A Retrospective Comparison of Daptomycin Thrice-Weekly Versus Q48H Dosing in Hemodialysis Patients with Vancomycin-Resistant Enterococcus (VRE) or Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia

Background. Multi-drug resistant bacteria are a growing concern in healthcare. Daptomycin is being used with increasing frequency in the treatment of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in hemodialysis (HD) patients. Thrice-weekly dosing of daptomycin in this population would allow for coordination of dosing with common outpatient HD schedules. The aim of this study is to determine if thrice-weekly dosing of daptomycin is equivalent to dosing every 48 hours in patients receiving chronic intermittent hemodialysis. Equivalence will be assessed with regard to microbiological cure, clinical cure, hospital length of stay, and mortality. Methods. All patients with positive blood cultures who received at least one dose of daptomycin between January 1st 2009 and December 31st 2010 at Indiana University Health Methodist and University Hospitals were identified. Adult patients with end-stage renal disease on a stable thrice-weekly hemodialysis regimen, confirmed VRE or MRSA bacteremia, and at least three doses of inpatient daptomycin therapy were enrolled in the study. Results. Twelve patients met criteria for inclusion in this study. Nine received daptomycin every 48 hours for the treatment of bacteremia, and three received daptomycin thrice-weekly after dialysis. There was no difference in time to clearance of blood cultures between the Q48H and thrice-weekly groups (2.11±2.15 days vs. 4.33±4.16 days; p=0.241).Length of hospital stay was not statistically significantly different between the two groups (22.8 days vs. 14.9 days; p=0.065).Conclusions. Thrice-weekly dosing of daptomycin may be effective for the treatment of bacteremia in hemodialysis patients

Radial gradients and anisotropies of cosmic rays in the interplanetary medium

Radial gradients and anisotropies of cosmic rays in interplanetary mediu

Evidence-based programs in children's services: A critical appraisal

Evidence-based programs (EBPs) are increasingly being implemented in children's services agencies in developed countries. However, this trend is meeting resistance from some researchers, policy makers and practitioners. In this article we appraise the main critiques, focusing on scientific, ideological, cultural, organizational and professional arguments. We contend that some of the resistance stems from misconceptions or an oversimplification of issues, while others represent valid concerns that need to be addressed by proponents of EBPs. We set out implications for the development and evaluation of programs and how they are introduced into service systems, and conclude with broader recommendations for children's services. © 2012 Elsevier Ltd

First order Fermi acceleration driven by magnetic reconnection

A box model is used to study first order Fermi acceleration driven by magnetic reconnection. It is shown, at least in this simple model, that the spectral index of the accelerated particles is related to the total compression in the same way as in diffusive shock acceleration and is not, as has been suggested, a universal $E^{-5/2}$ spectrum. The acceleration time-scale is estimated and some comments made about the applicability of the process.Comment: Accepted for MNRA

Index

The interest in relativistic beam-plasma instabilities has been greatly rejuvenated over the past two decades by novel concepts in laboratory and space plasmas. Recent advances in this long-standing field are here reviewed from both theoretical and numerical points of view. The primary focus is on the two-dimensional spectrum of unstable electromagnetic waves growing within relativistic, unmagnetized, and uniform electron beam-plasma systems. Although the goal is to provide a unified picture of all instability classes at play, emphasis is put on the potentially dominant waves propagating obliquely to the beam direction, which have received little attention over the years. First, the basic derivation of the general dielectric function of a kinetic relativistic plasma is recalled. Next, an overview of two-dimensional unstable spectra associated with various beam-plasma distribution functions is given. Both cold-fluid and kinetic linear theory results are reported, the latter being based on waterbag and Maxwell–Jüttner model distributions. The main properties of the competing modes (developing parallel, transverse, and oblique to the beam) are given, and their respective region of dominance in the system parameter space is explained. Later sections address particle-in-cell numerical simulations and the nonlinear evolution of multidimensional beam-plasma systems. The elementary structures generated by the various instability classes are first discussed in the case of reduced-geometry systems. Validation of linear theory is then illustrated in detail for large-scale systems, as is the multistaged character of the nonlinear phase. Finally, a collection of closely related beam-plasma problems involving additional physical effects is presented, and worthwhile directions of future research are outlined.Original Publication: Antoine Bret, Laurent Gremillet and Mark Eric Dieckmann, Multidimensional electron beam-plasma instabilities in the relativistic regime, 2010, Physics of Plasmas, (17), 12, 120501-1-120501-36. http://dx.doi.org/10.1063/1.3514586 Copyright: American Institute of Physics http://www.aip.org/</p

The Density Spike in Cosmic-Ray-Modified Shocks: Formation, Evolution, and Instability

