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To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey.
Setting:
Acute-care hospitals.
Participants:
ASP leaders.
Methods:
Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs.
Results:
Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had <99 beds, 162 (56.3%) had 100–399 beds, and 44 (15.2%) had ≥400+ beds. Also, 230 (79.9%) were healthcare system members. Moreover, 161 hospitals (54.8%) reported implementing FSTGs; 214 (72.4%) performed interactive PAF; 105 (34.9%) implemented procedures to optimize diagnostic testing; 235 (79.8%) measured antibiotic utilization; 258 (88.2%) measured CDI; and 110 (37.1%) measured FSTG adherence. Small hospitals performed less interactive PAF (61.0%; P = .0018). Small and nonsystem hospitals were less likely to optimize diagnostic testing: 25.2% (P = .030) and 21.0% (P = .0077), respectively. Small hospitals were less likely to measure antibiotic utilization (67.8%; P = .0010) and CDI (80.3%; P = .0038). Nonsystem hospitals were less likely to implement FSTGs (34.3%; P < .001).
Conclusions:
Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.
Gastropods are an important component of subtidal Antarctic communities including in common association with macroalgae. Nonetheless, limited data exist detailing their abundance and distribution on macroalgal species. This study documents the abundance and species composition of gastropod assemblages on the two largest, blade-forming Antarctic macroalgae, Himantothallus grandifolius and Sarcopeltis antarctica, sampled across two depths (9 and 18 m) at four sites for each species off Anvers Island, Antarctica. Gastropods were also enumerated on Desmarestia anceps, Desmarestia antarctica and Plocamium sp. but were not included in the main analyses because of small sample sizes. There were major differences between the gastropod assemblages on deep vs shallow H. grandifolius and S. antarctica with much higher numbers of individuals and also greater numbers of gastropod species at the greater depth. Differences between the gastropod assemblages on H. grandifolius and S. antarctica across sampling sites were apparent in non-parametric, multivariate analyses, although depth contributed more than site to these differences. Within common sites, assemblages on H. grandifolius were significantly different from those on S. antarctica at 18 m depth but not at 9 m depth, indicating that the host species can be but is not always more important than site in influencing the gastropod assemblages.
One major challenge in the study of late-Quaternary extinctions (LQEs) is providing better estimates of past megafauna abundance. To show how megaherbivore population size varied before and after the last extinctions in interior Alaska, we use both a database of radiocarbon-dated bone remains (spanning 25–0 ka) and spores of the obligate dung fungus, Sporormiella, recovered from radiocarbon-dated lake-sediment cores (spanning 17–0 ka). Bone fossils show that the last stage of LQEs in the region occurred at about 13 ka ago, but the number of megaherbivore bones remains high into the Holocene. Sporormiella abundance also remains high into the Holocene and does not decrease with major vegetation changes recorded by arboreal pollen percentages. At two sites, the interpretation of Sporormiella was enhanced by additional dung fungal spore types (e.g., Sordaria). In contrast to many sites where the last stage of LQEs is marked by a sharp decline in Sporormiella abundance, in interior Alaska our results indicate the continuance of megaherbivore abundance, albeit with a major taxonomic turnover (including Mammuthus and Equus extinction) from predominantly grazing to browsing dietary guilds. This new and robust evidence implies that regional LQEs were not systematically associated with crashes of overall megaherbivore abundance.
Geophysical granular flows, such as avalanches, debris flows, lahars and pyroclastic flows, are always strongly influenced by the basal topography that they flow over. In particular, localised bumps or obstacles can generate rapid changes in the flow thickness and velocity, or shock waves, which dissipate significant amounts of energy. Understanding how a granular material is affected by the underlying topography is therefore crucial for hazard mitigation purposes, for example to improve the design of deflecting or catching dams for snow avalanches. Moreover, the interactions with solid boundaries can also have important applications in industrial processes. In this paper, small-scale experiments are performed to investigate the flow of a granular avalanche over a two-dimensional smooth symmetrical bump. The experiments show that, depending on the initial conditions, two different steady-state regimes can be observed: either the formation of a detached jet downstream of the bump, or a shock upstream of it. The transition between the two cases can be controlled by adding varying amounts of erodible particles in front of the obstacle. A depth-averaged terrain-following avalanche theory that is formulated in curvilinear coordinates is used to model the system. The results show good agreement with the experiments for both regimes. For the case of a shock, time-dependent numerical simulations of the full system show the evolution to the equilibrium state, as well as the deposition of particles upstream of the bump when the inflow ceases. The terrain-following theory is compared to a standard depth-averaged avalanche model in an aligned Cartesian coordinate system. For this very sensitive problem, it is shown that the steady-shock regime is captured significantly better by the terrain-following avalanche model, and that the standard theory is unable to predict the take-off point of the jet. To retain the practical simplicity of using Cartesian coordinates, but have the improved predictive power of the terrain-following model, a coordinate mapping is used to transform the terrain-following equations from curvilinear to Cartesian coordinates. The terrain-following model, in Cartesian coordinates, makes identical predictions to the original curvilinear formulation, but is much simpler to implement.
