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Background Antimicrobial use in Irish older persons residential care facilities (OP RCFs) is higher than in other European countries. In 2020/21, for the first time, an antimicrobial pharmacist (AMP) was appointed to each community healthcare organization (CHO) to monitor, develop and promote antimicrobial stewardship in community settings. Objectives To establish baseline antibiotic use, develop antimicrobial stewardship tools for OP RCFs, promote best practice in relation to antimicrobial stewardship (AMS) and monitor trends in antimicrobial use in HSE (state-run) OP RCFs. Methods A baseline point prevalence survey (PPS) of antimicrobial use was conducted across all HSE OP RCFs between October 2020 and August 2021. Following the survey, key national recommendations and AMS resources were developed in collaboration with the national Antimicrobial Resistance and Infection Control Programme. Feedback was provided to participating facilities by CHO AMPs with antimicrobial stewardship support and education for nursing and medical staff. In September 2021, monthly monitoring of antibiotic use was established in HSE OP RCFs in collaboration with local managers, to capture the proportion of antibiotics used for prophylaxis or treatment each month. Results A baseline PPS of antimicrobial use in 2020/21 showed that 11.9% (528/4446) of residents were on a systemic antibiotic, with 6.3% on antibiotic prophylaxis. Urinary tract infection accounted for 51% of antibiotic prescriptions. Following the baseline PPS, CHO AMPs developed an AMS toolkit for OP RCFs, engaged with nursing and medical staff to communicate PPS results, AMS resources and support implementation of AMS recommendations. Subsequently, monthly self-reporting of antimicrobial use in HSE OP RCFs was commenced in September 2021 and showed a sustained decrease in antimicrobial use with 7.9% residents on an antibiotic in Quarter 2 2022, with 2.7% on antibiotic prophylaxis. Conclusions Newly appointed CHO AMPs have successfully promoted AMS across HSE OP RCFs. Following audit, feedback, education, development and promotion of antimicrobial stewardship resources, there was a sustained decrease in the proportion of residents on antibiotics used for treatment and prophylaxis of infection.

Background Antimicrobial use in mental health inpatient settings has not been extensively examined in Ireland. The Healthcare-Associated Infection and Antimicrobial Use in Long-Term Care Facilities (HALT) study 2016 found that Irish long-term care facilities caring for residents with psychiatric conditions had an antimicrobial prevalence rate of 7.7%, higher than the European average of 4.9%. National community antimicrobial prescribing guidelines are available at www.antibioticprescribing.ie. In addition, a preferred antibiotic initiative for community settings advocates prescribers to choose ‘Green’ (preferred) antibiotics over ‘Red’ (reserved) agents. Reserved agents are considered to have more adverse effects, drug interactions and potential for development of antimicrobial resistance. The patient safety implications of antimicrobial stewardship along with an ageing population, and potential drug–drug interactions between many antimicrobials and psychotropic medications prompted a review of antimicrobial use practices in mental health services. Methods A sample of adult inpatient mental health facilities (MHF) operated by the state's Health Service Executive (HSE) were surveyed by community antimicrobial pharmacists (AMPs) between November 2021 and January 2022. AMPs reviewed patients’ medication charts for systemic antimicrobial prescriptions in the previous 30 days in addition to medical notes and laboratory results (where available). Adherence to HSE National community antimicrobial guidelines and the systems and structures in place to support antimicrobial stewardship were assessed. Results In total, 1003 patients in 51 MHFs were surveyed. At the time of survey, 6.3% (n=66) patients were on a systemic antimicrobial and 15% (n=153) had received a systemic antimicrobial within the previous 30 days. Prophylaxis accounted for 50% of antibiotic use (3.3% of all patients), with the most common indication being the prevention of urinary tract infection (UTI) (58%). Prophylaxis duration exceeded six months in 61% of prescriptions. The median duration of treatment courses was seven days. The proportion of ‘Green’ (preferred) antimicrobials versus ‘Red’ (reserved) antimicrobials was 58% versus 38%. Co-amoxiclav, a ‘Red’ agent was the most commonly prescribed antibiotic for treatment of infection (31%). Adherence with choice of antimicrobial agent as per national antimicrobial guidelines was 76%; adherence of dosing regimen was 75% and adherence with recommended duration was 46%. The main themes for non-adherence with choice of agent were use of unnecessarily broad spectrum agents, nitrofurantoin prescribed in renal impairment and inappropriate formulation of nitrofurantoin chosen. Dipstick urinalysis was performed routinely (on admission and/or at designated intervals) for persons asymptomatic of UTI in 53% (n=27) of MHFs. Conclusions This PPS established antimicrobial use practices in HSE MHFs and identified opportunities for improvement relating to the safe and optimal use of antimicrobials. Key national recommendations from this survey were

