Antimicrobial prescribing in Nursing Homes in Northern Ireland: Results of Two Point-Prevalence Surveys

BACKGROUND: In 2005, the European Commission recommended that all member states should establish or strengthen surveillance systems for monitoring the use of antimicrobial agents. There is no evidence in the literature of any surveillance studies having been specifically conducted in nursing homes (NHs) in Northern Ireland (NI).

OBJECTIVE: The aim of this study was to determine the prevalence of antimicrobial prescribing and its relationship with certain factors (e.g. indwelling urinary catheterization, urinary incontinence, disorientation, etc.) in NH residents in NI.

METHODS: This project was carried out in NI as part of a wider European study under the protocols of the European Surveillance of Antimicrobial Consumption group. Two point-prevalence surveys (PPSs) were conducted in 30 NHs in April and November 2009. Data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics and were analysed descriptively.

RESULTS: The point prevalence of antimicrobial prescribing was 13.2% in April 2009 and 10.7% in November 2009, with a 10-fold difference existing between the NHs with the highest and lowest antimicrobial prescribing prevalence during both PPSs. The same NH had the highest rate of antimicrobial prescribing during both April (30.6%) and November (26.0%). The group of antimicrobials most commonly prescribed was the penicillins (April 28.6%, November 27.5%) whilst the most prevalent individual antimicrobial prescribed was trimethoprim (April 21.3%, November 24.3%). The majority of antimicrobials were prescribed for the purpose of preventing urinary tract infections (UTIs) in both April (37.8%) and in November (46.7%), with 5% of all participating residents being prescribed an antimicrobial for this reason. Some (20%) antimicrobials were prescribed at inappropriate doses, particularly those which were used for the purpose of preventing UTIs. Indwelling urinary catheterization and wounds were significant risk factors for antimicrobial use in April [odds ratio {OR} (95% CI) 2.0 (1.1, 3.5) and 1.8 (1.1, 3.0), respectively] but not in November 2009 [OR (95% CI) 1.6 (0.8, 3.2) and 1.2 (0.7, 2.2), respectively]. Other resident factors, e.g. disorientation, immobility and incontinence, were not associated with antimicrobial use. Furthermore, none of the NH characteristics investigated (e.g. number of beds, hospitalization episodes, number of general practitioners, etc.) were found to be associated with antimicrobial use in either April or November 2009.

CONCLUSIONS: This study has identified a high overall rate of antimicrobial use in NHs in NI, with variability evident both within and between homes. More research is needed to understand which factors influence antimicrobial use and to determine the appropriateness of antimicrobial prescribing in this population in general and more specifically in the management of recurrent UTIs.

Reproductive Patterns and Tidal Effects on Spat Settlement of Mytilus Edulis Populations in Dundrum Bay, Northern Ireland

The gametogenic and spat settlement patterns of two Mytihis edulis beds were studied in Dundrum Inner Bay, Northern Ireland. There was evidence of gonad development throughout the year with the main development period between November and March. Spawning was protracted, lasting from May to November. Slight inter-annual and inter-population differences in the riming of the phases were observed but the cycles at both beds were broadly similar to each other and to those of other British and Irish sites. Settlement occurred throughout the year and there was evidence of both primary and secondary spat settlement at both sites. Although the reproductive cycles were similar, distinct seasonal and inter-site differences in spatfall were apparent. At the Downshire Bridge bed, settlement peaked during summer and was dominated by spat in the 0•;5-1•0 mm size range. At Ballykinler, settlement levels were highest in the winter months and larger (>1 mm) spat dominated the samples. The orientation of spat collection pads also significantly affected numbers of the larger (>1 mm) spat. Collectors facing the flood tide attracted significantly more secondary settlers than ebb-facing collectors. This effect varied seasonally and was greater at the Ballykinler bed. It is suggested that hydrodynamic regimes may be an important factor in the differences in settlement patterns of M. edulis.

UTILISATION OF MOLLUSC RESOURCES IN N. IRELAND

Mussel beds in N. Ireland contain about 3–400 000 tonnes of molluscs of which 6–7% is edible flesh. Most of these resources are not suitable for direct human consumption and attempts are currently being made at Queen's University, to perfect a process to separate mussel shell and flesh aimed at the production of high grade products from a low grade source. This report deals with the likely consequences of large scale harvesting of mussels and offers possible alternatives.

