Bedre nytteverdi av blodkultur ved sepsis

Tema/problemstilling: Vårt kvalitetsforbedringsprosjekt er rettet mot behandling av pasienter med sepsis ved en indremedisinsk avdeling. Målet er å øke nytteverdien av blodkultur for å redusere bredspektret antibiotikabehandling. Kunnskapsgrunnlag: Det er sammenheng mellom bruk av bredspektrede antibiotika og resistensutvikling. Deeskalering, endring av antibiotikabehandlingen til et mer smalspektret regime etter blodkultursvar, er en strategi for å redusere bruk av bredspektrede antibiotika. Deeskalering hos sepsispasienter der blodkultursvaret med resistensbestemmelse tillater det er trygg praksis og anbefales i nasjonale retningslinjer for antibiotikabehandling i sykehus. Tiltak/kvalitetsindikator: Samtaler med leger på Diakonhjemmet og Ullevål sykehus bekrefter at flere pasienter blir stående unødvendig på bredspektret antibiotikabehandling etter at man har blodkultursvar, og at det kan være potensial for å sette i gang forbedringstiltak. Vi innfører et tiltak som sikrer direkte kontakt mellom mikrobiolog og aktuell kliniker. Vi har valgt indikatorer for å vurdere i hvor stor grad tiltak gjennomføres og positive og negative effekter av tiltaket. Ledelse/organisering: Vi har brukt PUKK-sirkelen og Kotters åtte punkter som verktøy for å strukturere prosjektperioden. Slik kan vi sette fokus på de delene av prosjektet som trenger ekstra oppmerksomhet. Vi vil forankre prosjektet i ledelsen gjennom god informasjon og forankring i sykehusets strategiplan. For å oppnå varig endring i praksis, vil vi blant annet gjennomføre halvårlige målinger etter at prosjektperioden er avsluttet. Konklusjon: Tiltaket vi foreslår bygger på allerede gjeldende systemer og vil kreve lite opplæring og ressurser. Effekten er lett målbar. Kunnskapsgrunnlaget viser også at intervensjoner for formidling av dyrkningssvar ved sepsis kan redusere bruken av bredspektret antibiotika uten skadelige bieffekter. Med bakgrunn i dette vil vi anbefale at tiltaket gjennomføres

Measurements of Anisotropy in the Cosmic Microwave Background Radiation at 0.5 Degree Angular Scales Near the Star Gamma Ursae Minoris

We present results from a four frequency observation of a 6 x 0.6 degree strip of the sky centered near the star Gamma Ursae Minoris during the fourth flight of the Millimeter-wave Anisotropy eXperiment (MAX). The observation was made with a 1.4 degree peak-to-peak sinusoidal chop in all bands. The FWHM beam sizes were 0.55 +/- 0.05 degrees at 3.5 cm-1 and 0.75 +/-0.05 degrees at 6, 9, and 14 cm-1. During this observation significant correlated structure was observed at 3.5, 6 and 9 cm-1 with amplitudes similar to those observed in the GUM region during the second and third flights of MAX. The frequency spectrum is consistent with CMB and inconsistent with thermal emission from interstellar dust. The extrapolated amplitudes of synchrotron and free-free emission are too small to account for the amplitude of the observed structure. If all of the structure is attributed to CMB anisotropy with a Gaussian autocorrelation function and a coherence angle of 25', then the most probable values of DeltaT/TCMB in the 3.5, 6, and 9 cm-1 bands are 4.3 (+2.7, -1.6) x 10-5, 2.8 (+4.3, -1.1) x 10-5, and 3.5 (+3.0, -1.6) x 10-5 (95% confidence upper and lower limits), respectively.Comment: 16 pages, postscrip

Measurements of Anisotropy in the Cosmic Microwave Background Radiation at Degree Angular Scales Near the Stars Sigma Hercules and Iota Draconis

We present results from two four-frequency observations centered near the stars Sigma Hercules and Iota Draconis during the fourth flight of the Millimeter-wave Anisotropy eXperiment (MAX). The observations were made of 6 x 0.6-degree strips of the sky with 1.4-degree peak to peak sinusoidal chop in all bands. The FWHM beam sizes were 0.55+/-0.05 degrees at 3.5 cm-1 and a 0.75+/-0.05 degrees at 6, 9, and 14 cm-1. Significant correlated structures were observed at 3.5, 6 and 9 cm-1. The spectra of these signals are inconsistent with thermal emission from known interstellar dust populations. The extrapolated amplitudes of synchrotron and free-free emission are too small to account for the amplitude of the observed structures. If the observed structures are attributed to CMB anisotropy with a Gaussian autocorrelation function and a coherence angle of 25', then the most probable values are DT/TCMB = (3.1 +1.7-1.3) x 10^-5 for the Sigma Hercules scan, and DT/TCMB = (3.3 +/- 1.1) x 10^-5 for the Iota Draconis scan (95% confidence upper and lower limits). Finally a comparison of all six MAX scans is presented.Comment: 13 pages, postscript file, 2 figure

