Stronger correlation between antibiotic use and the incidence of Clostridium difficile determined by culture results instead of faecal toxin detection only

The detection of Clostridium difficile in previous studies evaluating antibiotic use as a risk factor was limited to toxin assay tests. The reported associations may have been misleading due to the low sensitivity of toxin assay tests compared to culture results. Antibiotic use and the incidence of C. difficile of 19 units (wards) over 5years were analysed. Stool samples were tested for toxin A/B and cultured. The correlation of antibiotic use with the incidence of C. difficile determined by culture results was compared to the correlation determined by toxin assay results. Additionally, single antibiotics were analysed as risk factors. Of 5,772 faecal samples tested for C. difficile, 154 single-first cases were detected by the toxin assay and 251 additional single-first cases by culture. Antibiotic use was a significantly stronger risk factor in the correlation based on the culture results (R 2 = 0.63) versus toxin assay results (R 2 = 0.40). Multivariate analysis did not improve the correlation significantly and only the group of broad-spectrum beta-lactams was identified as an independent risk factor. The correlation between antibiotic use and C. difficile incidence rates significantly improves if detection is not limited to faecal toxin assays. Therefore, antibiotic pressure was previously underestimated as a risk facto

How much money can be saved by applying intravenous antibiotics once instead of several times a day?

Background: The preparation, administration and monitoring of intravenous (IV) applications are time consuming and require human resources. We estimated the potential time and cost savings by replacing antibiotics given 3-4 times daily with antibiotics with similar spectrum and efficacy given once daily. Methods: The savings of indirect costs were estimated based on the antibiotic consumption data of a two-year period (i.e. 2007 and 2008), a nurse's mean workload per application and the average nurse's salary in Switzerland. Results: The consumption of IV antibiotics in 2007 and 2008 at the University Hospital of Basel was 29.0 and 32.2 defined daily doses (DDD) per 100 patient days, respectively. Nurses spent an estimated 13,786h on the application of the estimated 82,715 does of IV antibiotics. A total of 56,404 applications or nursing staff time costs of 338,436 Swiss Francs (CHF; 236,669 €), equal to 16% of the overall costs spent on purchasing antibiotics in the year 2008, may have been saved by switching multiple-dose antibiotics to a hypothetical once-daily antibiotic. Including disposable materials, 21% or 456,884 CHF (319,499 €) could be saved annually (purchase costs not taken into account). Conclusion: We found a potential cost saving of 21% of the purchase costs in a 750-bed institution. Hence, indirect costs should be included in the calculation of the total cost for the application of broad-spectrum IV antibiotics. Switching from a 3-4 times daily application to a once-daily antibiotic should be considered if a once-daily antibiotic is deemed equally effective and has a similar spectru

Z2SAL: a translation-based model checker for Z

Despite being widely known and accepted in industry, the Z formal specification language has not so far been well supported by automated verification tools, mostly because of the challenges in handling the abstraction of the language. In this paper we discuss a novel approach to building a model-checker for Z, which involves implementing a translation from Z into SAL, the input language for the Symbolic Analysis Laboratory, a toolset which includes a number of model-checkers and a simulator. The Z2SAL translation deals with a number of important issues, including: mapping unbounded, abstract specifications into bounded, finite models amenable to a BDD-based symbolic checker; converting a non-constructive and piecemeal style of functional specification into a deterministic, automaton-based style of specification; and supporting the rich set-based vocabulary of the Z mathematical toolkit. This paper discusses progress made towards implementing as complete and faithful a translation as possible, while highlighting certain assumptions, respecting certain limitations and making use of available optimisations. The translation is illustrated throughout with examples; and a complete working example is presented, together with performance data

A Multi-wavelength Study of the Sunyaev-Zel'dovich Effect in the Triple-Merger Cluster MACS J0717.5+3745 with MUSTANG and Bolocam

