Impact of an Antimicrobial Stewardship Intervention on Urinary Tract Infection Treatment in the Emergency Department

STUDY OBJECTIVE: The study objective is to assess changes in treatment of uncomplicated urinary tract infections (UTIs) after implementation of recommendations based on national guidelines and local resistance rates. METHODS: This preintervention and postintervention study included patients discharged home from the emergency department (ED) with an uncomplicated UTI at a 439-bed teaching hospital. Emergency department prescribers were educated on how local antimicrobial resistance rates impact UTI practice guidelines. Empiric treatment according to recommendations was assessed as the primary outcome. Agreement between chosen therapy and isolated pathogen susceptibility was compared before and after education. Reevaluation in the ED or hospital admission within 30 days for a UTI was also evaluated. RESULTS: A total of 350 patients were studied (174 before and 176 after education). Of those, 255 had cystitis, and 95 had pyelonephritis. After education, choice of therapy consistent with recommendations increased from 44.8% to 83% (difference, 38.2%; 95% confidence interval [CI], 33%-43%; P \u3c .001). The change was predominately driven by an increase in nitrofurantoin use for cystitis from 12% to 80% (difference, 68%; 95% CI, 62%-73%; P \u3c .001). Agreement between empiric treatment and the isolated pathogen susceptibility improved for cystitis 74% to 89% (P = .05), and no change occurred in 30-day repeat ED visits for a UTI. CONCLUSIONS: After implementation of treatment recommendations for uncomplicated UTIs based on local resistance, empiric antibiotic selection improved in the ED. To further meet goals of antimicrobial stewardship, additional interventions are needed

The SLUGGS survey: probing the supermassive blackhole connection with bulges and haloes using red and blue globular cluster systems

Understanding whether the bulge or the halo provides the primary link to the growth of supermassive black holes has strong implications for galaxy evolution and supermassive black hole formation itself. In this paper, we approach this issue by investigating extragalactic globular cluster (GC) systems, which can be used to probe the physics of both the bulge and the halo of the host galaxy. We study the relation between the supermassive black hole masses (MBH) and the GC system velocity dispersions (σGC) using an updated and improved sample of 21 galaxies. We exploit the dichotomy of GC system colours, to test if the blue and red GCs correlate differently with black hole mass. This may be expected if they trace the potentially different formation history of the halo and of the bulge of the host galaxy, respectively. We find that MBH correlates with the total GC system velocity dispersion, although not as strongly as claimed by recent work of Sadoun & Colin. We also examine the MBH-σGC relation for barred/barless and core/non-core galaxies, finding no significant difference, and for the first time we quantify the impact of radial gradients in the GC system velocity dispersion profile on the MBH-σGC relation. We additionally predict MBH in 13 galaxies, including dwarf elliptical galaxies and the cD galaxy NGC 3311. We conclude that our current results cannot discriminate between the bulge/halo scenarios. Although there is a hint that the red GC velocity dispersion might correlate better with MBH than the blue GC velocity dispersion, the number statistics are still too low to be certain

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo

Entre o medo da contaminação pelo HIV e as representações simbólicas da AIDS: o espectro do desespero contemporâneo

Este estudo pretende colaborar para uma melhor compreensão dos sentimentos provocados no ser humano vivendo em plena era da AIDS. A falta de informação e, por consequência, o desconhecimento sobre a AIDS, sua dinâmica de transmissão e as medidas preventivas adequadas, transformam a convivência com esta síndrome num fator estressante para muitas pessoas, gerando sentimentos de medo e suscitando a correlação com diferentes representações simbólicas ligadas à contaminação pelo HIV. Vários autores formularam modelos teóricos para explicar esta correlação. Neste trabalho procura-se verificar os sentimentos emergentes e a respectiva vinculação aos significados simbólicos da doença sob o prisma destas teorias. Foram entrevistadas 31 pessoas, sendo 10 estudantes de diferentes cursos superiores da Universidade de São Paulo e 21 detentos do Sistema Penitenciário do Estado de São Paulo. Os resultados obtidos mostraram que, apesar dos grupos apresentarem características diferentes entre si, ambos atribuiram à AIDS significados simbólicos ligados ao medo da contaminação pelo HIVLack of knowledge and mis informations on HIV/AIDS are predictors of emotional responses as fear of contagion, homophobia, avoidance and excessive precautions. Fear of contagion is an affective stress response to the neurocognitive activity that leads to a perceived threat of AIDS in connection with the symbolic meanings os illness. Focused interviews were conducted with an opportunistic sample of 31 young people to know the affective responses and behaviors after blood screening for HIV antibody testing. The findings confirm the relationship of symbolic representation of illness as mystery, death, punishment and sexuality to fear of contagion and mitic conception of AIDS