How Porosity and Permeability Vary Spatially With Grain Size, Sorting, Cement Volume, and Mineral Dissolution In Fluvial Triassic Sandstones: The Value of Geostatistics and Local Regression

Although it is well known that sandstone porosity and permeability are controlled by a range of parameters such as grain size and sorting, amount, type, and location of diagenetic cements, extent and type of compaction, and the generation of intergranular and intragranular secondary porosity, it is less constrained how these controlling parameters link up in rock volumes (within and between beds) and how they spatially interact to determine porosity and permeability. To address these unknowns, this study examined Triassic fluvial sandstone outcrops from the UK using field logging, probe permeametry of 200 points, and sampling at 100 points on a gridded rock surface. These field observations were supplemented by laser particle-size analysis, thin-section point-count analysis of primary and diagenetic mineralogy, quantitiative XRD mineral analysis, and SEM/EDAX analysis of all 100 samples. These data were analyzed using global regression, variography, kriging, conditional simulation, and geographically weighted regression to examine the spatial relationships between porosity and permeability and their potential controls. The results of bivariate analysis (global regression) of the entire outcrop dataset indicate only a weak correlation between both permeability porosity and their diagenetic and depositional controls and provide very limited information on the role of primary textural structures such as grain size and sorting. Subdividing the dataset further by bedding unit revealed details of more local controls on porosity and permeability. An alternative geostatistical approach combined with a local modelling technique (geographically weighted regression; GWR) subsequently was used to examine the spatial variability of porosity and permeability and their controls. The use of GWR does not require prior knowledge of divisions between bedding units, but the results from GWR broadly concur with results of regression analysis by bedding unit and provide much greater clarity of how porosity and permeability and their controls vary laterally and vertically. The close relationship between depositional lithofacies in each bed, diagenesis, and permeability, porosity demonstrates that each influences the other, and in turn how understanding of reservoir properties is enhanced by integration of paleoenvironmental reconstruction, stratigraphy, mineralogy, and geostatistics.

Comparative growth rates and internal banding periodicity of maerl species (Corallinales, Rhodophyta) from northern Europe

Maerl is a type of rhodolith, found in ecologically important beds of high conservation value; a major conservation objective is to establish growth rates. Maerl shows internal banding of controversial periodicity that may contain a high-resolution record of palaeoceanographic-palaeoclimatic data. To investigate growth rates and banding periodicity, we used the vital stain Alizarin Red in combination with scanning electron microscopy (SEM). Three maerl species, Phymatolithon calcareum, Lithothamnion corallioides and L. glaciale, were collected from maerl beds in Ireland. Following staining, maerl was grown in three controlled temperature treatments and at two depths in the field (P. calcareum only), with Corallina officinalis as a control for the stain. Alizarin Red was shown to be a suitable marker for growth in European maerl species and for C. officinalis. The average tip growth rate of P. calcareum from Northern Ireland at 10 m depth and under constant laboratory conditions was c. 0.9 mm yr(-1), double the rates observed at 5 m depth and in L. corallioides. Our measurements and re-examination of reported data allow us to conclude that the three most abundant maerl species in Europe grow about 1 (0.5-1.5) mm per tip per year under a wide range of field and artificial conditions. Internal banding in temperate European maerl revealed by SEM is a result of regular changes in wall thickness; the approximately monthly periodicity of bands in field-grown specimens is consistent with previous suggestions that they may be lunar. The potential for maerl banding to be a high-resolution record of palaeoclimatic and palaeoenvironmental change could be realized with this vital stain in conjunction with isotopic or microgeochemical analyses.

Quantifying mircoorganism/organic matter interactions in saturated porous media.

