A point-prevalence survey of antimicrobial utilisation within New Brunswick hospitals to focus antimicrobial stewardship efforts and decrease low-value care.

Introduction: Il est important de minimiser le gaspillage et les risques associés aux soins sans valeur. La gestion de l’utilisation des antimicrobiens vise à optimiser leur emploi et doit être adaptée au milieu et à sa population. Objectifs: Évaluer les profiles d’utilisation actuels des antimicrobiens et fixer des objectifs pour les interventions en matière de gestion des antimicrobiens. Méthode: Vingt-et-un hôpitaux du Nouveau-Brunswick offrant des soins de courte durée en médecine générale, en chirurgie et en pédiatrie ont pris part à une enquête sur la prévalence ponctuelle. Tous les patients admis aux hôpitaux participants et ayant reçu au moins un antimicrobien systémique ont été inscrits à l’étude. Les principaux critères d’évaluation étaient le profil d’utilisation, selon l’indication et l’antimicrobien prescrit, le bienfondé de l’utilisation et la durée de la prophylaxie chirurgicale. Des statistiques descriptives et un test d’indépendance 2 furent utilisés pour l’analyse de données. Résultats: L’enquête a été menée de juin à août 2012. Un total de 2244 patients ont été admis pendant la durée de l’étude et 529 (23,6%) ont reçu un antimicrobien. Au total, 691 antimicrobiens ont été prescrits, soit 587 (85%) pour le traitement et 104 (15%) pour la prophylaxie. Les antimicrobiens les plus souvent prescrits pour le traitement (n=587) étaient des classes suivantes : quinolones (25,6%), pénicillines à spectre étendu (10,2%) et métronidazole (8,5%). Les indications les plus courantes du traitement étaient la pneumonie (30%), les infections gastro-intestinales (16%) et les infections de la peau et des tissus mous (14%). Selon des critères définis au préalable, 23% (n=134) des ordonnances pour le traitement étaient inappropriées et 20% (n=120) n’avaient aucune indication de documentée. Les domaines où les ordonnances étaient inappropriées étaient les suivants : défaut de passage de la voie intraveineuse à la voie orale (n=34, 6%), mauvaise dose (n=30, 5%), traitement d’une bactériurie asymptomatique (n=24, 4%) et doublement inutile (n=22, 4%). Dans 33% (n=27) des cas, les ordonnances pour la prophylaxie chirurgicale étaient pour une période de plus de 24 heures. Conclusions: Les résultats démontrent que les efforts de gestion des antimicrobiens doivent se concentrer sur les interventions conventionnelles de gestion de l’utilisation des antimicrobiens, l’amélioration de la documentation, l’optimisation de l’utilisation des quinolones et la réduction au minimum de la durée de la prophylaxie chirurgicale.

Using Zappers in a Common Learning Space (Windows 7)

This 8 minute video provides a step-by-step guide for tutors wishing to use zappers (Turning Point) in a Common Learning Space with Windows 7 and Office 2010.

Quick printed guide to zappers (Turning Point 5)

One side of A4 which provides step-by-step instructions to help you use Tunring Point 5 in Common Learning Spaces. Includes advice about dealing with technical glitches.

Delimitation of the Right to Life by Healthcare Professionals: Up to what point should the right to life be protected?

This article explores the medical care standard required by law for terminally illpatients and the possibility of limiting therapeutic efforts while respecting the duediligence expected from doctors. To this end, circumstances are identified in whichthe doctor is forced to choose between two possible actions: to guarantee the right tolife by continuing treatment, or to limit the right to healthcare by limiting therapeuticefforts. Two cases taken from English Common Law were reviewed that decided onthe factual problem at hand. In our country, the Constitutional Court established aline of jurisprudence on the role of the doctor in deciding whether or not to continuetreatment for a terminally ill person. Lastly, jurisprudence precedents are presentedalong with a comparative analysis of the solutions given in Great Britain andin Colombia.

