An evaluation of the effectiveness of an algorithm intervention in reducing inappropriate faecal samples sent for Clostridium difficile testing.

Background: Clostridium difficile (C. difficile) is a leading cause of infectious diarrhoea in hospitals. Sending faecal samples for testing expedites diagnosis and appropriate treatment. Clinical suspicion of C. difficile based on patient history, signs and symptoms is the basis for sampling. Sending faecal samples from patients with diarrhoea ‘just in case’ the patient has C. difficile may be an indication of poor clinical management.

Aim: To evaluate the effectiveness of an intervention by an Infection Prevention and Control Team (IPCT) in reducing inappropriate faecal samples sent for C. difficile testing.

Method: An audit of numbers of faecal samples sent before and after a decision-making algorithm was introduced. The number of samples received in the laboratory was retrospectively counted for 12-week periods before and after an algorithm was introduced.
Findings: There was a statistically significant reduction in the mean number of faecal samples sent post the algorithm. Results were compared to a similar intervention carried out in 2009 in which the same message was delivered by a memorandum. In 2009 the memorandum had no effect on the overall number of weekly samples being sent.

Conclusion: An algorithm intervention had an effect on the number of faecal samples being sent for C. difficile testing and thus contributed to the effective use of the laboratory service.

Laser Driven Nuclear Physics at ELI–NP

High power lasers have proven being capable to produce high energy γ-rays, charged particles and neutrons, and to induce all kinds of nuclear reactions. At ELI, the studies with high power lasers will enter for the first time into new domains of power and intensities: 10 PW and 10^23 W/cm^2. While the development of laser based radiation sources is the main focus at the ELI-Beamlines pillar of ELI, at ELI-NP the studies that will benefit from High Power Laser System pulses will focus on Laser Driven Nuclear Physics (this TDR, acronym LDNP, associated to the E1 experimental area), High Field Physics and QED (associated to the E6 area) and fundamental research opened by the unique combination of the two 10 PW laser pulses with a gamma beam provided by the Gamma Beam System (associated to E7 area). The scientific case of the LDNP TDR encompasses studies of laser induced nuclear reactions, aiming for a better understanding of nuclear properties, of nuclear reaction rates in laser-plasmas, as well as on the development of radiation source characterization methods based on nuclear techniques. As an example of proposed studies: the promise of achieving solid-state density bunches of (very) heavy ions accelerated to about 10 MeV/nucleon through the RPA mechanism will be exploited to produce highly astrophysical relevant neutron rich nuclei around the N~126 waiting point, using the sequential fission-fusion scheme, complementary to any other existing or planned method of producing radioactive nuclei.

The studies will be implemented predominantly in the E1 area of ELI-NP. However, many of them can be, in a first stage, performed in the E5 and/or E4 areas, where higher repetition laser pulses are available, while the harsh X-ray and electromagnetic pulse (EMP) environments are less damaging compared to E1.

A number of options are discussed through the document, having an important impact on the budget and needed resources. Depending on the TDR review and subsequent project decisions, they may be taken into account for space reservation, while their detailed design and implementation will be postponed.

The present TDR is the result of contributions from several institutions engaged in nuclear physics and high power laser research. A significant part of the proposed equipment can be designed, and afterwards can be built, only in close collaboration with (or subcontracting to) some of these institutions. A Memorandum of Understanding (MOU) is currently under preparation with each of these key partners as well as with others that are interested to participate in the design or in the future experimental program.