We examine the formation and evolution of the density enhancement (density spike) that appears downstream of strong, cosmic-ray-modified shocks. This feature results from temporary overcompression of the flow by the combined cosmic-ray shock precursor/gas subshock. Formation of the density spike is expected whenever shock modification by cosmic-ray pressure increases strongly. That occurence may be anticipated for newly generated strong shocks or for cosmic-ray-modified shocks encountering a region of higher external density, for example. The predicted mass density within the spike increases with the shock Mach number and with shocks more dominated by cosmic-ray pressure. We find this spike to be linearly unstable under a modified Rayleigh-Taylor instability criterion at the early stage of its formation. We confirm this instability numerically using two independent codes based on the two-fluid model for cosmic-ray transport. These two-dimensional simulations show that the instability grows impulsively at early stages and then slows down as the gradients of total pressure and gas density decrease. Observational discovery of this unstable density spike behind shocks, possibly through radio emission enhanced by the amplified magnetic fields would provide evidence for the existence of strongly cosmic-ray modified shock structures.Comment: 26 pages in Latex and 6 figures. Accepted to Ap

Fine structure in the gamma-ray sky

The EGRET results for gamma-ray intensities in and near the Galactic Plane have been analysed in some detail. Attention has been concentrated on energies above 1 GeV and the individual intensities in a $4^\circ$ longitude bin have been determined and compared with the large scale mean found from a nine-degree polynomial fit. Comparison has been made of the observed standard deviation for the ratio of these intensities with that expected from variants of our model. The basic model adopts cosmic ray origin from supernova remnants, the particles then diffusing through the Galaxy with our usual 'anomalous diffusion'. The variants involve the clustering of SN, a frequency distribution for supernova explosion energies, and 'normal', rather than 'anomalous' diffusion. It is found that for supernovae of unique energy, and our usual anomalous diffusion, clustering is necessary, particularly in the Inner Galaxy. An alternative, and preferred, situation is to adopt the model with a frequency distribution of supernova energies. The results for the Outer Galaxy are such that no clustering is required.Comment: 10 pages, 4 figures, 1 table, accepted for publication in J.Phys.G: Nucl.Part.Phy

Galactic Cosmic Rays from Supernova Remnants: II Shock Acceleration of Gas and Dust

This is the second paper (the first was astro-ph/9704267) of a series analysing the Galactic Cosmic Ray (GCR) composition and origin. In this we present a quantitative model of GCR origin and acceleration based on the acceleration of a mixture of interstellar and/or circumstellar gas and dust by supernova remnant blast waves. We present results from a nonlinear shock model which includes (i) the direct acceleration of interstellar gas-phase ions, (ii) a simplified model for the direct acceleration of weakly charged dust grains to energies of order 100keV/amu simultaneously with the gas ions, (iii) frictional energy losses of the grains colliding with the gas, (iv) sputtering of ions of refractory elements from the accelerated grains and (v) the further shock acceleration of the sputtered ions to cosmic ray energies. The calculated GCR composition and spectra are in good agreement with observations.Comment: to appear in ApJ, 51 pages, LaTeX with AAS macros, 9 postscript figures, also available from ftp://wonka.physics.ncsu.edu/pub/elliso

Nonthermal Bremsstrahlung and Hard X-ray Emission from Clusters of Galaxies

We have calculated nonthermal bremsstrahlung (NTB) models for the hard X-ray (HXR) tails recently observed by BeppoSAX in clusters of galaxies. In these models, the HXR emission is due to suprathermal electrons with energies of about 10-200 keV. Under the assumption that the suprathermal electrons form part of a continuous spectrum of electrons including highly relativistic particles, we have calculated the inverse Compton (IC) extreme ultraviolet (EUV), HXR, and radio synchrotron emission by the extensions of the same populations. For accelerating electron models with power-law momentum spectra (N[p] propto p^{- mu}) with mu <~ 2.7, which are those expected from strong shock acceleration, the IC HXR emission exceeds that due to NTB. Thus, these models are only of interest if the electron population is cut-off at some upper energy <~1 GeV. Similarly, flat spectrum accelerating electron models produce more radio synchrotron emission than is observed from clusters if the ICM magnetic field is B >~ 1 muG. The cooling electron model produces vastly too much EUV emission as compared to the observations of clusters. We have compared these NTB models to the observed HXR tails in Coma and Abell 2199. The NTB models require a nonthermal electron population which contains about 3% of the number of electrons in the thermal ICM. If the suprathermal electron population is cut-off at some energy above 100 keV, then the models can easily fit the observed HXR fluxes and spectral indices in both clusters. For accelerating electron models without a cutoff, the electron spectrum must be rather steep >~ 2.9.Comment: Accepted for publication in the Astrophysical Journal. 10 pages with 5 embedded Postscript figures in emulateapj.sty. An abbreviated abstract follow