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Deciding whether or not eradication of an invasive species has been successful is one of the main dilemmas facing managers of eradication programmes. When the species is no longer being detected, a decision must be made about when to stop the eradication programme and declare success. In practice, this decision is usually based on ad hoc rules, which may be inefficient. Since surveillance undertaken to confirm species absence is imperfect, any declaration of eradication success must consider the risk and the consequences of being wrong. If surveillance is insufficient, then eradication may be falsely declared (a Type I error), whereas continuation of surveillance when eradication has already occurred wastes resources (a Type II error). We review the various methods that have been developed for quantifying these errors and incorporating them into the decision-making process. We conclude with an overview of future developments likely to improve the practice of determining invasive species eradication success.
This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.
N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.
J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.
Benjamin Darnell is a D.Phil. candidate at New College, Oxford.
Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.
Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson
Healthcare-associated infections are likely to be caused by drug-resistant and possibly mixed organisms and to be treated with inappropriate antibiotics. Because prompt appropriate treatment is associated with better outcomes, we studied the epidemiology of healthcare-associated complicated skin and skin-structure infections (cSSSIs).
Patients.
Persons hospitalized with cSSSI and a positive culture result.
Methods.
We conducted a single-center retrospective cohort study from April 2006 through December 2007. We differentiated healthcare-associated from community-acquired cSSSIs by at least 1 of the following risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, and (4) transfer from a nursing home. Inappropriate treatment was defined as no antimicrobial therapy with activity against the offending pathogen(s) within 24 hours after collection of a culture specimen. Mixed infections were those caused by both a gram-positive and a gram-negative organism.
Results.
Among 717 hospitalized patients with cSSSI, 527 (73.5%) had healthcare-associated cSSSI. Gram-negative organisms were more common (relative risk, 1.24 [95% confidence interval, 1.14–1.35) and inappropriate treatment trended toward being more common (odds ratio, 1.29 [95% confidence interval, 0.85–1.95]) in healthcare-associated cSSSI than in community-acquired cSSSI. Mixed cSSSIs occurred in 10.6% of patients with healthcare-associated cSSSI and 6.3% of those with community-acquired cSSSI (P = .082) and were more likely to be treated inappropriately than to be nonmixed infections (odds ratio, 2.42 [95% confidence interval, 1.43–4.10]). Both median length of hospital stay (6.2 vs 2.9 days; P < .001) and mortality rate (6.6% vs 1.1%; P = .003) were significantly higher for healthcare-associated cSSSI than community-acquired cSSSI.
Conclusions.
Healthcare-associated cSSSIs are common and are likely to be caused by gram-negative organisms. Mixed infections carry a <2-fold greater risk of inappropriate treatment. Healthcare-associated cSSSIs are associated with increased mortality and prolonged length of hospital stay, compared with community-acquired cSSSIs.
Although the incidence of hospitalizations with infection due to vancomycin-resistant pathogens in the United States remained stable during 2000–2003, it increased from 4.60 to 9.48 hospitalizations per 100,000 population during 2003–2006. Hospitalizations with infection due to vancomycin-resistant pathogens also increased as a proportion of all US hospitalizations, from 3.16 to 6.51 hospitalizations with VRE infection per 10,000 total hospitalizations during 2003–2006. The number of hospitalizations with infection due to vancomycin-resistant pathogens is increasing in the United States. Because infection due to vancomycin-resistant organisms is associated with poor outcomes, the epidemiology of this trend needs further exploration.
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