Background The HALT study in 2016 found that residents in Irish OPS RCFs were twice as likely to be on systemic antimicrobial compared with European average (10% v 5%). National antibiotic prescribing guidelines are available at www.antibioticprescribing.ie and prescribers are encouraged to choose ‘green’ (preferred) over ‘red’ (reserved) agents. HSE Community Antimicrobial Pharmacists (AMPs) have been employed since 2020. We aimed to establish the quality and quantity of antimicrobial prescribing in OPS-RCFs to inform antimicrobial stewardship activities. Methods All residents in HSE OPS-RCFs were surveyed between October 2020 and August 2021. AMPs reviewed all medication charts for systemic antimicrobials prescribed within previous 30 days. Medical notes +/- laboratory results were reviewed for persons on antimicrobials. Adherence to guidelines was assessed and information obtained on practices related to antimicrobial use. Results The survey included 4,448 individuals in 121 OPS RCFs. 12% were on systemic antimicrobial at time of survey. 27% received an antimicrobial in the previous 30 days. 50% of antibiotic use on survey day was for prophylaxis (6.3% of all residents). Prophylaxis exceeded 6 months in 66% persons, and 12 months in 57%. There was high usage of green versus red agents (65% vs 30%). Co-amoxiclav (red) was most commonly prescribed antimicrobial to treat infection (19%). 42% of sites reported routine use of dipstick urinalysis to support diagnosis of UTI in asymptomatic residents. 36% of sites did not have onsite electronic laboratory access. 61% of facilities did not record residents’ pneumococcal vaccination status. Conclusion Key national recommendations: Review all UTI prophylaxis within 6 months of initiation with view to de-prescribing.Cease routine use of dipstick urinalysis to support diagnosis of UTI for asymptomatic persons.Electronic access to laboratory results on-site required to support timely decision-making.All staff should be aware of the national antimicrobial guidelines.Pneumococcal vaccine status should be determined, and provided as necessary.

Grenzenlos Deutsch ( GD) is an open educational resource (OER) that functions as a digital archive. Considerations of equity, social justice, and accessibility inform decision-making and workflow at all stages of fashioning the GD curriculum as a no-cost alternative to traditional beginning German textbooks. In this essay, six members of the GD team reflect on digital curation, considering how the team’s collective identities, values, and instructional goals intersect with the processes of creating and curating the curriculum, particularly the production and preservation of audiovisual material such as images, interviews, and videos as learning objects. Although these learning objects constitute a public archive, they also mark events of personal and collaborative significance in the private and professional lives of the GD collective, whose members played varying roles in producing these instructional materials.

Electronic health records (EHRs) have provided physicians with a systematic framework for collecting patient data, organizing notes from the healthcare team, and managing the daily workflow in the modern era of healthcare. Despite these advantages, EHRs have proven to be problematic for clinicians. The burdensome regulations requiring increased documentation with the EHR paradigm have led to inefficiencies from data-entry requirements forcing physicians to spend an inordinate amount of time on it, affecting the time available for direct patient care as well as leading to professional burnout. As a result, new modalities such as speech recognition, medical scribes, pre-made EHR templates, and digital scribes [a form of artificial intelligence (AI) based on ambient speech recognition] are increasingly being used to reduce charting time and increase the time available for patient care. The purpose of our review is to provide an up-to-date review of the literature on these modalities including their benefits and shortcomings, to help physicians and other medical professionals choose the best methods to document their patient-care encounters efficiently and effectively.

