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Background: Automated testing instruments (ATIs) are commonly used by clinical microbiology laboratories to perform antimicrobial susceptibility testing (AST), whereas public health laboratories may use established reference methods such as broth microdilution (BMD). We investigated discrepancies in carbapenem minimum inhibitory concentrations (MICs) among Enterobacteriaceae tested by clinical laboratory ATIs and by reference BMD at the CDC. Methods: During 2016–2018, we conducted laboratory- and population-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE) through the CDC Emerging Infections Program (EIP) sites (10 sites by 2018). We defined an incident case as the first isolation of Enterobacter spp (E. cloacae complex or E. aerogenes), Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem from normally sterile sites or urine identified from a resident of the EIP catchment area in a 30-day period. Cases had isolates that were determined to be carbapenem-resistant by clinical laboratory ATI MICs (MicroScan, BD Phoenix, or VITEK 2) or by other methods, using current Clinical and Laboratory Standards Institute (CLSI) criteria. A convenience sample of these isolates was tested by reference BMD at the CDC according to CLSI guidelines. Results: Overall, 1,787 isolates from 112 clinical laboratories were tested by BMD at the CDC. Of these, clinical laboratory ATI MIC results were available for 1,638 (91.7%); 855 (52.2%) from 71 clinical laboratories did not confirm as CRE at the CDC. Nonconfirming isolates were tested on either a MicroScan (235 of 462; 50.9%), BD Phoenix (249 of 411; 60.6%), or VITEK 2 (371 of 765; 48.5%). Lack of confirmation was most common among E. coli (62.2% of E. coli isolates tested) and Enterobacter spp (61.4% of Enterobacter isolates tested) (Fig. 1A), and among isolates testing resistant to ertapenem by the clinical laboratory ATI (52.1%, Fig. 1B). Of the 1,388 isolates resistant to ertapenem in the clinical laboratory, 1,006 (72.5%) were resistant only to ertapenem. Of the 855 nonconfirming isolates, 638 (74.6%) were resistant only to ertapenem based on clinical laboratory ATI MICs. Conclusions: Nonconfirming isolates were widespread across laboratories and ATIs. Lack of confirmation was most common among E. coli and Enterobacter spp. Among nonconfirming isolates, most were resistant only to ertapenem. These findings may suggest that ATIs overcall resistance to ertapenem or that isolate transport and storage conditions affect ertapenem resistance. Further investigation into this lack of confirmation is needed, and CRE case identification in public health surveillance may need to account for this phenomenon.
To identify phenotypes of type 1 diabetes based on glucose curves from continuous glucose-monitoring (CGM) using functional data (FD) analysis to account for longitudinal glucose patterns. We present a reliable prediction model that can accurately predict glycemic levels based on past data collected from the CGM sensor and real-time risk of hypo-/hyperglycemic for individuals with type 1 diabetes.
A longitudinal cohort study of 443 type 1 diabetes patients with CGM data from a completed trial. The FD analysis approach, sparse functional principal components (FPCs) analysis was used to identify phenotypes of type 1 diabetes glycemic variation. We employed a nonstationary stochastic linear mixed-effects model (LME) that accommodates between-patient and within-patient heterogeneity to predict glycemic levels and real-time risk of hypo-/hyperglycemic by creating specific target functions for these excursions.
The majority of the variation (73%) in glucose trajectories was explained by the first two FPCs. Higher order variation in the CGM profiles occurred during weeknights, although variation was higher on weekends. The model has low prediction errors and yields accurate predictions for both glucose levels and real-time risk of glycemic excursions.
By identifying these distinct longitudinal patterns as phenotypes, interventions can be targeted to optimize type 1 diabetes management for subgroups at the highest risk for compromised long-term outcomes such as cardiac disease or stroke. Further, the estimated change/variability in an individual’s glucose trajectory can be used to establish clinically meaningful and patient-specific thresholds that, when coupled with probabilistic predictive inference, provide a useful medical-monitoring tool.
We explored identity formation among nine gay men who were born between 1946 and 1964. This group of nine was the largest homogeneous sub-group within a larger sample (N = 18). Although participants share similar demographic characteristics, their individual social, personal and narrative identities diverge to represent distinctive embodied selves. Guided by queer and feminist theories, the qualitative analysis identified dominant and counter-narratives that demonstrate the complexity of sexual identity as it evolves over time. All nine men recall being aware of their gay identity as children; however, like many socially constructed labels, their outward identity was more complex and difficult to understand. The findings demonstrate how participants negotiated their sexual identities through decades of social change. As illustrated within each subset of identity (i.e. social, personal and narrative), some participants found themselves breaking ground for a broader gay rights social movement, while others described their experience of being relegated to silence and invisibility for most of their lives. This research contributes to an ongoing discussion concerning the individuality found among lesbian, gay, bisexual and transgender (LGBT) individuals in later life. As the LGBT population becomes more visible, there will be a growing need to understand the individualism that exists within this coalition and affirm their diversifying sexual and gender identities.
