Laboratory data as a quality indicator of health-care-associated infections in England.

Routine diagnostic laboratory results, e.g. numbers of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias, have been used as health-care-associated infection quality indicators for decades. The English health-care-associated infection quality indicator system was one of the earliest in the world to mandate the collection and public reporting of such data and has been associated with a reduction of MRSA bacteraemias and Clostridium difficile infections but has shown mixed results for other infections. Diagnostic laboratory data vary greatly between hospitals depending not only on the underlying frequency of the infection of interest, but on the case mix, numbers of samples processed and laboratory factors, which limits benchmarking. Further, over-reliance on laboratory reports has led to unintended negative consequences in England. So, while acknowledging the successes of the English system, the authors believe that it should be appraised in light of the goals of quality of care, patient safety, fairness and providing meaningful data, and alternative healthcare-associated infection quality indicator measurements considered

Planches du Mobilier de la nécropole du Gourjade [planches 103 à 180]

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Planches du Mobilier de la nécropole du Martinet [Planches 181 à 218]

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Planches du Mobilier de la nécropole du Causse [Planches 1 à 102]

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Adjunctive interferon-γ immunotherapy for the treatment of HIV-associated cryptococcal meningitis: a randomized controlled trial.

BACKGROUND: Interferon-gamma (IFNγ) is of key importance in the immune response to Cryptococcus neoformans. Mortality related to cryptococcal meningitis remains high, and novel treatment strategies are needed. We performed a randomized controlled trial to determine whether addition of IFNγ to standard therapy increased the rate of clearance of cryptococcal infection in HIV-associated cryptococcal meningitis. METHODS: Patients were randomized to amphotericin B 1 mg/kg per day and 5FC 100 mg/kg per day for 2 weeks (standard therapy), standard therapy and IFNγ1b 100 μg days 1 and 3 (IFNγ two doses), or standard therapy and IFNγ1b 100 μg days 1, 3, 5, 8, 10 and 12 (IFNγ six doses). Primary outcome was rate of clearance of cryptococcus from the cerebrospinal fluid (CSF) (early fungicidal activity, EFA) calculated from serial quantitative cultures, previously shown to be independently associated with survival. RESULTS: Rate of fungal clearance was significantly faster in IFNγ containing groups than with standard treatment. Mean EFA [log colony forming unit (CFU)/ml per day] was -0.49 with standard treatment, -0.64 with IFNγ two doses, and -0.64 with IFNγ six doses. Difference in EFA was -0.15 [confidence interval (95% CI) -0.02 to -0.27, P=0.02] between standard treatment and IFNγ two doses, and -0.15 (95% CI -0.05 to -0.26, P=0.006) between standard treatment and IFNγ six doses. Mortality was 16% (14/88) at 2 weeks and 31% (27/87) at 10 weeks, with no significant difference between groups. All treatments were well tolerated. CONCLUSION: Addition of short-course IFNγ to standard treatment significantly increased the rate of clearance of cryptococcal infection from the CSF, and was not associated with any increase in adverse events. Two doses of IFNγ are as effective as six doses

Generically multiple transitive algebraic group actions

With every nontrivial connected algebraic group $G$ we associate a positive integer ${\rm gtd}(G)$ called the generic transitivity degree of $G$ and equal to the maximal $n$ such that there is a nontrivial action of $G$ on an irreducible algebraic variety $X$ for which the diagonal action of $G$ on $X^n$ admits an open orbit. We show that ${\rm gtd}(G)\leqslant 2$ (respectively, ${\rm gtd}(G)=\nobreak 1$) for all solvable (respectively, nilpotent) $G$, and we calculate ${\rm gtd}(G)$ for all reductive $G$. We prove that if $G$ is nonabelian reductive, then the above maximal $n$ is attained for $X=G/P$ where $P$ is a proper maximal parabolic subgroup of $G$ (but not only for such homogeneous spaces of $G$). For every reductive $G$ and its proper maximal parabolic subgroup $P$, we find the maximal $r$ such that the diagonal action of $G$ (respectively, a Levi subgroup $L$ of ~$P$) on $(G/P)^r$ admits an open $G$-orbit (respectively, $L$-orbit). As an application, we obtain upper bounds for the multiplicities of trivial components in some tensor product decompositions. As another application, we classify all the pairs $(G, P)$ such that the action of $G$ on $(G/P)^3$ admits an open orbit, answering a question of {\sc M. Burger}.Comment: Revised version, 30 page