The post-Lisbon role of the European Parliament in the EU's Common Commercial Policy: Implications for bilateral trade negotiations. EU Diplomacy Paper 05/2012, July 2012

This paper sets out to conduct an empirical analysis of the post-Lisbon role of the European Parliament (EP) in the EU’s Common Commercial Policy through an examination of the ‘deep and comprehensive’ bilateral Free Trade Agreements (FTAs) currently negotiated as part of the EU’s Global Europe strategy. The EU-Korea and EU-India FTAs are used as case studies in order to determine the implications of the EP’s enhanced trade powers on the processes, actors and outcomes of EU bilateral trade policy. The EP is now endowed with the ‘hard power’ of consent in the ratification phase of FTAs, acting as a threat to strengthen its ‘soft power’ to influence negotiations. The EP is developing strategies to influence the mandate and now plays an important role in the implementation of FTAs. The entry of this new player on the Brussels trade policy field has brought about a shift in the institutional balance of power and opened up the EP as a new point of access for trade policy lobbyists. Finally, increased EP involvement in EU trade policy has brought about a politicisation of EU trade policy and greater normative outcomes of FTAs.

Investigating novel point-select techniques for older people

As the number and proportion of older people worldwide continues to grow, robotic devices can play a role in helping older people continue to live independent and active lives. Graphical user interfaces (GUIs) and interactions that involve pointing to items and selecting them are becoming more common in assistive robots. The authors are currently working on a project investigating techniques to improve point-select interactions for older people. In particular, the project studies how older people respond to expanding and moving targets. The research is ongoing, and this paper describes the methods that will be used in upcoming experiments.

Feedback dew-point sensor utilising optimally cut plastic optical fibres

A plastic optical fibre reflectance sensor that makes full use of the critical angle of the fibres is implemented to monitor dew formation on a Peltier-cooled reflector surface. The optical configuration permits isolation of optoelectronic components from the sensing head and better light coupling between the reflector and the detecting fibre, giving a better signal of the onset of dew formation on the reflector. Continuous monitoring of the rate of change in reflectance as well as the absolute reflectance signals, the use of a novel polymethyl-methacrylate-coated hydrophobic film reflector on the Peltier element and the application of feedback around the point of dew formation, further reduces the possibility of contamination of the sensor head. Under closed-loop operation, the sensor is capable of cycling around the point of dew formation at a frequency of 2.5 Hz.

From symmetry breaking to Poisson Point Process in 2D Voronoi Tessellations: the generic nature of hexagons

We bridge the properties of the regular triangular, square, and hexagonal honeycomb Voronoi tessellations of the plane to the Poisson-Voronoi case, thus analyzing in a common framework symmetry breaking processes and the approach to uniform random distributions of tessellation-generating points. We resort to ensemble simulations of tessellations generated by points whose regular positions are perturbed through a Gaussian noise, whose variance is given by the parameter α2 times the square of the inverse of the average density of points. We analyze the number of sides, the area, and the perimeter of the Voronoi cells. For all valuesα >0, hexagons constitute the most common class of cells, and 2-parameter gamma distributions provide an efficient description of the statistical properties of the analyzed geometrical characteristics. The introduction of noise destroys the triangular and square tessellations, which are structurally unstable, as their topological properties are discontinuous in α = 0. On the contrary, the honeycomb hexagonal tessellation is topologically stable and, experimentally, all Voronoi cells are hexagonal for small but finite noise withα <0.12. For all tessellations and for small values of α, we observe a linear dependence on α of the ensemble mean of the standard deviation of the area and perimeter of the cells. Already for a moderate amount of Gaussian noise (α >0.5), memory of the specific initial unperturbed state is lost, because the statistical properties of the three perturbed regular tessellations are indistinguishable. When α >2, results converge to those of Poisson-Voronoi tessellations. The geometrical properties of n-sided cells change with α until the Poisson- Voronoi limit is reached for α > 2; in this limit the Desch law for perimeters is shown to be not valid and a square root dependence on n is established. This law allows for an easy link to the Lewis law for areas and agrees with exact asymptotic results. Finally, for α >1, the ensemble mean of the cells area and perimeter restricted to the hexagonal cells agree remarkably well with the full ensemble mean; this reinforces the idea that hexagons, beyond their ubiquitous numerical prominence, can be interpreted as typical polygons in 2D Voronoi tessellations.

