The transmission of nosocomial pathogens in an intensive care unit: a space–time clustering and structural equation modelling approach

We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogen

Cluster Ellipticities as a Cosmological Probe

We investigate the dependence of ellipticities of clusters of galaxies on cosmological parameters using large-scale cosmological simulations. We determine cluster ellipticities out to redshift unity for LCDM models with different mean densities $\Omega_m$ and amplitudes of mass fluctuation $\sigma_{8,0}$. The mean ellipticity increases monotonically with redshift for all models. Larger values of $\sigma_{8,0}$, i.e., earlier cluster formation time, produce lower ellipticities. The dependence of ellipticity on $\Omega_m$ is relatively weak in the range $0.2 \leq \Omega_m \leq 0.5$ for high mass clusters. The mean ellipticity $\bar{e}(z)$ decreases linearly with the amplitude of fluctuations at the cluster redshift $z$, nearly independent of $\Omega_m$; on average, older clusters are more relaxed and are thus less elliptical. The distribution of ellipticities about the mean is approximated by a Gaussian, allowing a simple characterization of the evolution of ellipticity with redshift as a function of cosmological parameters. At $z=0$, the mean ellipticity of high mass clusters is approximated by $\bar{e}(z=0) = 0.248-0.069 \sigma_{8,0} + 0.013 \Omega_{m,0}$. This relation opens up the possibility that, when compared with future observations of large cluster samples, the mean cluster ellipticity and its evolution could be used as a new, independent tool to constrain cosmological parameters, especially the amplitude of mass fluctuations, $\sigma_{8,0}$.Comment: 16 pages, 4 figure

Seguimiento de poblaciones con baja densidad: una perspectiva de qué nivel de declive poblacional podemos detectar con certeza

Monitoring of mammal species is an important part in detecting changes in their status. Efforts are based on a variety of direct and indirect methods and many low density populations are monitored through field signs. We present data on the endangered European red squirrel from Kidland Forest in the UK. We used cone transects to both record changes in seed availability and to monitor population trends. We examined the difficulty of accurately detecting population change when populations are low and field signs are patchily distributed. Current efforts would be sufficient to detect significant population declines of 50–75% in years with a modest squirrel population but not when they fall below one squirrel for every 20 ha of forest. The findings emphasise that monitoring aims have to be clearly defined with an awareness and understanding of what level of change the adopted methodological approach can reliably detect. We propose that mammal monitoring schemes need to be based on a pilot scheme to determine effect size and planned accordingly. Key words: Squirrel, Sciurus vulgaris, Conservation, Power analysis.El seguimiento de las especies de mamíferos es una parte importante de la detección de los cambios producidos en su estatus. Los esfuerzos van dirigidos hacia diversos métodos directos e indirectos, y muchas poblaciones que presentan una densidad baja se monitorizan mediante rastros o signos de campo. En este trabajo presentamos datos de una especie en peligro, la ardilla roja, del bosque de Kidland en el Reino Unido. Se realizaron transectos de detección de piñas o conos para registrar tanto los cambios en la disponibilidad de semillas como para monitorizar las tendencias de la población. Examinamos la dificultad que presenta detectar con precisión los cambios poblacionales, cuando las poblaciones son pequeñas y los restos alimentarios de presencia están distribuidos de forma desigual. Los esfuerzos normales deberían ser suficientes para detectar disminuciones poblacionales significativas del 50–75% en años con una población de ardillas modesta, pero no cuando la densidad está por debajo de una ardilla cada 20 ha de bosque. Nuestros hallazgos enfatizan que los esfuerzos de seguimiento deben estar claramente definidos, con el conocimiento y la comprensión de qué nivel de cambio puede realmente detectar de forma fiable el enfoque metodológico adoptado. Proponemos que los seguimientos de mamíferos deben estar basados en un esquema piloto, con el fin de determinar el efecto del tamaño, y ser planificados consecuentemente. Palabras clave: Ardilla, Sciurus vulgaris, Conservación, Análisis de potencia

Advancing Pharmacist Collaborative Care within Academic Health Systems.