Suturing is an essential procedural skill that medical students are expected to be competent in before they graduate medical school; however, there is often a lack of suturing instruction and practice in undergraduate medicine curriculums. Silicone suturing task trainers created from 3D printed molds can help address this gap in medical education by improving student's manual skills before they perform procedures on real patients upon graduation. Commercially available suture task trainers on the market today lack validation from medical learners; therefore, this study aimed to evaluate the perceived efficacy of a silicone skin suture task trainer created from a 3D printed mold using input from novice medical trainees. A silicone task trainer created by MUN Med 3D was used to teach suturing during two surgery interest group skill development sessions. At the end of the sessions, 38 medical students completed a product evaluation survey that assessed the perceived educational efficacy of the suturing task trainer. Overall, the feedback received from the participants was positive and supported the use of silicone suturing task trainers in undergraduate medicine curriculums.

What does it mean to teach German as a foreign language in a US classroom? What is foreign and what is not, who is foreign and who is not, who is an insider and who is an outsider? This essay serves to decolonize German Studies by bringing a Critical Whiteness Studies perspective to the field of second language acquisition and into the German classroom. The two parts of this essay address theoretical considerations drawn from critical pedagogy and critical theory, in particular Critical Whiteness Studies and offer concrete activities for an intermediate or advanced German classroom that highlights the importance of reflectivity and positionality. In a multi-class lesson focused on the concepts of Auslander, Heimat, Leitkultur, and Reprasentation as seen through the films Yes I Am! (Sven Halfar, 2007) and Auslander raus! Schlingensiefs Container (Paul Poet, 2002) students will explore competing discourses about foreignness in diverse German-language contexts.

Kelp ecology is heavily biased toward the conspicuous sporophyte stage, whereas understanding of the microscopic gametophyte remains limited. Given that kelp gametophytes are known to grow in/on other species of algae, we sought to determine if species-specific polymerase chain reaction could detect kelp gametophytes in situ from coextracted host DNA. Upon verifying our molecular results, we also assessed distributional patterns of the kelp gametophytes according to site, host species, and vertical placement in the intertidal zone. We sampled Chondrus crispus, Mastocarpus stellatus, and Palmaria palmata (Florideophyceae) at Wallace Cove, New Brunswick, Canada, on 13 September 2016, where kelp sporophytes were abundant, and at an adjacent location without obvious sporophyte presence, L'Etete, on 26 September 2016. Species-specific primers were used to assess the presence of Alaria esculenta and Laminaria digitata DNA from coextracted red algal DNA. We successfully amplified kelp DNA from the host ...

BackgroundThere is a significant learning curve when teaching ultrasonography to medical trainees; task trainers can help learners to bridge this gap and develop their skills. Three-dimensional printing technology has the potential to be a great tool in the development of such simulators. ObjectiveThis scoping review aimed to identify what 3D-printed models have been used in ultrasound education to date, how they were created and the pros and limitations involved.DesignResearchers searched three online databases to identify 3D-printed ultrasound models used in medical education.ResultsTwelve suitable publications were identified for inclusion in this review. The models from included articles simulated largely low frequency and/or high stakes events, with many models simulating needle guidance procedures. Most models were created by using patient imaging data and a computer-aided design software to print structures directly or print casting molds. The benefits of 3D-printed educational trainers are their low cost, reproducibility, patient specificity and accuracy. The current limitations of this technology are upfront investments and a lack of optimisation of materials.ConclusionsThe use of 3D-printed ultrasound task trainers is in its infancy, and more research is needed to determine whether or not this technology will benefit medical learners in the future.

The (6R*,9S*,11S*) and (22S*,23R*,27R*,31R*) stereochemistry, respectively, of the tetrahydropyranyl and spiroacetal moieties in bistramide A (1) have been established by stereoselective syntheses and high field NMR comparisons. Routes to the gamma-amino acid moiety are outlined. (C) 2002 Elsevier Science Ltd. All rights reserved.