Emerging Anthropogenic Influences on the Southcentral Alaska Temperature and Precipitation Extremes and Related Fires in 2019

The late-season extreme fire activity in Southcentral Alaska during 2019 was highly unusual and consequential. Firefighting operations had to be extended by a month in 2019 due to the extreme conditions of hot summer temperature and prolonged drought. The ongoing fires created poor air quality in the region containing most of Alaska’s population, leading to substantial impacts to public health. Suppression costs totaled over $70 million for Southcentral Alaska. This study’s main goals are to place the 2019 season into historical context, provide an attribution analysis, and assess future changes in wildfire risk in the region. The primary tools are meteorological observations and climate model simulations from the NCAR CESM Large Ensemble (LENS). The 2019 fire season in Southcentral Alaska included the hottest and driest June–August season over the 1979–2019 period. The LENS simulation analysis suggests that the anthropogenic signal of increased fire risk had not yet emerged in 2019 because of the CESM’s internal variability, but that the anthropogenic signal will emerge by the 2040–2080 period. The effect of warming temperatures dominates the effect of enhanced precipitation in the trend towards increased fire risk.The National Science Foundation (#OIA-1753748), the State of Alaska, the United States Geological Survey (G17AC00363), and the Alaska Climate Adaptation Science Center (G17AC00213) provided support for this study. NOAA supported this work through grants #NA16OAR4310162 (R.T., J.E.W., A.Y.) and #NA16OAR4310142 (U.S.B., P.A.B.)Ye

Imaging of opioid receptors in the central nervous system

In vivo functional imaging by means of positron emission tomography (PET) is the sole method for providing a quantitative measurement of μ-, κ and δ-opioid receptor-mediated signalling in the central nervous system. During the last two decades, measurements of changes to the regional brain opioidergic neuronal activation—mediated by endogenously produced opioid peptides, or exogenously administered opioid drugs—have been conducted in numerous chronic pain conditions, in epilepsy, as well as by stimulant- and opioidergic drugs. Although several PET-tracers have been used clinically for depiction and quantification of the opioid receptors changes, the underlying mechanisms for regulation of changes to the availability of opioid receptors are still unclear. After a presentation of the general signalling mechanisms of the opioid receptor system relevant for PET, a critical survey of the pharmacological properties of some currently available PET-tracers is presented. Clinical studies performed with different PET ligands are also reviewed and the compound-dependent findings are summarized. An outlook is given concluding with the tailoring of tracer properties, in order to facilitate for a selective addressment of dynamic changes to the availability of a single subclass, in combination with an optimization of the quantification framework are essentials for further progress in the field of in vivo opioid receptor imaging

SN 2017gmr: An Energetic Type II-P Supernova with Asymmetries

We present high-cadence UV, optical, and near-infrared data on the luminous Type II-P supernova SN2017gmr from hours after discovery through the first 180 days. SN2017gmr does not show signs of narrow, high-ionization emission lines in the early optical spectra, yet the optical light-curve evolution suggests that an extra energy source from circumstellar medium (CSM) interaction must be present for at least 2 days after explosion. Modeling of the early light curve indicates a ∼500 Re progenitor radius, consistent with a rather compact red supergiant, and latetime luminosities indicate that up to 0.130±0.026 Me of 56Ni are present, if the light curve is solely powered by radioactive decay, although the 56Ni mass may be lower if CSM interaction contributes to the post-plateau luminosity. Prominent multipeaked emission lines of Hα and [O I] emerge after day 154, as a result of either an asymmetric explosion or asymmetries in the CSM. The lack of narrow lines within the first 2 days of explosion in the likely presence of CSM interaction may be an example of close, dense, asymmetric CSM that is quickly enveloped by the spherical supernova ejecta