Category: xboeoxwq

Phil Lesh Announces Two-Night Valentines Day Run With Stanley Jordan At Terrapin Crossroads

first_imgPhil Lesh & Friends will be hosting a two-night Valentine’s Day run at his Terrapin Crossroads on February 14 & 15. Joining him for these lovely performances are Stanley Jordan on guitar, multi-instrumentalists Barry Sless and Jason Crosby, John Molo on drums and The Midnight North Singers (Grahame Lesh, Elliott Peck and Alex Koford). Both shows are now sold out.Watch Phil Lesh Get Down For Three Full Sets At Terrapin Crossroads [Full Video]Prior to the two-night run, Stanley Jordan will be playing a solo show at the San Francisco venue on February 13. With love in the air, the nights are sure to be special for everyone.Enjoy this fan-shot video of Phil & Friends, featuring Stanley Jordan, perform “Eyes Of The World” at the Roseland in NYC back in 2012:[H/T JamBase]last_img read more

Newt Gingrich to speak at Lincoln Day Dinner

first_imgNotre Dame College Republicans (NDCR) has invited former Speaker of the House and 2012 presidential candidate Newt Gingrich for its annual Lincoln Day Dinner and Speech on April 15.“The Lincoln Day Dinner is an annual event that most Republican organizations hold,” NDCR president, senior Mark Gianfalla, said. “For us, we’ve had one as long as I’ve been here. … I think continually for the last 10 years our club has done it.“In the last few years we’ve really picked up the fundraising aspect of it and basically increased our budget for the event 500 times what it was two years ago.”Last year, the club invited Fox News contributor and conservative political pundit Ann Coulter to speak at the Lincoln Day events, drawing harsh criticism from several student groups and inspiring a series of protests on campus.The Lincoln Day celebrations include a speech, which is free but ticketed and open to the public, that will be held April 15 at 6 p.m. in Washington Hall, and the dinner that follows is for members of the club and community members.Gianfalla said he anticipates 250 attendees at the dinner, a dramatic increase from last year’s 85 attendees and 30 the year before.“Anybody who has an affiliation with the club is invited — dues-paying members obviously have first access, and then faculty and staff who want to attend,” Gianfalla said.“We have some alumni … but also a large portion of the local community that is supportive, both financially and through campaign efforts and club events — we invite those people as well. This year, a large portion of the attendees will be community members,” he said.To fund what Gianfalla described as a “$25,000 event,” the club has turned local party affiliates and national organizations for assistance. In particular, NDCR formed a partnership with the Young America’s Foundation (YAF), a group that describes itself as “the principal outreach organization for the conservative movement.”“We started a partnership with the Young America’s Foundation, which is a group that supports collegiate efforts to bring in conservative speakers,” Gianfalla said. “[YAF] negotiate the contracts with the speaker. They have existing relationships, and they contribute financially to bring in that speaker.“… They contribute thousands of dollars to our speaker fees every year; this year they’re contributing a large portion — at least half — and the rest of that is coming from the local Republican Party … and individuals in the community such as local party members and people who have supported us in the past who live locally. We also get some money from the University as a club, and a small portion of that comes from dues as well,” Gianfalla said.In choosing the Lincoln Day speaker, Gianfalla said budget limitations played a role in the decision but that the speaker’s “notoriety” and ability to draw a crowd was also a factor.“We want someone with good name recognition, who can fill a 650-person auditorium,” he said. “We also want [someone] who can add quality discussion, quality commentary during the speech.”NDCR secretary, sophomore Dylan Stevenson, added that Gingrich proved a good choice for the dinner because of his unique perspective and experiences in government.“To mention that Gingrich was Speaker of the House [of Representatives], House Minority Whip and that he was Time’s ‘Man of the Year’ in 1994 would be to mention just a few of his many achievements,” Stevenson said in an email. “He served over 20 years as a Representative in the House and had the ear of Presidents Reagan and Clinton.“One of the main reasons we invited him was to hear him reflect on these experiences and really give the club a good idea as to what it’s like to have access to the corridors of power. As a former Presidential candidate, he can provide a really unique perspective about that process as the two parties gear up for primaries.“I think one of the big things that he’ll do to help dialogue is draw attention to the Party and its principles. I think that, by highlighting how Conservative principles would help this country, he’ll get the proverbial ball rolling, and I think we’ll see intelligent discussion about these principles filtering through the student body. Moreover, given that we’re already seeing potential 2016 candidates make themselves known, I think he’ll add fuel to the fire of presidential intrigue that is starting to grow here,” Stevenson said.According to Gianfalla, Gingrich will speak on “domestic and foreign policy” in his speech, in line with the events that NDCR has participated in and hosted so far this year.“This year, we wanted to choose someone who would follow the theme of our programming,” Gianfalla said. “We had a big Rick Santorum speech at the beginning of the year, and we’ve had a lot of political discussion at our meetings and as well as a lot of debate.“We really wanted to engage the knowledge base of the student body … to broaden that base on issues. I think [Newt Gingrich] will foster that aspect of our programming this year very well.”Tags: lincoln day, lincoln day dinner, Mark Gianfalla, newt gingrich, Notre Dame College Republicanslast_img read more