Obligately intracellular microsporidia regulate their host cell life cycles, including apoptosis, but this has not been evaluated in phagocytic host cells such as macrophages that can facilitate infection but also can be activated to kill microsporidia. We examined two biologically dissimilar human-infecting microsporidia species, Encephalitozoon cuniculi and Vittaforma corneae, for their effects on staurosporine-induced apoptosis in the human macrophage-differentiated cell line, THP1. Apoptosis was measured after exposure of THP-1 cells to live and dead mature organisms via direct fluorometric measurement of Caspase 3, colorimetric and fluorometric TUNEL assays, and mRNA gene expression profiles using Apoptosis RT2 Profiler PCR Array. Both species of microsporidia modulated the intrinsic apoptosis pathway. In particular, live E. cuniculi spores inhibited staurosporine-induced apoptosis as well as suppressed pro-apoptosis genes and upregulated anti-apoptosis genes more broadly than V. corneae. Exposure to dead spores induced an opposite effect. Vittaforma corneae, however, also induced inflammasome activation via Caspases 1 and 4. Of the 84 apoptosis-related genes assayed, 42 (i.e. 23 pro-apoptosis, nine anti-apoptosis, and 10 regulatory) genes were more affected including those encoding members of the Bcl2 family, caspases and their regulators, and members of the tumour necrosis factor (TNF)/TNF receptor R superfamily.
Prior studies suggest that the influenza vaccine is protective against some outcomes in hospitalized patients infected with influenza despite vaccination. We utilized surveillance data from Columbus, Ohio to investigate this association over multiple influenza seasons and age groups. Data on laboratory-confirmed influenza-associated hospitalizations were collected as a part of the Influenza Hospitalization Surveillance Project for the 2012–2013, 2013–2014, and 2014–2015 influenza seasons. The association between influenza vaccination status was examined in relation to the outcomes of severe influenza and diagnosis of pneumonia among patients receiving antiviral treatment. Data were analyzed using multivariable logistic regression. We observed no overall association between influenza vaccination status and severe influenza among hospitalized patients. During the 2013–2014 season, those who were vaccinated were 41% less likely to be diagnosed with pneumonia compared with those who were unvaccinated (OR = 0·59 95% CI 0·41–0·86). The influenza vaccine may provide a secondary preventive function against pneumonia among influenza cases requiring hospitalization. However, a protective effect was only observed in 2013–2014, an influenza H1N1 dominant year. Differences in circulating influenza virus strains and vaccine matching to the circulating strains during influenza seasons may impact this association.
Phased VLA observations of the Galactic center magnetar J1745-2900 over 8-12 GHz reveal rich single pulse behavior. The average profile is comprised of several distinct components and is fairly stable over day timescales and GHz frequencies. The average profile is dominated by the jitter of relatively narrow pulses. The pulses in each of the four profile components are uncorrelated in phase and amplitude, although the occurrence of pulse components 1 and 2 appear to be correlated. Using a collection of the brightest individual pulses, we verify that the index of the dispersion law is consistent with the expected cold plasma value of 2. The scattering time is weakly constrained, but consistent with previous measurements, while the dispersion measure DM = 1763+3−10 pc cm−3 is lower than previous measurements, which could be a result of time variability in the line-of-sight column density or changing pulse profile shape over time or frequency.
When a rigid body collides with a liquid surface with sufficient velocity, it creates a splash curtain above the surface and entrains air behind the sphere, creating a cavity below the surface. While cavity dynamics has been studied for over a century, this work focuses on the water entry characteristics of deformable elastomeric spheres, which has not been studied. Upon free surface impact, an elastomeric sphere deforms significantly, giving rise to large-scale material oscillations within the sphere resulting in unique nested cavities. We study these phenomena experimentally with high-speed imaging and image processing techniques. The water entry behaviour of deformable spheres differs from rigid spheres because of the pronounced deformation caused at impact as well as the subsequent material vibration. Our results show that this deformation and vibration can be predicted from material properties and impact conditions. Additionally, by accounting for the sphere deformation in an effective diameter term, we recover previously reported characteristics for time to cavity pinch off and hydrodynamic force coefficients for rigid spheres. Our results also show that velocity change over the first oscillation period scales with the dimensionless ratio of material shear modulus to impact hydrodynamic pressure. Therefore, we are able to describe the water entry characteristics of deformable spheres in terms of material properties and impact conditions.
