-branching. The inter-relatedness of voltage-amplitude, noise, and side-branching in electrochemical nanoribbon growth is demonstrated. Published by AIP Publishing

Impact of Baseline Magnetic Resonance Imaging on Neurologic, Functional, and Safety Outcomes in Patients With Acute Traumatic Spinal Cord Injury

Study Design: Systematic review. Objective: To perform a systematic review to evaluate the utility of magnetic resonance imaging (MRI) in patients with acute spinal cord injury (SCI). Methods: An electronic search of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar was conducted for literature published through May 12, 2015, to answer key questions associated with the use of MRI in patients with acute SCI. Results: The literature search yielded 796 potentially relevant citations, 8 of which were included in this review. One study used MRI in a protocol to decide on early surgical decompression. The MRI-protocol group showed improved outcomes; however, the quality of evidence was deemed very low due to selection bias. Seven studies reported MRI predictors of neurologic or functional outcomes. There was moderate-quality evidence that longer intramedullary hemorrhage (2 studies) and low-quality evidence that smaller spinal canal diameter at the location of maximal spinal cord compression and the presence of cord swelling are associated with poor neurologic recovery. There was moderate-quality evidence that clinical outcomes are not predicted by SCI lesion length and the presence of cord edema. Conclusions: Certain MRI characteristics appear to be predictive of outcomes in acute SCI, including length of intramedullary hemorrhage (moderate-quality evidence), canal diameter at maximal spinal cord compression (low-quality evidence), and spinal cord swelling (low-quality evidence). Other imaging features were either inconsistently (presence of hemorrhage, maximal canal compromise, and edema length) or not associated with outcomes. The paucity of literature highlights the need for well-designed prospective studies. © 2017, © The Author(s) 2017

Posterior longitudinal ligament status in cervical spine bilateral facet dislocations

Objective: It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status. Design: Retrospective case series. Patients: A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between various injury patterns and posterior longitudinal ligament status. Results: The frequency of MRI abnormalities was: anterior longitudinal ligament disruption (26.7%), disc herniation or disruption (90%), posterior longitudinal ligament disruption (40%), facet fracture (63.3%) and disruption of the posterior column ligament complex (97%). There were no significant associations between injury to the posterior longitudinal ligament and other structures. Compared to surgical reports, MRI was accurate for determining the status for 24 of 26 ligaments (three of three anterior longitudinal ligament, seven of nine posterior longitudinal ligament, and 14 of 14 posterior column ligament complex) but generated false negatives in two instances (in both MRI showed an intact posterior longitudinal ligament that was torn at surgery). Conclusions: In contradis¬tinction to the existing concept, the posterior longitudinal ligament can remain intact in a substantial propor¬tion of hyperflexion injuries that produce bilateral cervical facet dislocation. Posterior longitudinal ligament integrity is not associated with any other injury pattern related to the anterior longitudinal ligament, intervertebral disc or facet fracture

Spinor formulation of topologically massive gravity

In the framework of real 2-component spinors in three dimensional space-time we present a description of topologically massive gravity (TMG) in terms of differential forms with triad scalar coefficients. This is essentially a real version of the Newman-Penrose formalism in general relativity. A triad formulation of TMG was considered earlier by Hall, Morgan and Perjes, however, due to an unfortunate choice of signature some of the spinors underlying the Hall-Morgan-Perjes formalism are real, while others are pure imaginary. We obtain the basic geometrical identities as well as the TMG field equations including a cosmological constant for the appropriate signature. As an application of this formalism we discuss the Bianchi Type $VIII - IX$ exact solutions of TMG and point out that they are parallelizable manifolds. We also consider various re-identifications of these homogeneous spaces that result in black hole solutions of TMG.Comment: An expanded version of paper published in Classical and Quantum Gravity 12 (1995) 291

On the shopfloor: exploring the impact of teacher trade unions on school-based industrial relations

Teachers are highly unionised workers and their trade unions exert an important influence on the shaping and implementation of educational policy. Despite this importance there is relatively little analysis of the impact of teacher trade unions in educational management literature. Very little empirical research has sought to establish the impact of teacher unions at school level. In an era of devolved management and quasi-markets this omission is significant. New personnel issues continue to emerge at school level and this may well generate increased trade union activity at the workplace. This article explores the extent to which devolved management is drawing school-based union representation into a more prominent role. It argues that whilst there can be significant differences between individual schools, increased school autonomy is raising the profile of trade union activity in the workplace, and this needs to be better reflected in educational management research

Electrodynamics with Lorentz-violating operators of arbitrary dimension

The behavior of photons in the presence of Lorentz and CPT violation is studied. Allowing for operators of arbitrary mass dimension, we classify all gauge-invariant Lorentz- and CPT-violating terms in the quadratic Lagrange density associated with the effective photon propagator. The covariant dispersion relation is obtained, and conditions for birefringence are discussed. We provide a complete characterization of the coefficients for Lorentz violation for all mass dimensions via a decomposition using spin-weighted spherical harmonics. The resulting nine independent sets of spherical coefficients control birefringence, dispersion, and anisotropy. We discuss the restriction of the general theory to various special models, including among others the minimal Standard-Model Extension, the isotropic limit, the case of vacuum propagation, the nonbirefringent limit, and the vacuum-orthogonal model. The transformation of the spherical coefficients for Lorentz violation between the laboratory frame and the standard Sun-centered frame is provided. We apply the results to various astrophysical observations and laboratory experiments. Astrophysical searches of relevance include studies of birefringence and of dispersion. We use polarimetric and dispersive data from gamma-ray bursts to set constraints on coefficients for Lorentz violation involving operators of dimensions four through nine, and we describe the mixing of polarizations induced by Lorentz and CPT violation in the cosmic-microwave background. Laboratory searches of interest include cavity experiments. We present the theory for searches with cavities, derive the experiment-dependent factors for coefficients in the vacuum-orthogonal model, and predict the corresponding frequency shift for a circular-cylindrical cavity.Comment: 58 pages two-column REVTeX, accepted in Physical Review

Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era

OBJECTIVE: Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship. METHODS: Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression. RESULTS: Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies. CONCLUSIONS: Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non-ID-trained pharmacists and clinicians in antibiotic stewardship

Chaotic Properties of Dilute Two and Three Dimensional Random Lorentz Gases I: Equilibrium Systems

We compute the Lyapunov spectrum and the Kolmogorov-Sinai entropy for a moving particle placed in a dilute, random array of hard disk or hard sphere scatterers - i.e. the dilute Lorentz gas model. This is carried out in two ways: First we use simple kinetic theory arguments to compute the Lyapunov spectrum for both two and three dimensional systems. In order to provide a method that can easily be generalized to non-uniform systems we then use a method based upon extensions of the Lorentz-Boltzmann (LB) equation to include variables that characterize the chaotic behavior of the system. The extended LB equations depend upon the number of dimensions and on whether one is computing positive or negative Lyapunov exponents. In the latter case the extended LB equation is closely related to an "anti-Lorentz-Boltzmann equation" where the collision operator has the opposite sign from the ordinary LB equation. Finally we compare our results with computer simulations of Dellago and Posch and find very good agreement.Comment: 48 pages, 3 ps fig