Review: Otso Waheela C is a Swiss Army gravel bike that can do almost…

first_imgIf you’ve read my other stories about Otso, you’re probably aware that I’m a big fan of their Voytek fat bike. Mostly, that comes from the narrow Q-factor with the ability to run multiple tire sizes thanks to some clever engineering and their Tuning Chip dropout system. So when I heard that they were bringing the same versatility concept to a carbon gravel bike, naturally I was intrigued. More than intrigued. I was downright excited. But as is often the case – would the actual bike live up to the hype I built up in my own head? I wasn’t sure, but I couldn’t wait to find out.In order to get a bike into my hands as soon as possible, Otso ended up sending one of their final test samples in a non-descript blacked out finish. Even without any visible branding (or maybe because of it), the bike attracted a lot of attention wherever it went. Mostly along the lines of, “wow, what is that? It looks awesome.” Without spilling the beans as to who made it, riders seemed to like the built in versatility. With three sets of tires and three different drop out positions, it’s essentially an all road bike, gravel race bike, and big tire gravel/bikepacking bike all in one. Chips help you get skinnyAs much as I love gravel, there are days where you need to put in miles on the pavement and this gets it done with a simple swap of the tires and change of the dropout position. And it’s not like it’s a dog once you throw on road shoes either. The frame is surprisingly efficient for something that’s made to fit large mountain bike tires from the 90’s.Otso lists tires down to 28mm as compatible with the Waheela C frameset, but to me that would have to be a big 28mm on wide rims. Even the 30mm G-Ones measured just 29.37mm on wide rims and I felt like that was as small as I would want to go with this bike.Of all the tire combinations I tried with the Waheela C however, this one was the most surprising. Most of the time when I’ve thrown a set of slicks in a CX or a gravel frame, the resulting BB drop has been too severe for my liking, leading to clipped pedals and funky handling. On the contrary, when swapped over to ‘all road’ tires with the Tuning Chip all the way forward, the Waheela just gets better. So far I’ve done a number of long training rides with the G-Ones and it really made me think that this really is a quiver killer. The ability to shorten the stays and raise the BB results in a nimble road machine with impressive power transfer. Something that can run 2.1″ MTB tires has no business being this good with 30mm tires. It looks a little weird with all of that empty space around the tire, but it rides well enough to make up for it.Gravel MasterTo be honest though, you don’t even need the road tires for it to be quick on pavement. While out riding some dirt trails with the 40mm (but actually 43.69mm) Terrene Elwoods mounted, I ran into some friends. Before I knew it, we were meeting up with a few other riders to start a quick group road ride. Even taking pulls up front, the Waheela motored along, big tires and all. The Elwoods are a little slick in the center for our greasy trails this time of year, but the trade off is that fast performance on the road. They also offer decent amounts of grip when you turn into a corner off road.Dropbar MTB? Monster Gravel? Yes.Getting even more radical, I mounted up the Schwalbe Racing Ralphs in a full 29 x 2.1″. Surprisingly, these actually fit in the frame in the front chip setting – though I wouldn’t recommend actually riding it that way. There’s just not enough tire clearance to be on the safe side. But in the middle and rear position? There’s more than enough room. Only in the absolute worst mud (the kind that globs over the sidewalls of your tire and doesn’t come off) was there any issue with mud clearance. But the key thing is that even then, the bike kept moving as the stays peeled away the mud (note that these were river bottom trails that were open, I wasn’t out destroying hand built trails).Overall, the road and gravel tires were my favorite set up, but the ability to run something like the Racing Ralphs is a huge bonus. To me, this would be best for using the Waheela as an offroad bike packing rig. It’s also fun just ride the big tires on mountain bike trails, but the bike is quite a bit slower on the pavement which still makes a gravel tire the best compromise in my eyes. Also note that for me on a medium frame with size 42 shoes, there was the tiniest bit of toe overlap with the 2.1″ tires. As in my toe would just touch the tread blocks, but if you pushed the bars to the side, the knobs would flex over it. Obviously bigger shoes may have more issue, so