Objectives: This study examined whether individuals with Parkinson’s disease (PD) are at increased vulnerability for vascular-related cognitive impairment relative to controls. The underlying assumption behind this hypothesis relates to brain reserve and that both PD and vascular risk factors impair similar fronto-executive cognitive systems. Methods: The sample included 67 PD patients and 61 older controls (total N=128). Participants completed neuropsychological measures of executive functioning, processing speed, verbal delayed recall/memory, language, and auditory attention. Cardiovascular risk was assessed with the Framingham Cardiovascular Risk index. Participants underwent brain imaging (T1 and T2 FLAIR). Trained raters measured total and regional leukoaraiosis (periventricular, deep subcortical, and infracortical). Results: Hierarchical regressions revealed that more severe cardiovascular risk was related to worse executive functioning, processing speed, and delayed verbal recall in both Parkinson patients and controls. More severe cardiovascular risk was related to worse language functioning in the PD group, but not controls. In contrast, leukoaraiosis related to both cardiovascular risk and executive functioning for controls, but not the PD group. Conclusions: Overall, results revealed that PD and cardiovascular risk factors are independent risk factors for cognitive impairment. Generally, the influence of cardiovascular risk factors on cognition is similar in PD patients and controls. (JINS, 2017, 23, 322–331)
The fact that crime and disorder are concentrated at a few places is interesting and deserves an explanation. It is also interesting that places show up in other criminological theories and in other disciplines. And it is useful to understand the methods for studying places. However, a primary reason we are interested in high-crime places is that it might be possible to do something about crime by addressing these places. We are convinced that focusing on places can substantially reduce crime and disorder. Our conviction is not a matter of faith, but is based on over twenty-five years of accumulating evidence.
This chapter summarizes the research evidence examining whether focusing on crime places reduces crime. We first discuss a broad range of place-based prevention strategies examined by Eck and Guerrette (2012). This review provides strong evidence for a place-based approach to crime prevention. We then turn to a specific form of place-based crime prevention – hot spots policing (Sherman and Weisburd 1995). Again, we have a strong body of evidence supporting a place-based approach. Having reviewed hot spots policing, we turn to the importance of place managers and third parties in controlling problem places. We then examine an extension of the third-party approach to argue that a place-based approach to crime may free crime control policy from the police monopoly. Then we describe how a place-based approach to crime could be incorporated in community corrections to improve probation and parole outcomes. Finally, we review the larger body of research on the potential threat of crime displacement, and its opposite, the diffusion of crime control benefits. Consistently, the evidence described in this chapter clearly shows the substantial utility of a place-based approach for reducing crime.
SITUATIONAL CRIME PREVENTION AT PLACES
In Chapter 3 we argued for the importance of social disorganization theories for understanding crime places. This is an area where basic research suggests promise (e.g., see Weisburd et al. 2012; Weisburd et al. 2014), but where there is little evidence of effectiveness of specific practices. Such evidence is beginning to be developed, but we can say little at this juncture. In contrast, the evidence regarding opportunity reduction and crime has grown systematically over the last few decades.
Take a moment to imagine a crime occurring – perhaps a street robbery or a bag snatch. When you do this, it is difficult not to visualize the crime occurring in a particular setting or place. So, you might imagine a dark street corner with dim street lighting or seating in the outside area of a public bar. It seems intuitively sensible to analyze and understand crime at this unit of analysis – in other words, to investigate how criminals behave and crime concentrates at small microplaces. However, engaging in such microlevel analysis has tended to be a more recent criminological undertaking, and there are still many fruitful avenues to explore in terms of advancing both our knowledge and the sophistication of the methods that we use in this research area.
In this chapter, we raise and endeavor to answer a number of questions concerning the appropriate scale of analysis of criminological enquiry. To do this, we will start by defining what we mean by place and how this differs from other geographic concepts. Next, we highlight what has become the key catalyst for the criminology of place – the tremendous concentration of crime at microgeographic units of analysis. The strong and consistent concentration of crime at addresses, street segments, and other microgeographic units across cities is key to understanding why it is important to study the criminology of place and why it has such strong policy implications. We then turn to some additional statistical benefits of studying crime at microgeographic units that have to do with what is often termed “spatial interaction effects.” Finally, we examine problems that crime and place researchers will need to consider, and recommend some future directions for research exploring crime concentration at places.