Over half of the far-infrared background light comes from galaxies at z >= 1.2

Submillimetre surveys during the past decade have discovered a population of luminous, high-redshift, dusty starburst galaxies. In the redshift range 1 <= z <= 4, these massive submillimetre galaxies go through a phase characterized by optically obscured star formation at rates several hundred times that in the local Universe. Half of the starlight from this highly energetic process is absorbed and thermally re-radiated by clouds of dust at temperatures near 30 K with spectral energy distributions peaking at 100 microns in the rest frame. At 1 <= z <= 4, the peak is redshifted to wavelengths between 200 and 500 microns. The cumulative effect of these galaxies is to yield extragalactic optical and far-infrared backgrounds with approximately equal energy densities. Since the initial detection of the far-infrared background (FIRB), higher-resolution experiments have sought to decompose this integrated radiation into the contributions from individual galaxies. Here we report the results of an extragalactic survey at 250, 350 and 500 microns. Combining our results at 500 microns with those at 24 microns, we determine that all of the FIRB comes from individual galaxies, with galaxies at z >= 1.2 accounting for 70 per cent of it. As expected, at the longest wavelengths the signal is dominated by ultraluminous galaxies at z > 1.Comment: Accepted to Nature. Maps available at http://blastexperiment.info

BLAST Observations of the South Ecliptic Pole field: Number Counts and Source Catalogs

We present results from a survey carried out by the Balloon-borne Large Aperture Submillimeter Telescope (BLAST) on a 9 deg^2 field near the South Ecliptic Pole at 250, 350 and 500 {\mu}m. The median 1{\sigma} depths of the maps are 36.0, 26.4 and 18.4 mJy, respectively. We apply a statistical method to estimate submillimeter galaxy number counts and find that they are in agreement with other measurements made with the same instrument and with the more recent results from Herschel/SPIRE. Thanks to the large field observed, the new measurements give additional constraints on the bright end of the counts. We identify 132, 89 and 61 sources with S/N>4 at 250, 350, 500 {\mu}m, respectively and provide a multi-wavelength combined catalog of 232 sources with a significance >4{\sigma} in at least one BLAST band. The new BLAST maps and catalogs are available publicly at http://blastexperiment.info.Comment: 25 pages, 6 figures, 4 tables, Accepted by ApJS. Maps and catalogs available at http://blastexperiment.info

SANEPIC: A Map-Making Method for Timestream Data From Large Arrays

We describe a map-making method which we have developed for the Balloon-borne Large Aperture Submillimeter Telescope (BLAST) experiment, but which should have general application to data from other submillimeter arrays. Our method uses a Maximum Likelihood based approach, with several approximations, which allows images to be constructed using large amounts of data with fairly modest computer memory and processing requirements. This new approach, Signal And Noise Estimation Procedure Including Correlations (SANEPIC), builds upon several previous methods, but focuses specifically on the regime where there is a large number of detectors sampling the same map of the sky, and explicitly allowing for the the possibility of strong correlations between the detector timestreams. We provide real and simulated examples of how well this method performs compared with more simplistic map-makers based on filtering. We discuss two separate implementations of SANEPIC: a brute-force approach, in which the inverse pixel-pixel covariance matrix is computed; and an iterative approach, which is much more efficient for large maps. SANEPIC has been successfully used to produce maps using data from the 2005 BLAST flight.Comment: 27 Pages, 15 figures; Submitted to the Astrophysical Journal; related results available at http://blastexperiment.info/ [the BLAST Webpage

BLAST05: Power Spectra of Bright Galactic Cirrus at Submillimeter Wavelengths

We report multi-wavelength power spectra of diffuse Galactic dust emission from BLAST observations at 250, 350, and 500 microns in Galactic Plane fields in Cygnus X and Aquila. These submillimeter power spectra statistically quantify the self-similar structure observable over a broad range of scales and can be used to assess the cirrus noise which limits the detection of faint point sources. The advent of submillimeter surveys with the Herschel Space Observatory makes the wavelength dependence a matter of interest. We show that the observed relative amplitudes of the power spectra can be related through a spectral energy distribution (SED). Fitting a simple modified black body to this SED, we find the dust temperature in Cygnus X to be 19.9 +/- 1.3 K and in the Aquila region 16.9 +/- 0.7 K. Our empirical estimates provide important new insight into the substantial cirrus noise that will be encountered in forthcoming observations.Comment: Submitted to the Astrophysical Journal. Maps and other data are available at http://blastexperiment.info