keep that in mind.Suspension? SureWant even more? Don’t forget that the Waheela C is suspension corrected so it’s designed to work exceptionally well with a Lauf Grit, Fox AX, or similar gravel oriented suspension fork. It’s also set up pretty well for in terms of frame mounts, though many bike packers would probably want to see 3 pack mounts on the forks and possibly internal dynamo wiring.If this was my bike, I’d have a set of 30mm slicks and something like the WTB Riddler 45s as the main set up which could easily cover all of my drop bar needs. That seems to be the beauty of the Waheela C – you can make it your ideal drop bar build without much work, whether that’s all road, gravel, or bike packing. If you’re tight on space and/or cash, you can do all of this with a single wheelset and a few tires. Or, you can have a second or third wheelset ready to go so you could transform the Waheela into a different bike in minutes. There are a few gravel bikes out there with a little more compliance when it comes to the ride, but most of them are not nearly as versatile.Dropper compatibleHeck, you can even run a dropper post which I’ve been playing with on this build. Is it a necessity? Absolutely not. Did it make it easier to bunny hop big trees and send sketchy chutes? Certainly. You know your riding style. If you think a dropper post might help you in your riding, it probably will. If you don’t understand what all the fuss is about, skip it. It definitely adds some weight to the build, but as pictured, the bike came in just over 20lbs with the gravel tires mounted.One thing is for sure – Otso’s bikes deserve more attention than they currently get. When I talk about the brand to many riders I’m met with blank stares. But mention the fact that it’s the bike arm of Wolf Tooth Components, and then it clicks. But if they keep putting out bikes like the Waheela C, I get the feeling that they won’t be flying under the radar for long.otsocycles.comcenter_img Three tires. Three positions. All the possibilities.If you haven’t read the first post yet, one of the big things that makes all Otso frames unique is their patent pending Tuning Chip dropout system. The dropouts offer three axle positions, with 20mm in total chainstay length adjustment resulting in 420, 430, and 440mm CS lengths. The droput system is also slightly angled, which means that from the front to the back position, the bottom bracket height changes by a claimed 4mm. That’s key when you’re trying to fit anything from a 30mm road slick to a 29 x 2.1″ MTB tire in the same frame, as it helps to compensate for the added bottom bracket height from running larger tires.That doesn’t mean you’ll be able to get the same bottom bracket height across the board, though. Osto sent three different tires to try out with the Waheela C, all meant to be mounted to the DT Swiss Spline C 1800 wheels. These rims have a 22mm inner width which isn’t quite as wide as you’ll find on modern XC MTB wheels (24-25mm), but it’s wide enough to mount the bigger tires while still allowing for you to run something like the 30mm Schwalbe G-one Speed.With so many tire and dropout combinations to experiment with, I kept track of the various positions and measurements to visualize how the bike changed from tire to tire and chip to chip. So far, I’ve only been able to measure all three positions on the Terrene Elwood gravel tires, and keep in mind that my measurements are only approximate. I ended up seeing an 8mm difference in BB height from front to rear position, but if my measurements were +/-2mm, that could then work out to be the 4mm in difference claimed by Otso. Whatever the case, it seems like good news.Why? Since I was able to replicate the BB height of both the 700c x 30mm G-One Speed in the front chip setting with the 700c x 40mm Terrene Elwood in the rear setting, you can run slicks or gravel tires without being forced to ride with a higher bottom bracket. Although if you wanted a slightly higher BB for increased pedal clearance, or a shorter chainstay length to quicken the handling, you have the ability to do so with the Tuning Chip system.Tuning Chip system from the original Otso VoytekThe front and rear positions use the same chip, just flipped around. A second chip with a centered hole provides the middle axle setting.It may seem like a daunting task to change out the chip position, but all that is needed is a 20mm socket wrench and a 5mm allen wrench. Pop off the 20mm nuts, loosen the brake mount bolt, pull out the chips, replace with whatever position you’re wanting to run, and retighten the two nuts and brake bolt. Once you get good at it you should be able to have it done in less than 5 minutes with a work stand.last_img read more

