Intensive care unit-acquired urinary tract infections in a regional critical care system

INTRODUCTION: Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. METHODS: A surveillance cohort study was conducted among all adults admitted to multi-system and cardiovascular surgery ICUs in the Calgary Health Region (CHR, population about 1 million) between 1 January 2000 and 31 December 2002. RESULTS: During the 3 years, 4465 patients were admitted 4915 times to a CHR ICU for 48 hours or more. A total of 356 ICU-acquired UTIs (defined as at least 10(5 )colony-forming units/ml of one or two organisms 48 hours or more after ICU admission) occurred among 290 (6.5%) patients, yielding an overall incidence density of ICU-acquired UTIs of 9.6 per 1000 ICU days. Four bacteremic/fungemic ICU-acquired UTIs occurred (0.1 per 1000 ICU days). Development of an ICU-acquired UTI was more common in women (relative risk [RR] 1.58; 95% confidence interval [CI] 1.43–1.75; P < 0.0001) and in medical (9%) compared with non-cardiac surgical (6%), and cardiac surgical patients (2%). The most common organisms isolated were Escherichia coli (23%), Candida albicans (20%), and Enterococcus species (15%). Antibiotic-resistant organisms were identified among 14% isolates. Although development of an ICU-acquired UTI was associated with significantly higher crude in-hospital mortality (86/290 [30%] vs. 862/4167 [21%]; RR = 1.43; 95% CI 1.19–1.73; P < 0.001); an ICU-acquired UTI was not an independent predictor for death. CONCLUSIONS: Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality

New XMM-Newton analysis of three bright X-ray sources in M31 globular clusters, including a new black hole candidate

We present detailed analysis of three globular cluster X-ray sources in the XMM-Newton extended survey of M31. The X-ray counterpart to the M31 globular cluster Bo 45 (XBo 45) was observed with XMM-Newton on 2006 December 26. Its combined pn+MOS 0.3--10 keV lightcurve exhibited a r.m.s variability of ~10%, and its 0.3--7.0 keV emission spectrum was well described by an absorbed power law with photon index 1.44$\pm$0.12. Its variability and emission is characteristic of low mass X-ray binaries (LMXBs) in the low-hard state, whether the accretor is a neutron star or black hole. Such behaviour is typically observed at luminosities \la10% Eddington. However, XBo 45 exhibited this behaviour at an unabsorbed, 0.3--10 keV luminosity of 2.5$\pm0.2\times 10^{38}$ erg s$^{-1}$, or{~140%} Eddington for a 1.4 $M_{\odot}$ neutron star accreting hydrogen. Hence, we identify XBo 45 as a new candidate black hole LMXB. XBo 45 appears to have been consistently bright for ~30 years, consistent with theoretical prediction for a globular cluster black hole binary formed via tidal capture. Bo 375 was observed in the 2007, January 2 XMM-Newton observation, and has a two-component spectrum that is typical for a bright neutron star LMXB. Bo 135 was observed in the same field as Bo 45, and could contain either a black hole or neutron star.Comment: Accepted by ApJ, 16 pages, 5 figures. This version includes the final changes made at the request of the refere

The 1996 Soft State Transitions of Cygnus X-1

We report continuous monitoring of Cygnus X-1 in the 1.3 to 200 keV band using ASM/RXTE and BATSE/CGRO for about 200 days from 1996 February 21 to 1996 early September. During this period Cygnus X-1 experienced a hard-to-soft and then a soft-to-hard state transition. The low-energy X-ray (1.3-12 keV) and high-energy X-ray (20-200 keV) fluxes are strongly anti-correlated during this period. During the state transitions flux variations of about a factor of 5 and 15 were seen in the 1.3-3.0 keV and 100-200 keV bands, respectively, while the average 4.8-12 keV flux remains almost unchanged. The net effect of this pivoting is that the total 1.3-200 keV luminosity remained unchanged to within about 15%. The bolometric luminosity in the soft state may be as high as 50-70% above the hard state luminosity, after color corrections for the luminosity below 1.3 keV. The blackbody component flux and temperature increase in the soft state is probably caused by a combination of the optically thick disk mass accretion rate increase and a decrease of the inner disk radius.Comment: 18 pages, 1 PostScript figure. Accepted for ApJ

Tests of Lorentz violation in muon antineutrino to electron antineutrino oscillations

A recently developed Standard-Model Extension (SME) formalism for neutrino oscillations that includes Lorentz and CPT violation is used to analyze the sidereal time variation of the neutrino event excess measured by the Liquid Scintillator Neutrino Detector (LSND) experiment. The LSND experiment, performed at Los Alamos National Laboratory, observed an excess, consistent with neutrino oscillations, of ${\bar\nu}_e$ in a beam of ${\bar\nu}_\mu$. It is determined that the LSND oscillation signal is consistent with no sidereal variation. However, there are several combinations of SME coefficients that describe the LSND data; both with and without sidereal variations. The scale of Lorentz and CPT violation extracted from the LSND data is of order $10^{-19}$ GeV for the SME coefficients $a_L$ and $E \times c_L$. This solution for Lorentz and CPT violating neutrino oscillations may be tested by other short baseline neutrino oscillation experiments, such as the MiniBooNE experiment.Comment: 10 pages, 10 figures, 2 tables, uses revtex4 replaced with version to be published in Physical Review D, 11 pages, 11 figures, 2 tables, uses revtex

Evolution of the E(1/21+)−E(3/21+)E(1/2^+_1)-E(3/2^+_1) energy spacing in odd-mass K, Cl and P isotopes for N=20−28N=20-28

The energy of the first excited state in the neutron-rich N=28 nucleus 45Cl has been established via in-beam gamma-ray spectroscopy following proton removal. This energy value completes the systematics of the E(1/2^+_1)-E(3/2^+_1) level spacing in odd-mass K, Cl and P isotopes for N=20-28. The results are discussed in the framework of shell-model calculations in the sd-fp model space. The contribution of the central, spin-orbit and tensor components is discussed from a calculation based on a proton single-hole spectrum from G-matrix and pi + rho meson exchange potentials. A composite model for the proton 0d_{3/2}-1s_{1/2} single-particle energy shift is presented.Comment: Phys. Rev. C, in pres

Questioning policy, youth participation and lifestyle sports

Young people have been identified as a key target group for whom participation in sport and physical activity could have important benefits to health and wellbeing and consequently have been the focus of several government policies to increase participation in the UK. Lifestyle sports represent one such strategy for encouraging and sustaining new engagements in sport and physical activity in youth groups, however, there is at present a lack of understanding of the use of these activities within policy contexts. This paper presents findings from a government initiative which sought to increase participation in sport for young people through provision of facilities for mountain biking in a forest in south-east England. Findings from qualitative research with 40 young people who participated in mountain biking at the case study location highlight the importance of non-traditional sports as a means to experience the natural environments through forms of consumption which are healthy, active and appeal to their identities. In addition, however, the paper raises questions over the accessibility of schemes for some individuals and social groups, and the ability to incorporate sports which are inherently participant-led into state-managed schemes. Lifestyle sports such as mountain biking involve distinct forms of participation which present a challenge for policy-makers who seek to create and maintain sustainable communities of youth participants