The implications of the 2003 Common Agricultural Policy reforms for land use and landscape quality in England

The assessment of the potential landscape impacts of the latest Common Agricultural Policy reforms constitutes a challenge for policy makers and it requires the development of models that can reliably project the likely spatial distribution of land uses. The aim of this study is to investigate the impact of 2003 CAP reforms to land uses and rural landscapes across England. For this purpose we modified an existing economic model of agriculture, the Land-Use Allocation Model (LUAM) to provide outputs at a scale appropriate for informing a semi-quantitative landscape assessment at the level of ‘Joint Character Areas’ (JCAs). Overall a decline in the cereal and oilseed production area is projected but intensive arable production will persist in specific locations (East of England, East Midlands and South East), having ongoing negative effects on the character of many JCAs. The impacts of de-coupling will be far more profound on the livestock sector; extensification of production will occur in traditional mixed farming regions (e.g. the South West), a partial displacement of cattle by sheep in the upland regions and an increase in the sheep numbers is expected in the lowlands (South East, Eastern and East Midlands). This extensification process will affect positively those JCAs of mixed farming conditions, but it will have negative impacts on the JCAs of historically low intensity farming (e.g. the uplands of north-west) because they will suffer from under-management and land idling. Our analysis shows that the territorialisation between intensively and extensively agricultural landscapes will continue.

Fenced in: Common property struggles in the management of communal rangelands in central Eastern Cape Province, South Africa

This paper takes as its starting point the assertion that current rangeland management in the central Eastern Cape Province (former Ciskei) of South Africa, is characterised primarily by an ‘open access’ approach. Empirical material drawn from three case-study communities in the region is used to examine the main barriers to management of rangeland as a ‘commons’. The general inability to define and enforce rights to particular grazing resourses in the face of competing claims from ‘outsiders’, as well as inadequate local institutions responsible for rangeland management are highlighted as being of key importance. These are often exacerbated by lack of available grazing land, diffuse user groups and local political and ethnic divisions. Many of these problems have a strong legacy in historical apartheid policies such as forced resettlement and betterment planning. On this basis it is argued that policy should focus on facilitating the emergence of effective, local institutions for rangeland management. Given the limited grazing available to many communities in the region, a critical aspect of this will be finding ways to legitimise current patterns of extensive resource use, which traverse existing ‘community’ boundaries. However, this runs counter to recent legislation, which strongly links community management with legal ownership of land within strict boundaries often defined through fencing. Finding ways to overcome this apparent disjuncture between theory and policy will be vital for the effective management of common pool grazing resources in the region.

Stratosphere‐troposphere coupling and annular mode variability in chemistry‐climate models

The internal variability and coupling between the stratosphere and troposphere in CCMVal‐2 chemistry‐climate models are evaluated through analysis of the annular mode patterns of variability. Computation of the annular modes in long data sets with secular trends requires refinement of the standard definition of the annular mode, and a more robust procedure that allows for slowly varying trends is established and verified. The spatial and temporal structure of the models’ annular modes is then compared with that of reanalyses. As a whole, the models capture the key features of observed intraseasonal variability, including the sharp vertical gradients in structure between stratosphere and troposphere, the asymmetries in the seasonal cycle between the Northern and Southern hemispheres, and the coupling between the polar stratospheric vortices and tropospheric midlatitude jets. It is also found that the annular mode variability changes little in time throughout simulations of the 21st century. There are, however, both common biases and significant differences in performance in the models. In the troposphere, the annular mode in models is generally too persistent, particularly in the Southern Hemisphere summer, a bias similar to that found in CMIP3 coupled climate models. In the stratosphere, the periods of peak variance and coupling with the troposphere are delayed by about a month in both hemispheres. The relationship between increased variability of the stratosphere and increased persistence in the troposphere suggests that some tropospheric biases may be related to stratospheric biases and that a well‐simulated stratosphere can improve simulation of tropospheric intraseasonal variability.

Ultraconserved words point to deep language ancestry across Eurasia

The search for ever deeper relationships among the World’s languages is bedeviled by the fact that most words evolve too rapidly to preserve evidence of their ancestry beyond 5,000 to 9,000 y. On the other hand, quantitative modeling indicates that some “ultraconserved” words exist that might be used to find evidence for deep linguistic relationships beyond that time barrier. Here we use a statistical model, which takes into account the frequency with which words are used in common everyday speech, to predict the existence of a set of such highly conserved words among seven language families of Eurasia postulated to form a linguistic superfamily that evolved from a common ancestor around 15,000 y ago. We derive a dated phylogenetic tree of this proposed superfamily with a time-depth of ∼14,450 y, implying that some frequently used words have been retained in related forms since the end of the last ice age. Words used more than once per 1,000 in everyday speech were 7- to 10-times more likely to show deep ancestry on this tree. Our results suggest a remarkable fidelity in the transmission of some words and give theoretical justification to the search for features of language that might be preserved across wide spans of time and geography.