NAHBS 2011 – Black Cat Cycles 29er Singlespeed, Touring Bike and Paul’s Cyclocross XC…

first_imgIt has four water bottle bosses, custom racks and retro 9 speed gearing with bar end shifters.Built for Paul of Paul Components, who calls it his CX XC bike. Swoopy seat stays with S-bends to keep it comfy. This one’s a bit more relaxed than their regular cross bikes, which are a bit more relaxed than euro ‘cross bikes with their taller BB and steeper head angle. The touring bike was built with oversized tubing to help carry the load and extra tire clearance. It handles a 45c tire w/o fenders, but smaller with ’em. Black Cat Cycles had three new bicycles on display next to their standard 26″ mountain bike, which was decked out with some 2012-ish Truvativ components that were slightly visible in the video they shot on the way to Austin.The touring bike, shown above, kept the classic aesthetic going, the cyclocross bike in the background was built for Paul of Paul Components and there was a new singlespeed 29er mountain bike, too. Jump past the break to see details and photos of ’em all, including the new Truvativ goodies… Their singlespeed 29er had handmade lugs made in-house. The frame had 140 hours of labor before paint. The tubes are butted True Temper tubing, even the bent ones. Fork crown is brass fillet brazed with silver brazed fork legs and steerer tube. Silver has a minimal heat affection, so it comes out stronger than if it were all brass brazed. All of their segmented forks are made that way. They created a custom curved stem to match the frame’s aesthetic.Swinger dropouts and 16.5″ chainstays, which is really short for a 29er and lets em keep a neutral head angle.Custom chainring by RCR Fabrications that mounts directly to XO crank.This is the mountain bike they rode in the video, and here are the new Truvativ components:last_img read more

Rinks ordered to close for new reservations for two weeks after outbreak

first_imgVermont Business Magazine Following the decision by the State of New Hampshire to close indoor skating facilities for two weeks, Governor Phil Scott today issued an executive order(link is external) prohibiting Vermont’s skating rinks from accepting new reservation for use of their facilities beginning today, October 16, at 5 pm, through midnight on October 30, 2020. Governor Scott said the directive is intended to prevent an influx of new users from high risk areas into Vermont’s ice rinks.“As of today, New Hampshire’s skating facilities were closed by their governor for two weeks in response to outbreaks that have resulted in 158 cases of COVID-19 among 23 different ice hockey teams,” Governor Scott said.  “In addition, there is an outbreak in central Vermont that may be connected to the outbreaks in New Hampshire. To reduce the risk to Vermonters, and to help sustain the progress we have made, rinks in Vermont may not take any additional reservations for the next two weeks.”Rinks may allow their currently scheduled operations over this two-week period, provided all other existing health and safety guidance is fully implemented. Governor Scott’s executive order also directs the Vermont Agency of Commerce and Community Development, in consultation with the Vermont Department of Health and the Agency of Natural Resources, to review current recreation guidance to determine if a more aggressive response is needed to prevent further spread of COVID-19 related to activities in indoor skating, hockey and other recreational facilities. Pop-up testing site will be open in Barre on SaturdayThe Vermont Department of Health on Tuesday first reported the outbreak of COVID-19 cases among members of youth and adult recreational hockey and Broomball teams in central Vermont. The outbreak is associated with people who practiced or played at the Central Vermont Memorial Civic Center in Montpelier earlier this month. Health officials said there has been no community spread of the virus beyond close contacts at this time.As of Friday, the Health Department has identified 18 confirmed cases among players and several close contacts.Most of the cases identified so far are among adults. The Health Department has informed schools if any cases were in attendance while they were infectious.The department’s contact tracing team has been reaching out to anyone who may have been affected, and is providing appropriate guidance and recommendations for isolation, quarantine and testing. Vermonters are asked to please answer the phone if called by the department. This is how you will learn of any risk to your health – and is the most effective way to contain outbreaks from spreading in the community.A pop-up test clinic will be held this Saturday, October 17, at the Barre Auditorium from 9:00 a.m. – 3:00 p.m. Testing is recommended for people with direct links to the teams, the Civic Center and their close contacts. Testing is not recommended for the wider Montpelier community in response to this situation. People can register for the pop-up clinic at healthvermont.gov/covid19-testing(link is external).The investigation began last week as part of the department’s standard outreach following receipt of positive COVID-19 laboratory test results.Health Commissioner Mark Levine, MD expressed appreciation for the cooperation the department has received from the players, the leagues and officials at the Civic Center. Dr. Levine asked Vermonters to remember the core actions that help protect against exposure to the virus and to preventing its spread — wear a mask, keep a 6-foot distance from others, avoid crowded spaces, wash hands frequently and stay home when sick.For more information about COVID-19, including symptoms, testing and prevention, visit healthvermont.gov/covid19(link is external).Source: Montpelier, Vt. – Governor 10.16.2020last_img read more

