Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

Summary Background Healthcare associated infections (HAI) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HAI and contain antimicrobial resistance (AMR). Aim To measure the prevalence of HAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HAI was 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most common HAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3% and 13.8% in acute adults, paediatric and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HAI continues to be a public health concern in Scotland. UTI and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings

Shining new light on mammalian diving physiology using wearable near-infrared spectroscopy

Investigation of marine mammal dive-by-dive blood distribution and oxygenation has been limited by a lack of non-invasive technology for use in freely diving animals. Here, we developed a non-invasive near-infrared spectroscopy (NIRS) device to measure relative changes in blood volume and haemoglobin oxygenation continuously in the blubber and brain of voluntarily diving harbour seals. Our results show that seals routinely exhibit preparatory peripheral vasoconstriction accompanied by increased cerebral blood volume approximately 15 s before submersion. These anticipatory adjustments confirm that blood redistribution in seals is under some degree of cognitive control that precedes the mammalian dive response. Seals also routinely increase cerebral oxygenation at a consistent time during each dive, despite a lack of access to ambient air. We suggest that this frequent and reproducible reoxygenation pattern, without access to ambient air, is underpinned by previously unrecognised changes in cerebral drainage. The ability to track blood volume and oxygenation in different tissues using NIRS will facilitate a more accurate understanding of physiological plasticity in diving animals in an increasingly disturbed and exploited environment

Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using NHANES arsenic, iodine, lead and cadmium data

Background There are numerous methods for adjusting measured concentrations of urinary biomarkers for hydration variation. Few studies use objective criteria to quantify the relative performance of these methods. Our aim was to compare the performance of existing methods for adjusting urinary biomarkers for hydration variation. Methods Creatinine, osmolality, excretion rate (ER), bodyweight adjusted ER (ERBW) and empirical analyte-specific urinary flow rate (UFR) adjustment methods on spot urinary concentrations of lead (Pb), cadmium (Cd), non-arsenobetaine arsenic (AsIMM) and iodine (I) from the US National Health and Nutrition Examination Survey (NHANES) (2009–2010 and 2011–2012) were evaluated. The data were divided into a training dataset (n = 1,723) from which empirical adjustment coefficients were derived and a testing dataset (n = 428) on which quantification of the performance of the adjustment methods was done by calculating, primarily, the correlation of the adjusted parameter with UFR, with lower correlations indicating better performance and, secondarily, the correlation of the adjusted parameters with blood analyte concentrations (Pb and Cd), with higher correlations indicating better performance. Results Overall performance across analytes was better for Osmolality and UFR based methods. Excretion rate and ERBW consistently performed worse, often no better than unadjusted concentrations. Conclusions Osmolality adjustment of urinary biomonitoring data provides for more robust adjustment than either creatinine based or ER or ERBW methods, the latter two of which tend to overcompensate for UFR. Modified UFR methods perform significantly better than all but osmolality in removing hydration variation, but depend on the accuracy of UFR calculations. Hydration adjustment performance is analyte-specific and further research is needed to establish a robust and consistent framework

Partial pressure of oxygen in adipose tissue and its relationship with fatness in a natural animal model of extreme fat deposition, the grey seal

Excessive adiposity is associated with altered oxygen tension and comorbidities in humans. In contrast, marine mammals have high adiposity with no apparent detrimental effects. However, partial pressure of oxygen (Po2) in their subcutaneous adipose tissue (blubber) and its relationship with fatness have not been reported. We measured Po2 and temperature at different blubber depths in 12 healthy juvenile grey seals. Fatness was estimated from blubber thickness and morphometric parameters. Simultaneously, we monitored breathing pattern; heart rate and arterial blood saturation with a pulse oximeter; and relative changes in total hemoglobin, deoxyhemoglobin, and oxyhemoglobin in blubber capillaries using near-infrared spectroscopy (NIRS) as proxies for local oxygenation changes. Blubber Po2 ranged from 14.5 to 71.4 mmHg (39.2 ± 14.1 mmHg), which is similar to values reported in other species. Blubber Po2 was strongly and negatively associated with fatness (LME: p < 0.0001, R2marginal = 0.53, R2conditional = 0.64, n = 10), but not with blubber depth. No other parameters explained variability in Po2, suggesting arterial blood and local oxygen delivery did not vary within and between measurements. The fall in blubber Po2 with increased fatness in seals is consistent with other animal models of rapid fat deposition. However, the Po2 levels at which blubber becomes hypoxic and consequences of low blubber Po2 for its health and function, particularly in very fat individuals, remain unknown. How seals avoid detrimental effects of low oxygen tension in adipose tissue, despite their high and fluctuating adiposity, is a fruitful avenue to explore

