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To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI).
Quality improvement study.
Two urban acute care hospitals.
All inpatient stool testing for C. difficile required review and approval prior to specimen processing in the laboratory. An infection preventionist reviewed all orders daily through chart review and conversations with nursing; orders meeting clinical criteria for testing were approved, orders not meeting clinical criteria were discussed with the ordering provider. The proportion of completed tests meeting clinical criteria for testing and the primary outcome of C. difficile HAI were compared before and after the intervention.
The frequency of completed C. difficile orders not meeting criteria was lower [146 (7.5%) of 1,958] in the intervention period (January 10, 2022–October 14, 2022) than in the sampled 3-month preintervention period [26 (21.0%) of 124; P < .001]. C. difficile HAI rates were 8.80 per 10,000 patient days prior to the intervention (March 1, 2021–January 9, 2022) and 7.69 per 10,000 patient days during the intervention period (incidence rate ratio, 0.87; 95% confidence interval, 0.73–1.05; P = .13).
A stringent order-approval process reduced clinically nonindicated testing for C. difficile but did not significantly decrease HAIs.
INTRODUCTION
Trophic interactions, the consumption of one organism, or a part of it, by another, are a fundamental component of all ecosystems. The vast majority of net primary productivity is eventually consumed, either by herbivores if the tissue is still alive, or by decomposers if the tissue has died (e.g. Cebrian, 2004). Similarly, these primary consumers are themselves consumed either by predators, parasites or decomposers (secondary consumers). Thus, trophic interactions form the pathways through which carbon flows through an ecosystem and, to a large extent, these interactions control ecosystem carbon dynamics, either directly (via consumption of another organism) or indirectly (e.g. altering competition between the prey individual/population and other organisms).
In this chapter we consider the principal ways by which trophic interactions influence soil carbon fluxes (Fig. 10.1). Firstly, we discuss the impacts of both above- and below-ground herbivores on carbon flux into, and out of, the soil and the interactions between herbivores, plants and soil organisms (dashed box in Fig. 10.1). Secondly, we investigate the role of soil fauna in organic matter decomposition, either directly via the consumption of litter, or indirectly via feeding on saprotrophs or the movement of organic matter (dotted box in Fig. 10.1). Thirdly, we examine the role of resource availability versus predation in structuring soil food webs, followed by the linkages between soil biodiversity and a range of ecosystem processes, including plant growth, litter decomposition and carbon mineralization (solid box in Fig. 10.1).
We investigate the coronal structure of rapidly-rotating, solar-like stars using Chandra HETGS spectra of the short-period binary ER Vul, and by comparison with X-ray observations of the Sun and other dwarf stars. ER Vul consists of two solar-like (G0 + G5) dwarfs with rotation rates ~ 40 times that of the Sun. This binary is not interacting and these stars are the fastest rotating G dwarfs suitable for high resolution X-ray spectroscopy. X-ray (1.8-40 Å) spectra were obtained on 2001 March 29-30 along with 10.5 hours of simultaneous VLA monitoring at 3.6 and 20 cm. These spectra show hot, multi-temperature coronal emission with emission lines ranging in temperature from O VII (2 MK) to Fe XXIV (30 MK). ER Vul showed only low-level variability during the X-ray observation. Unlike the behaviour of longer period active binaries, no large, long-duration flares were detected, consistent with previous X-ray observations of this binary. No evidence for eclipses is seen in either the X-ray or radio emission. The coronal emission measure distribution and elemental abundances were derived for ER Vul.
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