With 6th grade commission recommendations expected this spring, Hinson says shift to middle school couldn’t happen until at least 2019-20

first_imgShawnee Mission Superintendent Jim Hinson at Tuesday’s SuperChat.The 48-person commission on sixth-grade alignment convened by the Shawnee Mission School District last year is scheduled to make its recommendations to the school board in May. But if that group ends up advising that the district shift sixth graders out of the elementary setting and up to the middle school level, don’t expect a change to occur overnight.At his SuperChat question and answer session at Hocker Grove Middle School on Tuesday, Superintendent Jim Hinson said that if the commission recommended the shift, it would be at least two full school years before the changes could occur.“If ultimately there’s a decision made to move sixth grade to the middle school level, that is a multiple year transitioning process,” Hinson said. “If that decision is made this summer, obviously nothing happens for the 17-18 school year. We would not be able to make that happen for the 18-19 school year. Maybe 19-20 — but again a lot has to occur to move over 2,000 students out of their elementary buildings.”Hinson noted that the district would likely look to resuscitate two former junior high facilities that have housed administrative operations for the past several years, Broadmoor and Indian Creek, as middle school buildings if the board were to approve shifting sixth graders to the middle school level. Even with the addition of those two buildings as schools, the district would still face middle school capacity issues on the western side of the district. Hinson said the district would likely need to look to build a new middle school building to accommodate high-growth areas in Lenexa and Shawnee. But finding the 30 to 40 acre parcel of land needed for such a project is a major challenge.“It remains very difficult to find property on the western side of our school district that would be suitable to build a middle school,” he said.If the commission recommends the district keep its current alignment with sixth grade at the elementary level, the district will need to make major changes to the elementary school feeder boundaries to ensure elementaries have space to accommodate students. Boundary changes would still be necessary with the move to the middle school level, but they would be considerably more limited.“If sixth grade stays at the elementary level, we will be facing significant elementary attendance area boundary changes,” Hinson said. “If sixth grade moves to the middle school level, we will still have some elementary attendance area boundary changes, but not nearly the number.”Hinson said that he did not anticipate any of the proposed changes to affect the currently established high school attendance area boundaries. But, he said, if sixth graders move to the middle school level, it was likely that a single middle school may be split to feed into two different high schools.You can find the district’s overview of the sixth grade commission’s work here.last_img read more

Winner: Saving Magic game app

first_imgMichigan State University FCU finds a fun way to provide financial educationby. Karen BankstonWorking with game developers at its namesake sponsor, Michigan State University Federal Credit Union created and launched a financial education app in game form that has been downloaded to more than 10,000 devices since its rollout in August 2013.Saving Magic is an interactive game, developed with MSU’s College of Communications Arts and Sciences Department, in which coins fall from the sky and players can choose whether to use the money right away for small rewards or save it for larger goals, such as special skills.The app is designed for 5- to 12-year-olds to illustrate the advantages of saving over spending, says Sarah Bohan, VP/corporate relations for $2.5 billion, 181,000-member MSU FCU.Though the app, available for iOS and Android devices, can be downloaded for free by anyone, the credit union’s core target audience is 6,000 young members who are rewarded for saving (real) money in their Dollar Dog accounts. continue reading » ShareShareSharePrintMailGooglePinterestDiggRedditStumbleuponDeliciousBufferTumblrlast_img read more