PLACE AND SPACE
Geographic concepts are sometimes used in criminological research without a clear understanding of their meaning. Place and space are two such concepts. The subtle difference between them is important to keep in mind, as they can be a guide to establishing a carefully constructed study and influence the interpretation of findings. Furthermore, as will become apparent later in this chapter, a confusion of these concepts can mislead the reader in the interpretation of an argument. For example, it is important to keep in mind that place does not necessarily mean small units of analysis, nor does space necessarily refer to large areas.
Over the last two decades, there has been increased interest in the distribution of crime and other antisocial behavior at lower levels of geography. The focus on micro geography and its contribution to the understanding and prevention of crime has been called the 'criminology of place'. It pushes scholars to examine small geographic areas within cities, often as small as addresses or street segments, for their contribution to crime. Here, the authors describe what is known about crime and place, providing the most up-to-date and comprehensive review available. Place Matters shows that the study of criminology of place should be a central focus of criminology in the twenty-first century. It creates a tremendous opportunity for advancing our understanding of crime, and for addressing it. The book brings together eighteen top scholars in criminology and place to provide comprehensive research expanding across different themes.
This chapter explores the importance of place in theory and research in both mainstream criminology and other disciplines. As we noted in earlier chapters, traditional criminology has focused primarily on understanding why people commit crime. This focus on criminality has generally inhibited study of microgeographies and their role in producing crime. However, more recently there has been a trend toward integrating microgeographic places into traditional theorizing about criminality. In the first part of the chapter we discuss this trend, focusing on some recent innovations in understanding criminality that have incorporated place-based perspectives. In the second part of the chapter we focus on how other disciplines have influenced thinking in this area, focusing in particular on contributions in psychology, economics, and public health. Finally, we explore how trends in other disciplines might influence future directions of study in the criminology of place.
THE GROWING ROLE OF MICROGEOGRAPHIC PLACES IN TRADITIONAL THEORIZING OF CRIMINALITY
As we noted in Chapter 1, places, at least at a macro level, played a key part in the development of criminology in the nineteenth and early twentieth centuries. But despite the role of place in crime in empirical study in Europe and theoretical development in the Chicago School through social disorganization theory, microgeographic places were mostly ignored. This was not because early criminologists failed to recognize the role of place in crime. Crime occurs in specific environments, and this was apparent to observers of the crime problem. Nonetheless, as we noted in Chapter 1, early criminologists did not see “crime places” – small discrete areas within communities – as a relevant focus of criminological study. This was the case, in part, because crime opportunities provided by places were assumed to be so numerous as to make concentration on specific places of little utility for theory or policy. What is the point of focusing theory or research on the opportunities offered by specific places if such opportunities can be found throughout the urban context?
Moreover, criminologists did not see the utility in focusing in on situational opportunities when criminal motivation was the key to understanding crime rates. Criminologists traditionally assumed that situational factors played a relatively minor role in explaining crime as compared with the “driving force of criminal dispositions” (Clarke and Felson 1993, 4; Trasler 1993).
In the previous chapter, we showed that crime is concentrated at very small geographic units, substantially smaller than neighborhoods, and that these concentrations, on average, are relatively stable. This is true whether examining high- or low-crime neighborhoods. Although high-crime places do cluster, they seldom form a homogeneous block of high-crime places. Rather, interspersed within concentrations of high-crime places are many low- and modest-crime places.
Why is crime concentrated in a relatively small number of places? Standard criminology has not asked this question, largely because standard criminology focuses on criminality and implicitly assumes that the density of offenders explains crime density. Recognition that place characteristics matter is the starting point for this chapter. We look at two perspectives on crime place characteristics. We use the term “perspective” because each type of explanation is comprised of multiple theories linked by a common orientation. The first perspective arises from opportunity theories of crime. The second perspective arises from social disorganization theories of crime.
We begin by contrasting two ways of thinking about how a place becomes a crime hot spot and suggest that the process by which high-crime places evolve must involve place characteristics. In the next sections, we examine opportunity and social disorganization explanations. In the final section of the chapter, we examine possible ways researchers might link these two perspectives.
PROCESSES THAT CREATE CRIME PLACES
Before we look for explanations of why places become hot spots of crime it is important to consider two processes that might lead to such an outcome. Criminologists have generally proposed two generic models to account for the processes that lead to variation in place susceptibility to crime. One model suggests that places may start with reasonably similar risks of an initial criminal attack, but once attacked the risk of a subsequent attack on the place rises. Over time, places diverge in their crime risk, and consequently in their crime counts. This temporal contagion model is also known as a boost model (see Chapter 2) or a state-dependence model. It puts the emphasis on offenders’ willingness to return to a previously successful crime site (Johnson et al. 2007; Townsley et al. 2000). It suggests that irrespective of initial crime risk the occurrence of a crime will lead to changes in risk of crime at a place.