Interhemispheric coupling, the West Antarctic Ice Sheet and warm Antarctic interglacials

Ice core evidence indicates that even though atmospheric CO2 concentrations did not exceed ~300 ppm at any point during the last 800 000 years, East Antarctica was at least ~3–4 °C warmer than preindustrial (CO2~280 ppm) in each of the last four interglacials. During the previous three interglacials, this anomalous warming was short lived (~3000 years) and apparently occurred before the completion of Northern Hemisphere deglaciation. Hereafter, we refer to these periods as "Warmer than Present Transients" (WPTs). We present a series of experiments to investigate the impact of deglacial meltwater on the Atlantic Meridional Overturning Circulation (AMOC) and Antarctic temperature. It is well known that a slowed AMOC would increase southern sea surface temperature (SST) through the bipolar seesaw and observational data suggests that the AMOC remained weak throughout the terminations preceding WPTs, strengthening rapidly at a time which coincides closely with peak Antarctic temperature. We present two 800 kyr transient simulations using the Intermediate Complexity model GENIE-1 which demonstrate that meltwater forcing generates transient southern warming that is consistent with the timing of WPTs, but is not sufficient (in this single parameterisation) to reproduce the magnitude of observed warmth. In order to investigate model and boundary condition uncertainty, we present three ensembles of transient GENIE-1 simulations across Termination II (135 000 to 124 000 BP) and three snapshot HadCM3 simulations at 130 000 BP. Only with consideration of the possible feedback of West Antarctic Ice Sheet (WAIS) retreat does it become possible to simulate the magnitude of observed warming.

Thermodynamics/dynamics coupling in weakly compressible turbulent stratified fluids

In traditional and geophysical fluid dynamics, it is common to describe stratified turbulent fluid flows with low Mach number and small relative density variations by means of the incompressible Boussinesq approximation. Although such an approximation is often interpreted as decoupling the thermodynamics from the dynamics, this paper reviews recent results and derive new ones that show that the reality is actually more subtle and complex when diabatic effects and a nonlinear equation of state are retained. Such an analysis reveals indeed: (1) that the compressible work of expansion/contraction remains of comparable importance as the mechanical energy conversions in contrast to what is usually assumed; (2) in a Boussinesq fluid, compressible effects occur in the guise of changes in gravitational potential energy due to density changes. This makes it possible to construct a fully consistent description of the thermodynamics of incompressible fluids for an arbitrary nonlinear equation of state; (3) rigorous methods based on using the available potential energy and potential enthalpy budgets can be used to quantify the work of expansion/contraction B in steady and transient flows, which reveals that B is predominantly controlled by molecular diffusive effects, and act as a significant sink of kinetic energy.

Northern winter climate change: assessment of uncertainty in CMIP5 projections related to stratosphere–troposphere coupling

Future changes in the stratospheric circulation could have an important impact on Northern winter tropospheric climate change, given that sea level pressure (SLP) responds not only to tropospheric circulation variations but also to vertically coherent variations in troposphere-stratosphere circulation. Here we assess Northern winter stratospheric change and its potential to influence surface climate change in the Coupled Model Intercomparison Project – phase 5 (CMIP5) multi-model ensemble. In the stratosphere at high latitudes, an easterly change in zonally averaged zonal wind is found for the majority of the CMIP5 models, under the Representative Concentration Pathway 8.5 scenario. Comparable results are also found in the 1% CO2 increase per year projections, indicating that the stratospheric easterly change is common feature in future climate projections. This stratospheric wind change, however, shows a significant spread among the models. By using linear regression, we quantify the impact of tropical upper troposphere warming, polar amplification and the stratospheric wind change on SLP. We find that the inter-model spread in stratospheric wind change contributes substantially to the inter-model spread in Arctic SLP change. The role of the stratosphere in determining part of the spread in SLP change is supported by the fact that the SLP change lags the stratospheric zonally averaged wind change. Taken together, these findings provide further support for the importance of simulating the coupling between the stratosphere and the troposphere, to narrow the uncertainty in the future projection of tropospheric circulation changes.