Children who understand emotions become more attentive over time

first_imgShare What is going on in the minds of young children when it seems they are daydreaming or appear to be scatterbrained?A study that my coauthor, Susanne A Denham, and I conducted recently shows that inattentive children may sometimes be absorbed in trying to figure out the emotions of their parents, siblings, teachers and friends.Young children are vitally interested in which emotions these important people in their small social world are feeling in respect to them and others, why they are doing so and whether their emotional displays are “real” or “fake.” Share on Facebook Pinterest Share on Twittercenter_img Email LinkedIn We found that children who have a better knowledge of emotions have no need to ponder these questions. They become free to pay attention to their social partners, to play and to academic learning, among many other things.Why emotion knowledge mattersThe research project, named “Elefant” – short for “Emotional Learning is fantastic” – surveyed 261 children from 33 kindergartens in Lower Saxony, a state in northern Germany, as well as their teachers and parents.Two separate surveys over an interval of 14 months were conducted. The study tested children’s “emotion knowledge”: that is, their ability to identify facial expressions of emotions and typical situations that give rise to emotions, such as happiness when receiving a birthday gift.It also included knowledge of strategies for controlling one’s own emotional expressions. A further component was the slowly developing insight that people often differ in their emotions because they appraise situations in light of their own preferences and beliefs.Along with this, children’s self-regulation of their behavior, their memory span and their language skills were tested.Children, especially young boys, who come from low socioeconomic status and do not understand complicated language usually tend to have more attention problems than others. The Elefant study confirmed these findings.In addition, it found that children who had a better understanding about emotions had fewer attention problems later on even after such demographic factors had been taken into account.In fact, children who understood more about emotions in the first survey managed to shape up their attention skills more than those who initially were largely ignorant of their own and others’ emotions.What is ‘emotion knowledge’?As the capacity to understand emotion progresses, one’s own behaviors and those of others become more predictable. This, in turn, absorbs less attention and promotes helpful behavior. It also leads to positive social relationships and academic achievements.Children with limited “emotion knowledge,” on the other hand, often seem distracted. Their attention may be occupied by the explanation of their own confusing emotional states, the negative emotions of others or the regulation of their own emotions.In addition, these young “emotional illiterates” tend to harbor more ill feelings because they believe that others will harm them. They tend to become more often angry and aggressive and have less productive relationships with teachers and peers.Last but not least, their academic achievements are compromised.Implications for children with ADHDThis study expands on previous research on the development of attention deficit problems (ADHD) in children.The common assumption in research was that children’s deficits in memory, attention and inhibition that are often summarily called executive functions partly explained their symptoms of ADHD.With our study, we find that children’s knowledge of emotions provides a better explanation for their attention control than other factors, such as demographics and executive functioning.“Emotion knowledge” should therefore occupy a more central role in future studies and in kindergarten education. Lessons on emotion knowledge should be included in training for teachers so as to help young children improve their attention.By Maria von Salisch, Professor of Developmental Psychology, Leuphana University and Susanne A Denham, University Professor of Pscyhology, George Mason UniversityThis article was originally published on The Conversation. Read the original article.last_img read more