INTRODUCTION:The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. SUMMARY:We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist-interprofessional teams and (3) physician-pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. CONCLUSIONS:The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system

Time independent description of rapidly oscillating potentials

The classical and quantum dynamics in a high frequency field are found to be described by an effective time independent Hamiltonian. It is calculated in a systematic expansion in the inverse of the frequency ($\omega$) to order $\omega^{-4}$. The work is an extension of the classical result for the Kapitza pendulum, which was calculated in the past to order $\omega^{-2}$. The analysis makes use of an implementation of the method of separation of time scales and of a quantum gauge transformation in the framework of Floquet theory. The effective time independent Hamiltonian enables one to explore the dynamics in presence of rapidly oscillating fields, in the framework of theories that were developed for systems with time independent Hamiltonians. The results are relevant, in particular, for exploration of the dynamics of cold atoms.Comment: 4 pages, 1 figure. Revised versio

Floquet states and persistent currents transitions in a mesoscopic ring

We consider the effect of an oscillating potential on the single-particle spectrum and the time-averaged persistent current of a one-dimensional phase-coherent mesoscopic ring with a magnetic flux. We show that in a ring with an even number of spinless electrons the oscillating potential has a strong effect on the persistent current when the excited side bands are close to the eigen levels of a pure ring. Resonant enhancement of side bands of the Floquet state generates a sign change of the persistent current.Comment: 2 figure

Resonant Auger spectroscopy at the L2,3 shake-up thresholds as a probe of electron correlation effects in nickel

The excitation energy dependence of the three-hole satellites in the L3-M4,5M4,5 and L2-M4,5M4,5 Auger spectra of nickel metal has been measured using synchrotron radiation. The satellite behavior in the non-radiative emission spectra at the L3 and L2 thresholds is compared and the influence of the Coster-Kronig channel explored. The three-hole satellite intensity at the L3 Auger emission line reveals a peak structure at 5 eV above the L3 threshold attributed to resonant processes at the 2p53d9 shake-up threshold. This is discussed in connection with the 6-eV feature in the x-ray absorption spectrum.Comment: 8 pages, 4 figures; http://prb.aps.org/abstract/PRB/v58/i7/p3677_

Anharmonic double-phonon excitations in the interacting boson model

Double-$\gamma$ vibrations in deformed nuclei are analyzed in the context of the interacting boson model. A simple extension of the original version of the model towards higher-order interactions is required to explain the observed anharmonicities of nuclear vibrations. The influence of three- and four-body interactions on the moments of inertia of ground- and $\gamma$-bands, and on the relative position of single-$\gamma$ and double-$\gamma$ bands is studied in detail. As an example of a realistic calculation, spectra and transitions of the highly $\gamma$-anharmonic nuclei $^{164}$Dy, $^{166}$Er, and $^{168}$Er are interpreted in this approach.Comment: 38 pages, TeX (ReVTeX). 15 ps figures. Submitted to Phys. Rev.

Phase diffusion as a model for coherent suppression of tunneling in the presence of noise

We study the stabilization of coherent suppression of tunneling in a driven double-well system subject to random periodic $\delta-$function ``kicks''. We model dissipation due to this stochastic process as a phase diffusion process for an effective two-level system and derive a corresponding set of Bloch equations with phase damping terms that agree with the periodically kicked system at discrete times. We demonstrate that the ability of noise to localize the system on either side of the double-well potenital arises from overdamping of the phase of oscillation and not from any cooperative effect between the noise and the driving field. The model is investigated with a square wave drive, which has qualitatively similar features to the widely studied cosinusoidal drive, but has the additional advantage of allowing one to derive exact analytic expressions.Comment: 17 pages, 4 figures, submitted to Phys. Rev.