We present 90, 140, and 268GHz sub-arcminute resolution imaging of the Sunyaev-Zel'dovich effect (SZE) in MACSJ0717.5+3745. Our 90GHz SZE data result in a sensitive, 34uJy/bm map at 13" resolution using MUSTANG. Our 140 and 268GHz SZE imaging, with resolutions of 58" and 31" and sensitivities of 1.8 and 3.3mJy/beam respectively, was obtained using Bolocam. We compare these maps to a 2-dimensional pressure map derived from Chandra X-ray observations. Our MUSTANG data confirm previous indications from Chandra of a pressure enhancement due to shock-heated, >20keV gas immediately adjacent to extended radio emission seen in low-frequency radio maps. The MUSTANG data also detect pressure substructure that is not well-constrained by the X-ray data in the remnant core of a merging subcluster. We find that the small-scale pressure enhancements in the MUSTANG data amount to ~2% of the total pressure measured in the 140GHz Bolocam observations. The X-ray template also fails on larger scales to accurately describe the Bolocam data, particularly at the location of a subcluster known to have a high line of sight optical velocity (~3200km/s). Our Bolocam data are adequately described when we add an additional component - not described by a thermal SZE spectrum - coincident with this subcluster. Using flux densities extracted from our model fits, and marginalizing over the temperature constraints for the region, we fit a thermal+kinetic SZE spectrum to our data and find the subcluster has a best-fit line of sight proper velocity of 3600+3440/-2160km/s. This agrees with the optical velocity estimates for the subcluster. The probability of velocity<0 given our measurements is 2.1%. Repeating this analysis using flux densities measured non-parametrically results in a 3.4% probability of a velocity<=0. We note that this tantalizing result for the kinetic SZE is on resolved, subcluster scales.Comment: 10 Figures, 18 pages. this version corrects issues with the previous arXiv versio

Measuring the redshift dependence of the CMB monopole temperature with PLANCK data

We study the power of PLANCK data to constrain deviations of the Cosmic Microwave Background black body temperature from adiabatic evolution using the thermal Sunyaev-Zeldovich anisotropy induced by clusters of galaxies. We consider two types of data sets: the cosmological signal is removed in the Time Ordered Information or is removed from the final maps; and two different statistical estimators, based on the ratio of temperature anisotropies at two different frequencies and on a fit to the spectral variation of the cluster signal with frequency. To test for systematics, we construct a template from clusters drawn from a hydro-simulation included in the pre-launch Planck Sky Model. We demonstrate that, using a proprietary catalog of X-ray selected clusters with measured redshifts, electron densities and X-ray temperatures, we can constrain deviations of adiabatic evolution, measured by the parameter $\alpha$ in the redshift scaling $T(z)=T_0(1+z)^{1-\alpha}$, with an accuracy of $\sigma_\alpha=0.011$ in the most optimal case and with $\sigma_\alpha=0.016$ for a less optimal case. These results represent a factor 2-3 improvement over similar measurements carried out using quasar spectral lines and a factor 6-20 with respect to earlier results using smaller cluster samples.Comment: 12 pages in ApJ styl

ALMA Observations of SPT-Discovered, Strongly Lensed, Dusty, Star-Forming Galaxies

We present Atacama Large Millimeter/submillimeter Array (ALMA) 860 micrometer imaging of four high-redshift (z=2.8-5.7) dusty sources that were detected using the South Pole Telescope (SPT) at 1.4 mm and are not seen in existing radio to far-infrared catalogs. At 1.5 arcsec resolution, the ALMA data reveal multiple images of each submillimeter source, separated by 1-3 arcsec, consistent with strong lensing by intervening galaxies visible in near-IR imaging of these sources. We describe a gravitational lens modeling procedure that operates on the measured visibilities and incorporates self-calibration-like antenna phase corrections as part of the model optimization, which we use to interpret the source structure. Lens models indicate that SPT0346-52, located at z=5.7, is one of the most luminous and intensely star-forming sources in the universe with a lensing corrected FIR luminosity of 3.7 X 10^13 L_sun and star formation surface density of 4200 M_sun yr^-1 kpc^-2. We find magnification factors of 5 to 22, with lens Einstein radii of 1.1-2.0 arcsec and Einstein enclosed masses of 1.6-7.2x10^11 M_sun. These observations confirm the lensing origin of these objects, allow us to measure the their intrinsic sizes and luminosities, and demonstrate the important role that ALMA will play in the interpretation of lensed submillimeter sources.Comment: Accepted for publication in the Astrophysics Journa

The 10 Meter South Pole Telescope

The South Pole Telescope (SPT) is a 10 m diameter, wide-field, offset Gregorian telescope with a 966-pixel, multi-color, millimeter-wave, bolometer camera. It is located at the Amundsen-Scott South Pole station in Antarctica. The design of the SPT emphasizes careful control of spillover and scattering, to minimize noise and false signals due to ground pickup. The key initial project is a large-area survey at wavelengths of 3, 2 and 1.3 mm, to detect clusters of galaxies via the Sunyaev-Zeldovich effect and to measure the small-scale angular power spectrum of the cosmic microwave background (CMB). The data will be used to characterize the primordial matter power spectrum and to place constraints on the equation of state of dark energy. A second-generation camera will measure the polarization of the CMB, potentially leading to constraints on the neutrino mass and the energy scale of inflation.Comment: 47 pages, 14 figures, updated to match version to be published in PASP 123 903 (May, 2011