Antibiotic cycling, mixing don’t affect resistance, study says

first_imgEditor’s note: This story was updated on Jan 29, 2018, with comments from lead study author Joppe van Duijn, MD.Since the 1980s, the concept of rotating antibiotic treatments for patients with bacterial infections has been viewed as a potential strategy for reducing antibiotic resistance rates in hospitals. The idea behind the strategy is that withdrawing the use of an antibiotic in favor of another on a hospital-wide level will reduce the selective pressure for resistance so that the drug will remain effective.This approach, called antibiotic cycling, involves using a specific antibiotic as a first-line therapy for all patients for a defined period, replacing that antibiotic with a drug of a different class but a similar spectrum of activity for the same duration, then repeating the cycle. More than two different antibiotics can be part of this rotation. The strategy has been likened to crop rotation.Another strategy for reducing the prevalence of drug resistance, called antibiotic mixing, takes a less structured approach, with each consecutive patient on a ward being treated with an alternative class of antibiotic.These approaches have been of considerable interest in intensive care units (ICUs), where patients are vulnerable to antibiotic-resistant gram-negative bacterial infections, antibiotic usage is high, and transmission of drug-resistant bacteria frequently occurs. But neither antibiotic cycling nor mixing has produced conclusive results in clinical studies, and it’s unclear if one strategy would be better for reducing rates of antibiotic-resistant gram-negative bacteria.Now, a team of European researchers writing in The Lancet Infectious Diseases has concluded that neither strategy is particularly effective.Strategies produce similar resultsIn the multi-center, cluster-randomized crossover study, the researchers randomly assigned eight European ICUs to two 9-month intervention periods in which they could use one of three antibiotic groups (third- or fourth-generation cephalosporins, piperacillin-tazobactam, or carbapenems) for empirical treatment of patients with ICU-acquired gram-negative bacterial infections. The intervention periods were separated by a 1-month washout period.In the cycling intervention, the preferred empirical treatment changed every 6 weeks; during mixing, it changed with every consecutive empirical treatment course. Treating physicians could deviate from the protocol in case of safety concerns and were allowed to use non-study antibiotics for combination therapy.Over the almost 3-year study period (June 2011 through February 2014), three ICUs were assigned to mixing followed by cycling, and five were assigned to cycling followed by mixing. The primary end point was unit-wide prevalence of carriage with antibiotic-resistant, gram-negative bacteria—defined as Enterobacteriaceae with extended-spectrum beta-lactamase production or resistance to piperacillin-tazobactam and Acinetobacter spp and Pseudomonas aeruginosa with resistance to piperacillin-tazobactam or carbapenems—measured through monthly point-prevalence screening cultures.Overall, 4,069 patients were admitted to the ICUs during the cycling periods and 4,707 were admitted during the mixing periods. Of these patients, 1,598 (745 during cycling and 853 during mixing) were present for the monthly point-prevalence surveys and were included in the final analysis.Use of the three different antibiotic classes overall was similar during the two intervention periods, accounting for 42% of all antibiotics used in the ICUs during the cycling intervention and 43% of antibiotics used during mixing (compared with 39% during baseline). Microbiological screening results showed that the mean prevalence of antibiotic-resistant, gram-negative bacteria was 23% during the cycling interventions (168 out of 745 patients) and 22% during mixing (184 of 853 patients).The authors of the study say the interventions achieved their intended goal of varying the use of the three antibiotics without changing the volume used over time. In addition, there were substantial differences in exposure to the three antibiotics in the two interventions. During cycling, antibiotic use for the non-preferred drugs fell by half to two-thirds, while use of the three antibiotics remained stable during mixing. But the differences in exposure didn’t affect the overall prevalence of antibiotic resistance on the ICUs.”In this cluster-randomised crossover study in eight ICUs, 9-month periods of antibiotic cycling and mixing did not change the unit-wide prevalence of antibiotic-resistant, gram-negative bacteria,” the authors write. “Therefore, structured rotation of antibiotic prescription policies for possible gram-negative bacteria cannot be considered as a measure to reduce antibiotic resistance in ICUs.”Despite the results, lead study author Joppe van Duijn, MD, of the Julius Center for Health Sciences and Primary Care in the Netherlands said in an email that a lot of unanswered questions remain about antibiotic rotation. “There are a lot of rotation strategies possible, of which we tested just two,” van Duijn said. “Antibiotic rotation will, therefore, need to be further studied to find out which specific intervention fits which specific ICU best.”Ultimately, van Duijn and his colleagues conclude, lowering the total volume of antibiotics used in ICUs remains the best strategy for reducing selection pressure and controlling the emergence of antibiotic-resistant bacteria. That can best be achieved, they say, by improved diagnostics that can determine which patients need antibiotics and which don’t, and by biomarker-guided reductions in antibiotic duration.See also:Jan 24 Lancet Infect Dis studylast_img read more

New safety manual out from BOC

first_imgSubscribe Get instant access to must-read content today!To access hundreds of features, subscribe today! At a time when the world is forced to go digital more than ever before just to stay connected, discover the in-depth content our subscribers receive every month by subscribing to gasworld.Don’t just stay connected, stay at the forefront – join gasworld and become a subscriber to access all of our must-read content online from just $270.last_img