Spectra and Light Curves of Failed Supernovae

Astronomers have proposed a number of mechanisms to produce supernova explosions. Although many of these mechanisms are now not considered primary engines behind supernovae, they do produce transients that will be observed by upcoming ground-based surveys and NASA satellites. Here we present the first radiation-hydrodynamics calculations of the spectra and light curves from three of these "failed" supernovae: supernovae with considerable fallback, accretion induced collapse of white dwarfs, and energetic helium flashes (also known as type .Ia supernovae).Comment: 33 pages, 14 figure

Development of the Arizona Robotic Telescope Network

The Arizona Robotic Telescope Network (ARTN) project is a long term effort to develop a system of telescopes to carry out a flexible program of PI observing, survey projects, and time domain astrophysics including monitoring, rapid response, and transient/target-of-opportunity followup. Steward Observatory operates and shares in several 1-3m class telescopes with quality sites and instrumentation, largely operated in classical modes. Science programs suited to these telescopes are limited by scheduling flexibility and people-power of available observers. Our goal is to adapt these facilities for multiple co-existing queued programs, interrupt capability, remote/robotic operation, and delivery of reduced data. In the long term, planning for the LSST era, we envision an automated system coordinating across multiple telescopes and sites, where alerts can trigger followup, classification, and triggering of further observations if required, such as followup imaging that can trigger spectroscopy. We are updating telescope control systems and software to implement this system in stages, beginning with the Kuiper 61'' and Vatican Observatory 1.8-m telescopes. The Kuiper 61'' and its Mont4K camera can now be controlled and queue-scheduled by the RTS2 observatory control software, and operated from a remote room at Steward. We discuss science and technical requirements for ARTN, and some of the challenges in adapting heterogenous legacy facilities, scheduling, data pipelines, and maintaining capabilities for a diverse user base.Comment: Proceedings of SPIE Astronomical Telescopes & Instrumentation 2018, Observatory Operations: Strategies, Processes, and Systems VI

Wearable near-infrared spectroscopy as a physiological monitoring tool for seals under anaesthesia

Chemical immobilisation of pinnipeds is a routine procedure in research and veterinary practice. Yet, there are inevitable risks associated with chemical immobilisation, and the physiological response to anaesthetic agents in pinnipeds remains poorly understood. The current study used wearable continuous-wave near-infrared spectroscopy (NIRS) data from 10 trials of prolonged anaesthesia (0.5 to 1.4 h) induced through ketamine and midazolam in five grey seals (Halichoerus grypus) involved in other procedures. The aim of this study was to (1) analyse the effect of each compound on heart rate, arterial oxygen saturation (SpO2), and relative concentration changes in oxygenated [ΔO2Hb] and deoxygenated haemoglobin [ΔHHb] in cerebral tissue and (2) to investigate the use of NIRS as a real-time physiological monitoring tool during chemical immobilisation. Average group responses of ketamine (n = 27) and midazolam (n = 11) administrations were modelled using generalised additive mixed models (GAMM) for each dependent variable. Following ketamine and midazolam administration, [ΔHHb] increased and [ΔO2Hb] remained relatively stable, which was indicative of apnoea. Periods of apnoea were confirmed from respiratory band data, which were simultaneously collected during drugging trials. Given that SpO2 remained at 97% during apnoea, we hypothesized that increasing cerebral [ΔHHb] was a result of venous congestion as opposed to decreased oxygen delivery. Changes in heart rate were limited and appeared to be driven by the individual pharmacological actions of each drug. Future research could include simultaneous measures of metabolic rate, such as the relative change in concentration of cytochrome-c-oxidase, to guide operators in determining when apnoea should be considered prolonged if changes in [ΔHHb] and [ΔO2Hb] occur beyond the limits recorded in this study. Our findings support the use of NIRS as real-time physiological monitoring tool during pinniped chemical immobilisation, which could assist veterinarians and researchers in performing safe anaesthetic procedures