Proteins and humic acids are common constituents of waste water. Latex colloids (colloids) acted as surrogates for microorganisms in multiple pulse dynamic column experiments (MPEs) that permitted colloid mobility to be quantified before and after the injection of either BSA (a protein), or Suwannee River humic acid (SRHA).
At low OM coverage colloid breakthrough curves demonstrated both BSA and SRHA reduced colloid deposition rates, but did not affect colloid irreversible deposition mechanisms. By contrast, high levels of SRHA surface coverage not only further reduced the matrix’s ability to attenuate colloids, but also resulted in reversible adsorption of a significant fraction of colloids deposited. Modelling of colloid responses using random sequential adsorption modelling suggested that 1 microgram of SRHA had the same effect as the deposition of 5.90±0.14 x109 colloids; the model suggested that adsorption of the same mass of BSA was equivalent to the deposition of between 7.1x108 and 2.3x109 colloids.
Colloid responses in MPEs where BSA coverage of colloid deposition sites approached saturation demonstrated the sand matrix remained capable of adsorbing colloids. However, in contrast to responses observed in MPEs at low surface coverage, continued colloid injection showed that the sand’s attenuation capacity increased with time, i.e. colloid concentrations declined as more were deposited (filter ripening).
Importance: Study results highlight the contrasting responses that may arise due to the interactions between colloids and OM in porous media. Results not only underscore that colloids can interact differently with various forms of deposited OM, but also that a single type of OM may generate dramatically different responses depending on the degree of surface coverage. The MPE method provides a means of quantifying the influence of OM on microorganism mobility in porous media such as filter beds, which may be used for either drinking water treatment or waste water treatment. In the wider environment study findings have potential to allow more confident predictions of the mobility of sewage derived pathogens discharging to groundwater.

The Klondike goldfields and Pleistocene environments of Beringia

The Klondike goldfields of Yukon, Canada, contain a key record of Pleistocene Beringia, the region of Alaska, Siberia, and Yukon that remained largely unglaciated during the late Cenozoic. A concentration of mining exposures, with relict permafrost that is locally more than 700,000 years old, provides exceptional preservation of paleoenvironmental archives and a new perspective on the nature of paleoenvironments during the Pleistocene. A critical feature is the stratigraphic association of distal tephra beds with these paleoenvironmental archives, which facilitates their regional correlation and, in many cases, provides independent ages for the paleoenvironmental assemblages. Paleoenvironmental analyses of fossil arctic ground-squirrel middens and buried vegetation indicate the presence of cryoxerophilous ("steppe-tundra") vegetation growing on well-drained substrates with deep active layers (seasonal thaw depths) during cold intervals of the Pleistocene. Studies of full-glacial paleosols and cryostratigraphic relations of associated ground ice indicate the importance of active loess deposition and surface vegetation cover in maintaining the functionally distinct mammoth-steppe biome, which supported grazing mega-fauna populations, including mammoth, horse, and bison.

Late Quaternary tephrostratigraphy, Ahklun Mountains, SW Alaska

Radiocarbon-dated sediment cores from six lakes in the Ahklun Mountains, south-western Alaska, were used to interpolate the ages of late Quaternary tephra beds ranging in age from 25.4 to 0.4ka. The lakes are located downwind of the Aleutian Arc and Alaska Peninsula volcanoes in the northern Bristol Bay area between 159° and 161°W at around 60°N. Sedimentation-rate age models for each lake were based on a published spline-fit procedure that uses Monte Carlo simulation to determine age model uncertainty. In all, 62 C ages were used to construct the six age models, including 23 ages presented here for the first time. The age model from Lone Spruce Pond is based on 18 ages, and is currently the best-resolved Holocene age model available from the region, with an average 2s age uncertainty of about±109 years over the past 14.5ka. The sedimentary sequence from Lone Spruce Pond contains seven tephra beds, more than previously found in any other lake in the area. Of the 26 radiocarbon-dated tephra beds at the six lakes and from a soil pit, seven are correlated between two or more sites based on their ages. The major-element geochemistry of glass shards from most of these tephra beds supports the age-based correlations. The remaining tephra beds appear to be present at only one site based on their unique geochemistry or age. The 5.8ka tephra is similar to the widespread Aniakchak tephra [3.7±0.2 (1s) ka], but can be distinguished conclusively based on its trace-element geochemistry. The 3.1 and 0.4ka tephras have glass major- and trace-element geochemical compositions indistinguishable from prominent Aniakchak tephra, and might represent redeposited beds. Only two tephra beds are found in all lakes: the Aniakchak tephra (3.7±0.2ka) and Tephra B (6.1±0.3ka). The tephra beds can be used as chronostratigraphic markers for other sedimentary sequences in the region, including cores from Cascade and Sunday lakes, which were previously undated and were analyzed in this study to correlate with the new regional tephrostratigraphy. © 2012 John Wiley & Sons, Ltd.

