A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: A Prospective Interventional Study

© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations. Those not reviewed by an ID Fellow were considered controls and received standard sepsis pathway care. The primary outcome was antibiotic appropriateness 48 hours after sepsis trigger. RESULTS In total, 164 patients triggered the sepsis pathway: 6 patients were excluded (previous sepsis trigger); 158 patients were eligible; 106 had ID intervention; and 52 were control cases. Of these 158 patients, 91 (58%) had sepsis, and 15 of these 158 (9.5%) had severe sepsis. Initial antibiotic appropriateness, assessable in 152 of 158 patients, was appropriate in 80 (53%) of these 152 patients and inappropriate in 72 (47%) of these patients. In the intervention arm, 93% of ID Fellow recommendations were followed or partially followed, including 53% of cases in which antibiotics were de-escalated. ID Fellow intervention improved antibiotic appropriateness at 48 hours by 24% (adjusted risk ratio, 1.24; 95% confidence interval, 1.04-1.47; P=.035). The appropriateness agreement among 3 blinded ID staff opinions was 95%. Differences in intervention and control group mortality (13% vs 17%) and median length of stay (13 vs 17.5 days) were not statistically significant. CONCLUSION Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early ID AMS improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation. Further studies are needed to evaluate clinical outcomes. Infect Control Hosp Epidemiol 2017;38:1032-1038

Influence of phase separation microstructure on the mechanical properties of transparent modifier-free glasses

International audienc

Fracture toughness of a metal–organic framework glass

International audienceAbstract Metal-organic framework glasses feature unique thermal, structural, and chemical properties compared to traditional metallic, organic, and oxide glasses. So far, there is a lack of knowledge of their mechanical properties, especially toughness and strength, owing to the challenge in preparing large bulk glass samples for mechanical testing. However, a recently developed melting method enables fabrication of large bulk glass samples (>25 mm 3 ) from zeolitic imidazolate frameworks. Here, fracture toughness ( K Ic ) of a representative glass, namely ZIF-62 glass (Zn(C 3 H 3 N 2 ) 1.75 (C 7 H 5 N 2 ) 0.25 ), is measured using single-edge precracked beam method and simulated using reactive molecular dynamics. K Ic is determined to be ~0.1 MPa m 0.5 , which is even lower than that of brittle oxide glasses due to the preferential breakage of the weak coordinative bonds (Zn-N). The glass is found to exhibit an anomalous brittle-to-ductile transition behavior, considering its low fracture surface energy despite similar Poisson’s ratio to that of many ductile metallic and organic glasses

Magnetic field regression using artificial neural networks for cold atom experiments

Accurately measuring magnetic fields is essential for magnetic-field sensitive experiments in fields like atomic, molecular, and optical physics, condensed matter experiments, and other areas. However, since many experiments are conducted in an isolated vacuum environment that is inaccessible to experimentalists, it can be challenging to accurately determine the magnetic field. Here, we propose an efficient method for detecting magnetic fields with the assistance of an artificial neural network (NN). Instead of measuring the magnetic field directly at the desired location, we detect magnetic fields at several surrounding positions, and a trained NN can accurately predict the magnetic field at the target location. After training, we achieve a relative error of magnetic field magnitude (magnitude of error over the magnitude of magnetic field) below 0.3$\%$, and we successfully apply this method to our erbium quantum gas apparatus. This approach significantly simplifies the process of determining magnetic fields in isolated vacuum environments and can be applied to various research fields across a wide range of magnetic field magnitudes.Comment: 7 pages, 4 figure

Are bisphosphonates effective in the treatment of osteoarthritis pain? A meta-analysis and systematic review.

Osteoarthritis (OA) is the most common form of arthritis worldwide. Pain and reduced function are the main symptoms in this prevalent disease. There are currently no treatments for OA that modify disease progression; therefore analgesic drugs and joint replacement for larger joints are the standard of care. In light of several recent studies reporting the use of bisphosphonates for OA treatment, our work aimed to evaluate published literature to assess the effectiveness of bisphosphonates in OA treatment

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

CEO Compensation

This paper surveys the recent literature on CEO compensation. The rapid rise in CEO pay over the past 30 years has sparked an intense debate about the nature of the pay-setting process. Many view the high level of CEO compensation as the result of powerful managers setting their own pay. Others interpret high pay as the result of optimal contracting in a competitive market for managerial talent. We describe and discuss the empirical evidence on the evolution of CEO pay and on the relationship between pay and firm performance since the 1930s. Our review suggests that both managerial power and competitive market forces are important determinants of CEO pay, but that neither approach is fully consistent with the available evidence. We briefly discuss promising directions for future research