Intracluster supernovae in the Multi-epoch Nearby Cluster Survey

The Multi-Epoch Nearby Cluster Survey (MENeaCS) has discovered twenty-three cluster Type Ia supernovae (SNe) in the 58 X-ray selected galaxy clusters (0.05 < z < 0.15) surveyed. Four of our SN Ia events have no host galaxy on close inspection, and are likely intracluster SNe. Deep image stacks at the location of the candidate intracluster SNe put upper limits on the luminosities of faint hosts, with M_{r} > -13.0 mag and M_{g} > -12.5 mag in all cases. For such limits, the fraction of the cluster luminosity in faint dwarfs below our detection limit is <0.1%, assuming a standard cluster luminosity function. All four events occurred within ~600 kpc of the cluster center (projected), as defined by the position of the brightest cluster galaxy, and are more centrally concentrated than the cluster SN Ia population as a whole. After accounting for several observational biases that make intracluster SNe easier to discover and spectroscopically confirm, we calculate an intracluster stellar mass fraction of 0.16^{+0.13}_{-0.09} (68% CL) for all objects within R_{200}. If we assume that the intracluster stellar population is exclusively old, and the cluster galaxies themselves have a mix of stellar ages, we derive an upper limit on the intracluster stellar mass fraction of <0.47 (84% one-sided CL). When combined with the intragroup SNe results of McGee & Balogh, we confirm the declining intracluster stellar mass fraction as a function of halo mass reported by Gonzalez and collaborators. (Abridged)Comment: 24 pages, 8 figures, ApJ publishe

Ejecta, Dust, and Synchrotron Radiation in B0540-69.3: A More Crab-Like Remnant than the Crab

We present near and mid-infrared observations of the pulsar-wind nebula (PWN) B0540-69.3 and its associated supernova remnant made with the {\it Spitzer Space Telescope}. We report detections of the PWN with all four IRAC bands, the 24 $\mu$m band of MIPS, and the Infrared Spectrograph (IRS). We find no evidence of IR emission from the X-ray/radio shell surrounding the PWN resulting from the forward shock of the supernova blast wave. The flux of the PWN itself is dominated by synchrotron emission at shorter (IRAC) wavelengths, with a warm dust component longward of 20 $\mu$m. We show that this dust continuum can be explained by a small amount (\sim 1-3 \times 10^{-3} \msun) of dust at a temperature of $\sim 50-65$ K, heated by the shock wave generated by the PWN being driven into the inner edge of the ejecta. This is evidently dust synthesized in the supernova. We also report the detection of several lines in the spectrum of the PWN, and present kinematic information about the PWN as determined from these lines. Kinematics are consistent with previous optical studies of this object. Line strengths are also broadly consistent with what one expects from optical line strengths. We find that lines arise from slow ($\sim 20$ km s$^{-1}$) shocks driven into oxygen-rich clumps in the shell swept-up by an iron-nickel bubble, which have a density contrast of $\sim 100-200$ relative to the bulk of the ejecta, and that faster shocks ($\sim 250$ km s$^{-1}$) in the hydrogen envelope are required to heat dust grains to observed temperatures. We infer from estimates of heavy-element ejecta abundances that the progenitor star was likely in the range of 20-25 $M_\odot$.Comment: 46 pages, 10 figures, accepted for publication in Ap

Towards High-resolution Imaging from Underwater Vehicles

Large area mapping at high resolution underwater continues to be constrained by sensor-level environmental constraints and the mismatch between available navigation and sensor accuracy. In this paper, advances are presented that exploit aspects of the sensing modality, and consistency and redundancy within local sensor measurements to build high-resolution optical and acoustic maps that are a consistent representation of the environment. This work is presented in the context of real-world data acquired using autonomous underwater vehicles (AUVs) and remotely operated vehicles (ROVs) working in diverse applications including shallow water coral reef surveys with the Seabed AUV, a forensic survey of the RMS Titanic in the North Atlantic at a depth of 4100 m using the Hercules ROV, and a survey of the TAG hydrothermal vent area in the mid-Atlantic at a depth of 3600 m using the Jason II ROV. Specifically, the focus is on the related problems of structure from motion from underwater optical imagery assuming pose instrumented calibrated cameras. General wide baseline solutions are presented for these problems based on the extension of techniques from the simultaneous localization and mapping (SLAM), photogrammetric and the computer vision communities. It is also examined how such techniques can be extended for the very different sensing modality and scale associated with multi-beam bathymetric mapping. For both the optical and acoustic mapping cases it is also shown how the consistency in mapping can be used not only for better global mapping, but also to refine navigation estimates.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86051/1/hsingh-21.pd