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The aim of this study was to quantify the time delay between screening and initiation of contact isolation for carriers of extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales (ESBL-E).
Methods:
This study was a secondary analysis of contact isolation periods in a cluster-randomized controlled trial that compared 2 strategies to control ESBL-E (trial no. ISRCTN57648070). Patients admitted to 20 non-ICU wards in Germany, the Netherlands, Spain, and Switzerland were screened for ESBL-E carriage on admission, weekly thereafter, and on discharge. Data collection included the day of sampling, the day the wards were notified of the result, and subsequent ESBL-E isolation days.
Results:
Between January 2014 and August 2016, 19,122 patients, with a length of stay ≥2 days were included. At least 1 culture was collected for 16,091 patients (84%), with a median duration between the admission day and the day of first sample collection of 2 days (interquartile range [IQR], 1–3). Moreover, 854 (41%) of all 2,078 ESBL-E carriers remained without isolation during their hospital stay. In total, 6,040 ESBL-E days (32% of all ESBL-E days) accrued for patients who were not isolated. Of 2,078 ESBL-E-carriers, 1,478 ESBL-E carriers (71%) had no previous history of ESBL-E carriage. Also, 697 (34%) were placed in contact isolation with a delay of 4 days (IQR, 2–5), accounting for 2,723 nonisolation days (15% of ESBL-E days).
Conclusions:
Even with extensive surveillance screening, almost one-third of all ESBL-E days were nonisolation days. Limitations in routine culture-based ESBL-E detection impeded timely and exhaustive implementation of targeted contact isolation.
The Guarded Negation Fragment (GNFO) is a fragment of first-order logic that contains all positive existential formulas, can express the first-order translations of basic modal logic and of many description logics, along with many sentences that arise in databases. It has been shown that the syntax of GNFO is restrictive enough so that computational problems such as validity and satisfiability are still decidable. This suggests that, in spite of its expressive power, GNFO formulas are amenable to novel optimizations. In this article we study the model theory of GNFO formulas. Our results include effective preservation theorems for GNFO, effective Craig Interpolation and Beth Definability results, and the ability to express the certain answers of queries with respect to a large class of GNFO sentences within very restricted logics.
To examine variation in antibiotic coverage and detection of resistant pathogens in community-onset pneumonia.
DESIGN
Cross-sectional study.
SETTING
A total of 128 hospitals in the Veterans Affairs health system.
PARTICIPANTS
Hospitalizations with a principal diagnosis of pneumonia from 2009 through 2010.
METHODS
We examined proportions of hospitalizations with empiric antibiotic coverage for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PAER) and with initial detection in blood or respiratory cultures. We compared lowest- versus highest-decile hospitals, and we estimated adjusted probabilities (AP) for patient- and hospital-level factors predicting coverage and detection using hierarchical regression modeling.
RESULTS
Among 38,473 hospitalizations, empiric coverage varied widely across hospitals (MRSA lowest vs highest, 8.2% vs 42.0%; PAER lowest vs highest, 13.9% vs 44.4%). Detection rates also varied (MRSA lowest vs highest, 0.5% vs 3.6%; PAER lowest vs highest, 0.6% vs 3.7%). Whereas coverage was greatest among patients with recent hospitalizations (AP for anti-MRSA, 54%; AP for anti-PAER, 59%) and long-term care (AP for anti-MRSA, 60%; AP for anti-PAER, 66%), detection was greatest in patients with a previous history of a positive culture (AP for MRSA, 7.9%; AP for PAER, 11.9%) and in hospitals with a high prevalence of the organism in pneumonia (AP for MRSA, 3.9%; AP for PAER, 3.2%). Low hospital complexity and rural setting were strong negative predictors of coverage but not of detection.
CONCLUSIONS
Hospitals demonstrated widespread variation in both coverage and detection of MRSA and PAER, but probability of coverage correlated poorly with probability of detection. Factors associated with empiric coverage (eg, healthcare exposure) were different from those associated with detection (eg, microbiology history). Providing microbiology data during empiric antibiotic decision making could better align coverage to risk for resistant pathogens and could promote more judicious use of broad-spectrum antibiotics.
We develop category theory within Univalent Foundations, which is a foundational system for mathematics based on a homotopical interpretation of dependent type theory. In this system, we propose a definition of ‘category’ for which equality and equivalence of categories agree. Such categories satisfy a version of the univalence axiom, saying that the type of isomorphisms between any two objects is equivalent to the identity type between these objects; we call them ‘saturated’ or ‘univalent’ categories. Moreover, we show that any category is weakly equivalent to a univalent one in a universal way. In homotopical and higher-categorical semantics, this construction corresponds to a truncated version of the Rezk completion for Segal spaces, and also to the stack completion of a prestack.
Dyke-Davidoff-Masson syndrome, or cerebral hemiatrophy, is a pre- or perinatally acquired entity characterized by predominantly neurologic symptoms, such as seizures, facial asymmetry, contralateral hemiplegia, and mental retardation. Psychiatric symptoms are rarely reported. We report the first case of left cerebral hemiatrophy and a late onset of treatment-resistant schizoaffective disorder after a stressful life event. The patient finally responded well to clozapine. The clinical history and results from structural neuroimaging are highlighted to discuss the possible developmental bias for psychotic disorders.