A 136-m-long drill core of sediments was recovered from tropical high-altitude Lake Titicaca, Bolivia-Peru, enabling a reconstruction of past climate that spans four cycles of regional glacial advance and retreat and that is estimated to extend continuously over the last 370,000 yr. Within the errors of the age model, the periods of regional glacial advance and retreat are concordant respectively with global glacial and interglacial stages. Periods of ice advance in the southern tropical Andes generally were periods of positive water balance, as evidenced by deeper and fresher conditions in Lake Titicaca. Conversely, reduced glaciation occurred during periods of negative water balance and shallow closed-basin conditions in the lake. The apparent coincidence of positive water balance of Lake Titicaca and glacial growth in the adjacent Andes with Northern Hemisphere ice sheet expansion implies that regional water balance and glacial mass balance are strongly influenced by global-scale temperature changes, as well as by precessional forcing of the South American summer monsoon.
EURO-GANEX aims to recycle both major and minor actinides. As the final waste
composition is free from actinides, adapted immobilization matrices should be
developed. Synroc is a potential wasteform that has proven itself to be
efficient in immobilizing high-level wastes (HLW). In this study, a new
composition of Synroc, Synroc-Z, is designed and characterized. The key
modification is in decreasing the amount of zirconolite phase, which is the main
host phase for actinides and increasing the amount of other phases (hollandite
and perovskite). As designed the obtained amount of zirconolite is lower than in
Synroc-C compositions. Synroc-Z samples were synthesized with a waste loading of
20 wt.% at various temperatures and pressures via hot-pressing to determine the
optimum process parameters, which were determined to be 1150-1200°C and
20 MPa, respectively.
Ferromagnetic (FM) electrodes chemically anchored with thiol functionalizedmolecules can yield novel molecular spintronics devices (MSDs). However,significant challenges lie in developing commercially viable MSD fabricationapproach utilizing FM electrodes. A practical MSD fabrication approach shouldconsider FM electrodes’ susceptibility to oxidation, chemicaletching, and stress induced deformations during fabrication and usage. Thispaper will discuss NiFe, an alloy used in the present day memory devices andhigh-temperature engineering applications, as a candidate for FM electrode andfor the fabrication of MSDs. Our spectroscopic reflectance studies show thatNiFe starts oxidizing aggressively beyond ∼90 ⁰C. The NiFesurfaces, aged for several months or heated for several minutes below∼90 ⁰C, were suitable for chemical bonding with thethiol-functionalized molecules. NiFe also demonstrated excellent etchingresistance in widely used dichloromethane solvent for dissolving moleculardevice elements. NiFe also reduced the mechanical stress induced deformities inother FM metals like cobalt. This paper also discusses the successfulutilization of NiFe electrodes in the magnetic tunnel junction based moleculardevice fabrication approach. This research is expected to address the knowledgegap blocking the experimental development of FM based MSDs.
Annual rings are not commonly produced in tropical trees because they grow in a relatively aseasonal environment. However, in the subalpine zones of Hawaiʻi's highest volcanoes, there is often strong seasonal variability in temperature and rainfall. Using classical dendrochronological methods, annual growth rings were shown to occur in Sophora chrysophylla, a native tree species on Maunakea, Hawaiʻi. Chronologies were established from nearby non-native, live conifer trees and these were used to verify the dates from a total of 52 series from 22 S. chrysophylla trees, establishing an 86-y chronology (1926–2011). Ring-width patterns were significantly correlated with monthly rainfall from August of the previous year. This study is the first in the eastern tropical Pacific region to demonstrate annual growth rings in trees.
On the death of Edward Gibbon (1737–94), his unpublished papers were left to his friend John Baker Holroyd, first earl of Sheffield, who published them in two volumes in 1796. Gibbon had written six manuscript accounts of his own life, and, according to Sheffield, had always intended to publish his autobiography in his lifetime. The memoir as edited by Sheffield begins with Gibbon's family history, and taking in his education, travels, and career as a historian, finishes with his anxiety over the future of Europe in 1788. Sheffield then continues the story until Gibbon's death through his correspondence, providing a linking narrative, and this, together with 210 other letters to and from Gibbon, takes up Volume 1. His great work, The History of the Decline and Fall of the Roman Empire, is also reissued (in the 1896–1900 edition by J. B. Bury) in the Cambridge Library Collection.
On the death of Edward Gibbon (1737–94), his unpublished papers were left to his friend John Baker Holroyd, first earl of Sheffield, who published them in two volumes in 1796. Volume 2 contains abstracts from Gibbon's reading, with his reflections on what he read, and extracts from his journal (sometimes in French, with a parallel translation), short pieces on various aspects of Roman history, an outline of his planned history of the world from the ninth to the end of the fifteenth century, literary criticism, a history of the House of Brunswick (ancestors of the Hanoverian British royal family), and a riposte to a criticism of his own great work, The History of the Decline and Fall of the Roman Empire, which is also reissued (in the 1896–1900 edition by J. B. Bury) in the Cambridge Library Collection.
Recently Dr. R. N. Sinha, of the Canadian Department of Agriculture, sent in for determination some spider mites causing serious damage to barley in Manitoba. Previously this same mite had been collected in North Dakota and Oregon. The mites proved to be an undescribed species of Tetranychus, a genus not usually associated with grasses.