A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship

BACKGROUND: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department. METHODS: We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014. RESULTS: Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients admitted to hospital were prescribed a parenteral antimicrobial. More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam. Blood cultures were obtained in less than one-third of patients who were treated with a parenteral antibiotic. CONCLUSIONS: Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures. Blood cultures may have limited value to support prescribing review as part of antimicrobial stewardship initiatives

Mode-division-multiplexing of multiple Bessel-Gaussian beams carrying orbital-angular-momentum for obstruction-tolerant free-space optical and millimetre-wave communication links

We experimentally investigate the potential of using ‘self-healing’ Bessel-Gaussian beams carrying orbital-angular-momentum to overcome limitations in obstructed free-space optical and 28-GHz millimetre-wave communication links. We multiplex and transmit two beams (l = +1 and +3) over 1.4 metres in both the optical and millimetre-wave domains. Each optical beam carried 50-Gbaud quadrature-phase-shift-keyed data, and each millimetre-wave beam carried 1-Gbaud 16-quadrature-amplitude-modulated data. In both types of links, opaque disks of different sizes are used to obstruct the beams at different transverse positions. We observe self-healing after the obstructions, and assess crosstalk and power penalty when data is transmitted. Moreover, we show that Bessel-Gaussian orbital-angular-momentum beams are more tolerant to obstructions than non-Bessel orbital-angular-momentum beams. For example, when obstructions that are 1 and 0.44 the size of the l = +1 beam, are placed at beam centre, optical and millimetre-wave Bessel-Gaussian beams show ~6 dB and ~8 dB reduction in crosstalk, respectively

EVALUATION OF OIL BASED AVIAN INFLUENZA VACCINE (H5NI) PREPARED WITH DIFFERENT CONCENTRATIONS OF ADJUVANT

Bird flu vaccine from H5N1 strain of avian influenza virus was prepared with two concentrations of adjuvant (Montanide ISA 70MVG). Two vaccines (I and II) were prepared containing 50 and 60% Montanide, respectively. Immune response of both the vaccines as single, as well as booster, dose was evaluated in layer birds through haemagglutination inhibition test. Single dose of both vaccines showed poor immune response, while booster dose gave better response with both the vaccines. However, the vaccine prepared with 60% Montanide provided better immune response compared with the vaccine containing 50% montanide

Orbital Angular Momentum-based Space Division Multiplexing for High-capacity Underwater Optical Communications

To increase system capacity of underwater optical communications, we employ the spatial domain to simultaneously transmit multiple orthogonal spatial beams, each carrying an independent data channel. In this paper, we multiplex and transmit four green orbital angular momentum (OAM) beams through a single aperture. Moreover, we investigate the degrading effects of scattering/turbidity, water current, and thermal gradient-induced turbulence, and we find that thermal gradients cause the most distortions and turbidity causes the most loss. We show systems results using two different data generation techniques, one at 1064 nm for 10-Gbit/s/beam and one at 520 nm for 1-Gbit/s/beam, we use both techniques since present data-modulation technologies are faster for infrared (IR) than for green. For the higher-rate link, data is modulated in the IR, and OAM imprinting is performed in the green using a specially-designed metasurface phase mask. For the lower rates, a green laser diode is directly modulated. Finally, we show that inter-channel crosstalk induced by thermal gradients can be mitigated using multi-channel equalisation processing.Comment: 26 pages, 5 figure

Update of the measurement of the cross section for e^+e^- -> psi(3770) -> hadrons

We have updated our measurement of the cross section for e^+e^- -> psi(3770) -> hadrons, our publication "Measurement of sigma(e^+e^- -> psi(3770) -> hadrons) at E_{c.m.} = 3773 MeV", arXiv:hep-ex/0512038, Phys.Rev.Lett.96, 092002 (2006). Simultaneous with this arXiv update, we have published an erratum in Phys.Rev.Lett.104, 159901 (2010). There, and in this update, we have corrected a mistake in the computation of the error on the difference of the cross sections for e^+e^- -> psi(3770) -> hadrons and e^+e^- -> psi(3770) -> DDbar. We have also used a more recent CLEO measurement of cross section for e^+e^- -> psi(3770) -> DDbar. From this, we obtain an upper limit on the branching fraction for psi(3770) -> non-DDbar of 9% at 90% confidence level.Comment: 3 pages, 0 figures. This is an erratum to Phys.Rev.Lett.96:092002,2006. Added a reference

Determination of the D0 -> K+pi- Relative Strong Phase Using Quantum-Correlated Measurements in e+e- -> D0 D0bar at CLEO

We exploit the quantum coherence between pair-produced D0 and D0bar in psi(3770) decays to study charm mixing, which is characterized by the parameters x and y, and to make a first determination of the relative strong phase \delta between doubly Cabibbo-suppressed D0 -> K+pi- and Cabibbo-favored D0bar -> K+pi-. We analyze a sample of 1.0 million D0D0bar pairs from 281 pb^-1 of e+e- collision data collected with the CLEO-c detector at E_cm = 3.77 GeV. By combining CLEO-c measurements with branching fraction input and time-integrated measurements of R_M = (x^2+y^2)/2 and R_{WS} = Gamma(D0 -> K+pi-)/Gamma(D0bar -> K+pi-) from other experiments, we find \cos\delta = 1.03 +0.31-0.17 +- 0.06, where the uncertainties are statistical and systematic, respectively. In addition, by further including external measurements of charm mixing parameters, we obtain an alternate measurement of \cos\delta = 1.10 +- 0.35 +- 0.07, as well as x\sin\delta = (4.4 +2.7-1.8 +- 2.9) x 10^-3 and \delta = 22 +11-12 +9-11 degrees.Comment: 37 pages, also available through http://www.lns.cornell.edu/public/CLNS/2007/. Incorporated referee's comment