The mechanical properties of porous ceramics are greatly influenced by their microstructure. Therefore, mechanical behavior of highly porous ceramics is different from that of dense ceramics. In this work, we evaluate different mechanical testing methods such as static compression, Brazilian disc test and 3-point bending on their suitability for comparison of highly porous ceramic materials. It is shown that 3-point bending is more suitable than static compression or Brazilian disc testing, as the material exhibits no critical crack propagation under compressive loading. With 3-point bending tests, a quantitative comparison of the mechanical properties of foams with different microstructures and porosities is possible. Under cyclic compression the foams exhibit a very high degree of crack tolerance in combination with preservation of their structural integrity even at high strains of 10%.
To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.
Design.
A retrospective analysis of bar code medication administration (BCMA) data.
Setting.
Acute care wards of 128 VA hospitals throughout the United States.
Methods.
Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route.
Results.
Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).
Conclusions.
Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a “low-hanging fruit” to increase awareness of appropriate antibiotic use.
Various wireless applications are currently under development for the unlicensed 60 GHz band. This paper describes three examples with different system requirements. The first two are point-to-multipoint wireless networks (in an airplane and in a car) and the third one is a short range point-to-point connection. Special requirements of the applications are a high number of users for the point-to-multipoint connection and a high data rate of 10 Gbit/s for the point-to-point connection system. Implementation aspects are pointed out, which are important to demonstrate the functionality of the system in a relevant environment and are key aspects to develop the related products. For example, integration aspects of the antenna into an airplane passenger seat and the receiver concept of the radio frequency-(RF) front-end to reducing the power consumption at ultrahigh data rates are described. Additionally, to determine the geometrical system architecture, ray-tracing simulations inside an aircraft and inside a car were performed.
This work deals with the expressive power of logics on finite graphs with access to an additional “arbitrary” linear order. The queries that can be expressed this way are the order-invariant queries for the logic. For the standard logics used in computer science, such as first-order logic, it is known that access to an arbitrary linear order increases the expressiveness of the logic. However, when we look at the separating examples, we find that they have satisfying models whose Gaifman Graph is complex – unbounded in valence and in treewidth. We thus explore the expressiveness of order-invariant queries over well-behaved graphs. We prove that first-order order-invariant queries over strings and trees have no additional expressiveness over first-order logic in the original signature. We also prove new upper bounds on order-invariant queries over bounded treewidth and bounded valence graphs. Our results make use of a new technique of independent interest: the application of algebraic characterizations of definability to show collapse results.
Abstract. We overview work on languages for querying finite structures, where the finite structures “live” inside some infinite interpreted structure. The goal is to take the query languages that have been investigated in finite model theory —first-order logic, second-order logic, fixpoint logic, etc. — and find natural extensions of them that take into account the ambient structure. Most of our discussion will be on first-order query languages. From the point of view of model theory, this means we fix an infinite structure and look at first-order formulas with additional relational predicates that range over finite sets; thus our languages lie between first-order logic and weak second order logic. The bulk of the survey consists of characterization theorems stating what sorts of queries can be defined in these logics. Not surprisingly, the expressiveness of first-order queries is determined by the model theory of the infinite structure. When the structure has a decision procedure, one can ask how complex it is to evaluate these formulas, in terms of the size of the finite structure that is plugged in for the free relational parameters. That is, we can consider formulas in these logics as templates for standard formulas, and ask how decision procedures behave as the templates are instantiated differently. The model-theoretic perspective and the symbolic computation perspective turn out to be closely connected. We also discuss applications of the results to spatial databases and to abstract complexity.
Introduction. ClassicalFiniteModelTheory andDescriptiveComplexity Theory [25, 17] give results about the expressiveness and complexity of logics over finite relational structures. This paper surveys work generalizing finite model theory to the situation where there is some infinite interpreted structure M where the finite relations live. We want to talk about logics that can access both the finite structure and the infinite background model; what classes are definable within such a logic, and what can we say about them with respect to computability and complexity? Answering these questions requires a suitable model of definability in the presence of built-in structure, as well as a notion of complexity appropriate when one works in an abstract setting, possibly over noneffective domains. There are several candidate approaches to logics over finite models “with a background structure”, and for each of these there are multiple complexity models one could compare against.
GaN based pH-sensors were used to measure the reaction and the kinetics of a lipase assay producing caprylic acid. Sensor structures consist of an AlGaN/GaN-heterostructure grown by plasma-induced molecular beam epitaxy with a thin GaN cap layer. The carrier concentration of the two-dimensional electron gas is manipulated by changing the surface potential due to changes in pH value.
We settle a number of questions concerning definability in first order logic with an extra predicate symbol ranging over semi-linear sets. We give new results both on the positive and negative side: we show that in first-order logic one cannot query a semi-linear set as to whether or not it contains a line, or whether or not it contains the line segment between two given points. However, we show that some of these queries become definable if one makes small restrictions on the semi-linear sets considered.
We study classes of ultrafilters on ω defined by a natural property of the Loeb measure in the Nonstandard Universe corresponding to the ultrafilter. This class, the Property M ultrafilters, is shown to contain all ultrafilters built up by taking iterated products over collections of pairwise nonisomorphic selective ultrafilters. Results on Property M ultrafilters are applied to the construction of extensions of probability measures, and to the study of measurable reductions between ultrafilters.
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