Factors associated with home death for individuals who receive homesupportservices:A retrospective cohort study

Objectives: To determine the factors associated with a home death among older adults who received palliative care nursing home services in the home. Methods: The participants in this retrospective cohort study were 151 family caregivers of patients who had died approximately 9 months prior to the study telephone interview. The interview focused on the last year of life and covered two main areas, patient characteristics and informal caregiver characteristics. Results: Odds ratios [OR] and 95% confidence intervals [95% CI] were used to determine which of the 15 potential informal caregiver and seven patient predictor variables were associated with dying at home. Multivariate analysis revealed that the odds of dying at home were greater when the patient lived with a caregiver [OR = 7.85; 95% CI = (2.35, 26.27)], the patient stated a preference to die at home [OR= 6.51; 95% CI = (2.66,15.95)], and the family physician made home visits [OR = 4.79; 95% CI = (1.97,11.64)]. However the odds were lower for patients who had caregivers with fair to poor health status [OR = 0.22; 95% CI = (0.07, 0.65)] and for patients who used hospital palliative care beds [OR = 0.31; 95% CI = (0.12, 0.80)]. Discussion: The findings suggest that individuals who indicated a preference to die at home and resided with a healthy informal caregiver had better odds of dying at home. Home visits by a family physician were also associated with dying at home.

The Palisades is a key reference site for the middle Pleistocene of eastern Beringia: New evidence from paleomagnetics and regional tephrostratigraphy

The Palisades, in central Alaska, is one of the most prominent exposures of Quaternary sediments on the Yukon River. Perennially-frozen silt and sand at the Palisades are presently thought to preserve paleoenvironmental records from the Holocene to ~Marine Isotope Stage (MIS) 8 and, beneath a major unconformity, the earliest Pleistocene (~2 Ma). We present new paleomagnetic and tephrochronologic constraints that substantially revise the age of the sediments at the Palisades. We describe 15 new tephra beds, including five beds below the prominent PAL tephra that correlate to known tephra with independent age control from other sites in eastern Beringia. These five known tephra include Chester Bluff tephra, which is present in east-central Alaska and the Yukon, and the newly named Alyeska Pipeline and Taylor Highway tephra from central Alaska; all are constrained to the middle Pleistocene. Paleomagnetic transects from the base of the bluff to the MIS 5e forest bed yield normal polarity, with the exception of a brief reversal event between Old Crow tephra (124 ± 10 ka) and the MIS 5e forest bed that is likely the first documentation of the Blake paleomagnetic event in Alaskan loess. The detailed tephrostratigraphy and paleomagnetic data collectively suggest that most of the sedimentary record at the Palisades is middle Pleistocene in age. The Palisades thus preserves a rare record of late to middle Pleistocene paleoenvironments with multiple regionally distributed tephra beds. © 2013 Elsevier Ltd.

Effectiveness of granular columns in containing settlement

Laboratory-based research studies and full-scale evaluations of the behaviour of ground improved with granular columns are ample regarding bearing capacity, but limited in respect to the settlement response. This paper presents a laboratory model study that considers the settlement performance of isolated pad footings bearing on reinforced sand deposits under the influence of a fluctuating groundwater table. This is a particularly onerous condition for loose sand deposits in coastal areas which may undergo significant collapse settlement over time. Loose and dense experimental sand beds were constructed and the performance of rigid footings under a maintained load and bearing on sand incorporating different column configurations were monitored under cycling of the water table over a period of 28 days, with one filling/empting cycle every 18 h. It was found that settlement, while greatly reduced compared with unreinforced footings, was ongoing and typically occurred at a much greater rate for loose sand than dense sand. Also, settlement rates were slightly higher for fully penetrating than partially penetrating columns and also for footings reinforced by a column group rather than a single column. This was attributed to the migration of sand grains into the larger column voids.

Determining optimal duration of seed translocation periods for benthic mussel (Mytilus edulis) cultivation using physiological and behavioural measures of stress