Sunyaev Zel'dovich Effect Observations of Strong Lensing Galaxy Clusters: Probing the Over-Concentration Problem

We have measured the Sunyaev Zel'dovich (SZ) effect for a sample of ten strong lensing selected galaxy clusters using the Sunyaev Zel'dovich Array (SZA). The SZA is sensitive to structures on spatial scales of a few arcminutes, while the strong lensing mass modeling constrains the mass at small scales (typically < 30"). Combining the two provides information about the projected concentrations of the strong lensing clusters. The Einstein radii we measure are twice as large as expected given the masses inferred from SZ scaling relations. A Monte Carlo simulation indicates that a sample randomly drawn from the expected distribution would have a larger median Einstein radius than the observed clusters about 3% of the time. The implied overconcentration has been noted in previous studies with smaller samples of lensing clusters. It persists for this sample, with the caveat that this could result from a systematic effect such as if the gas fractions of the strong lensing clusters are substantially below what is expected.Comment: submitte

The Growth of Cool Cores and Evolution of Cooling Properties in a Sample of 83 Galaxy Clusters at 0.3 < z < 1.2 Selected from the SPT-SZ Survey

We present first results on the cooling properties derived from Chandra X-ray observations of 83 high-redshift (0.3 < z < 1.2) massive galaxy clusters selected by their Sunyaev-Zel'dovich signature in the South Pole Telescope data. We measure each cluster's central cooling time, central entropy, and mass deposition rate, and compare to local cluster samples. We find no significant evolution from z~0 to z~1 in the distribution of these properties, suggesting that cooling in cluster cores is stable over long periods of time. We also find that the average cool core entropy profile in the inner ~100 kpc has not changed dramatically since z ~ 1, implying that feedback must be providing nearly constant energy injection to maintain the observed "entropy floor" at ~10 keV cm^2. While the cooling properties appear roughly constant over long periods of time, we observe strong evolution in the gas density profile, with the normalized central density (rho_0/rho_crit) increasing by an order of magnitude from z ~ 1 to z ~ 0. When using metrics defined by the inner surface brightness profile of clusters, we find an apparent lack of classical, cuspy, cool-core clusters at z > 0.75, consistent with earlier reports for clusters at z > 0.5 using similar definitions. Our measurements indicate that cool cores have been steadily growing over the 8 Gyr spanned by our sample, consistent with a constant, ~150 Msun/yr cooling flow that is unable to cool below entropies of 10 keV cm^2 and, instead, accumulates in the cluster center. We estimate that cool cores began to assemble in these massive systems at z ~ 1, which represents the first constraints on the onset of cooling in galaxy cluster cores. We investigate several potential biases which could conspire to mimic this cool core evolution and are unable to find a bias that has a similar redshift dependence and a substantial amplitude.Comment: 17 pages with 15 figures, plus appendix. Published in Ap

X-ray Properties of the First SZE-selected Galaxy Cluster Sample from the South Pole Telescope

We present results of X-ray observations of a sample of 15 clusters selected via their imprint on the cosmic microwave background (CMB) from the thermal Sunyaev-Zel'dovich (SZ) effect. These clusters are a subset of the first SZ-selected cluster catalog, obtained from observations of 178 deg^2 of sky surveyed by the South Pole Telescope. Using X-ray observations with Chandra and XMM-Newton, we estimate the temperature, T_X, and mass, M_g, of the intracluster medium (ICM) within r_500 for each cluster. From these, we calculate Y_X=M_g T_X and estimate the total cluster mass using a M_500-Y_X scaling relation measured from previous X-ray studies. The integrated Comptonization, Y_SZ, is derived from the SZ measurements, using additional information from the X-ray measured gas density profiles and a universal temperature profile. We calculate scaling relations between the X-ray and SZ observables, and find results generally consistent with other measurements and the expectations from simple self-similar behavior. Specifically, we fit a Y_SZ-Y_X relation and find a normalization of 0.82 +- 0.07, marginally consistent with the predicted ratio of Y_SZ/Y_X=0.91+-0.01 that would be expected from the density and temperature models used in this work. Using the Y_X derived mass estimates, we fit a Y_SZ-M_500 relation and find a slope consistent with the self-similar expectation of Y_SZ ~ M^5/3 with a normalization consistent with predictions from other X-ray studies. We compare the X-ray mass estimates to previously published SZ mass estimates derived from cosmological simulations of the SPT survey. We find that the SZ mass estimates are lower by a factor of 0.89+-0.06, which is within the ~15% systematic uncertainty quoted for the simulation-based SZ masses.Comment: 28 pages, 19 figures, submitted to Ap