Application of a microwave dissolution technique to soil materials aided by acid digestion procedures has many advantages, but the incomplete dissolution of sandy soils has been noted. The objectives of this study were to modify a microwave oven digestion technique to facilitate the determination of the total elemental content of soils and geologic materials containing greater than 45% sand and apply these data to determine natural separations in parent materials. A microwave dissolution technique using aqua regia (HNO3 and HCl) and hydrofluoric acid (HF) was modified such that the HF is added to the solid 16 hours prior to aqua‐regia addition and subsequent microwave heating. Elemental recoveries were validated using a NBS coal fly ash standard. This procedure was applied to soil core samples representing a wide range of geological and pedological weathering sequences and soil textural classes. Separations in the parent material were determined by observing natural breaks in the elemental concen...

This article examines the representation of white female heroines in works of lesser-known colonial writers including Agnes Sapper, Henny Koch, Elisa Bake, Valerie Hodann, and Hanna Christaller. Whiteness as portrayed by these authors is both powerful and fragile; white German women are both the bearers of German culture, able to bring order and civilization to “wild” Africa, and vulnerable creatures who can be attacked and violated by natives. The responsibility for upholding this racialized German identity and bearing white German children in Germany’s African colonies is placed on female characters, and the need to protect these young female heroines from Black male violence is used to justify the genocide against the Herero and Nama peoples.

The University of Chicago Solar Energy Group has had a continuing program and commitment to develop an advanced evacuated solar collector integrating nonimaging concentration into its design. During the period from 1985--1987, some of our efforts were directed toward designing and prototyping a manufacturable version of an Integrated Compound Parabolic Concentrator (ICPC) evacuated collector tube as part of an international cooperative effort involving six organizations in four different countries. This ``multilateral`` project made considerable progress towards a commercially practical collector. One of two basic designs considered employed a heat pipe and an internal metal reflector CPC. We fabricated and tested two large diameter (125mm) borosilicate glass collector tubes to explore this concept. The other design also used a large diameter (125mm) glass tube but with a specially configured internal shaped mirror CPC coupled to a U-tube absorber. Performance projections in a variety of systems applications using the computer design tools developed by the International Energy Agency (IEA) task on evacuated collectors were used to optimize the optical and thermal design. The long-term goal of this work continues to be the development of a high efficiency, low cost solar collector to supply solar thermal energy at temperatures up to 250{degree}C. Somemore » experience and perspectives based on our work are presented and reviewed. Despite substantial progress, the stability of research support and the market for commercial solar thermal collectors were such that the project could not be continued. A cooperative path involving university, government and industrial collaboration remains the most attractive near term option for developing a commercial ICPC.« less

A group of psychiatrists and mental health staff from many of the new entrants to the European Community and from candidate countries as well as from the UK met in Luton, Bedfordshire on 17 and 18 Sep- in Luton, Bedfordshire on 17 and 18 September 2004 to discuss early intervention tember 2004 to discuss early intervention in psychotic illness. At the end of the conference, the delegates discussed the issues raised by Andrej Marus raised by Andrej Marusic (2004) in the ˇicˇ (2004) in the Journal, peer-reviewed

Use of a two-stage concentrator with a fresnel lens primary and a nonimaging dielectric totally internally reflecting secondary, has unique advantages for photovoltaic concentration. Some preliminary ray trace studies have shown that with planar lenses, an increase in angular acceptance for a given geometric concentration to about 2/3 of the maximum theoretical limit can be achieved. To demonstrate this, two preprototype concentrators, each having a geometric concentration of 248:1 for a 0.635cm (0.25 inch) diameter cell, have been designed, built, and tested. Measurements of the angular response show an acceptance of 8{degrees} (full angle) which is drastically better than the 1{degrees}--2{degrees} achievable without a secondary, and is in excellent agreement with the ray trace predictions. For these preprototypes, passive cooling was sufficient to prevent any thermal problems for both the cell and secondary. No problems associated with nouuniform cell illumination were found, as evidenced by the fill factor of 71%--73% measured under concentration. Initial measurements of the system electrical efficiency lie in the range 7.5%--9.9% for a variety of individual cells.