During the benthic cultivation process of Mytilus edulis (blue mussels), wild mussel seed is often transplanted from naturally occurring subtidal beds to sheltered in-shore waters to be grown to a commercial size. The survival of these relaid mussels is ultimately a function of their quality and physiological condition upon relaying and it has been recognised that mussels can suffer from a loss in condition following transportation. We investigated whether the process of being transported to ongrowing plots had a negative effect on the physiological health and resultant behaviour of mussels by simulating transportation conditions in a controlled experiment. Mussels were kept, out of water, in plastic piping to recreate translocation conditions and further, we tested if depth held in a ship hold (0, 1.5 and 3 m) and length of time emersed (12, 24 and 48 h) affected mussel condition and behaviour. Physiological condition was assessed by quantifying mussel tissue pH and whole tissue glucose, glycogen, succinate and propionate concentrations. The rate of byssogenesis was also quantified to estimate recovery following a period of re-immersion. The depth at which mussels were held did not affect any of the physiological indicators of mussel stress but short-term byssus production was affected. Mussels held at 3 m produced fewer byssus threads during the first 72 h following re-immersion compared with mussels at 0 m (i.e. not buried) suggesting that depth held can impede recovery following transportation. Duration of emersion affected all stress indicators. Specifically, mussels held out of water for 48 h had a reduced physiological condition compared with those emersed for just 12 h. This work has practical implications for the benthic cultivation industry and based on these results we recommend that mussels are held out of water for less than 24 h prior to relaying to ensure physiological health and resultant condition is preserved.

Consistent effects of consumer species loss across different habitats

Our knowledge of the effects of consumer species loss on ecosystem functioning is limited by a paucity of manipulative field studies, particularly those that incorporate inter-trophic effects. Further, given the ongoing transformation of natural habitats by anthropogenic activities, studies should assess the relative importance of biodiversity for ecosystem processes across different environmental contexts by including multiple habitat types. We tested the context-dependency of the effects of consumer species loss by conducting a 15-month field experiment in two habitats (mussel beds and rock pools) on a temperate rocky shore, focussing on the responses of algal assemblages following the single and combined removals of key gastropod grazers (Patella vulgata, P. ulyssiponensis, Littorina littorea and Gibbula umbilicalis). In both habitats, the removal of limpets resulted in a larger increase in macroalgal richness than that of either L. littorea or G. umbilicalis. Further, by the end of the study, macroalgal cover and richness were greater following the removal of multiple grazer species compared to single species removals. Despite substantial differences in physical properties and the structure of benthic assemblages between mussel beds and rock pools, the effects of grazer loss on macroalgal cover, richness, evenness and assemblage structure were remarkably consistent across both habitats. There was, however, a transient habitat-dependent effect of grazer removal on macroalgal assemblage structure that emerged after three months, which was replaced by non-interactive effects of grazer removal and habitat after 15 months. This study shows that the effects of the loss of key consumers may transcend large abiotic and biotic differences between habitats in rocky intertidal systems. While it is clear that consumer diversity is a primary driver of ecosystem functioning, determining its relative importance across multiple contexts is necessary to understand the consequences of consumer species loss against a background of environmental change.

The effects of transportation stress and barnacle fouling on predation rates of starfish (Asterias rubens) on mussels (Mytilus edulis).

The starfish, Asterias rubens, is widely distributed throughout the northern hemisphere and is an important predator on benthic mussel (Mytilus edulis) beds. Whilst several studies have examined how the size of individuals determines this predator–prey relationship, less is known about how the physiological condition of the prey (mussels) and the extent of their fouling may alter these relationships. Such issues are of particular interest to those working within the benthic mussel cultivation industry to inform best management practice and to help minimise losses during the aquaculture process. The potential role of starfish in the removal of epibiotic barnacles from mussels, the presence of which increases processing costs within the industry, is also of interest. We tested whether stressing mussels by aerial exposure for 48 h and whether the extent of barnacle fouling on mussels affected the feeding rates of three different size classes of starfish feeding on two different size classes of mussels. Feeding rates on stressed and unstressed mussels were similar for each starfish–mussel size combination. Barnacle fouling reduced the feeding rate of medium-sized starfish on larger-sized mussels. We also observed starfish, of all size classes, preying directly on the epibiotic barnacles on mussels, however, feeding rates were low and considered unlikely to reduce the extent of fouling on mussels. Our findings show that the predator–prey relationship between starfish and mussels does not differ between unstressed mussels and those experimentally stressed by aerial exposure for 48 h so that this level of stress is unlikely to affect predation rates by A. rubens following relaying in commercial operations. Whilst barnacle fouling suppressed predation rates in one of our experimental treatments, it does not appear that fouling by barnacles would provide a significant refuge from predation for the majority of mussels in benthic aquaculture stocks. Instead we found the size relationship between starfish and mussels was more important in determining predation rates. Starfish are also unlikely to help reduce barnacle fouling on cultured mussels by preying solely on fouling barnacles and the need to control starfish predation during culture remains.