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In patients with β-lactam allergies, administration of non–β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.
As a technique for non-destructive materials analysis, computed tomography (CT) has been especially useful for studying the dependence of the structure of ceramics on manufacturing processes. CT also has been used for characterizing the lithology of reservoir cores while they are still contained in preservation material or a core barrel.
The parameter measured by CT is the X-ray attenuation coefficient, which is a function of both material density and material composition.
Computed tomography (CT), commonly known as CAT scanning (computerized axial tomography), is a technology that produces an image of the internaI structure of a cross sectional slice through an object via the reconstruction of a matrix of X-ray attenuation coefficients. This non-destructive method is fast (50 ms to 7 min per image depending on the technological generation of the instrument) and requires minimal sample preparation. Images are generated from digital computations, and instruments essentially have a linear response. This allows quantitative estimations of density variations, dimensions and areas directly from console displays.
Introduction: We sought to characterize the management of uncomplicated subcutaneous abscesses (SA) by Canadian emergency physicians (EPs). Methods: Cross-sectional study of CAEP membership. Subjects were emailed an invitation to an online survey, and two biweekly reminders. Wilcoxon rank sum test was used for association with age, and Chi Square and Fischers exact test were used for binary variables. Results: Response rate was 21.2 % (392 Reponses / 1850 surveyed). Duration of practice ranged from 30.2 % practising <= 5 years, to 25.7% practising >= 20 years. Teaching setting was described in 89.1% of responses. Irrigation with saline is performed by 57.1 % of EPs, tap water 2.1 %, or disinfectant 2.1% of EPs, with 39.1% not doing any irrigation. Approximately half (49.2%) typically do not pack or close wounds, while 40.6 % employ ribbon or gauze packing, and 1.6 % primary closure. Antibiotics are generally not prescribed by 16.8%. EPs prescribe antibiotics when suspecting surrounding cellulitis (84.2%), immunocompromised host (51.6%), MRSA (28.9%), or recurrence within 30 days (27.5 %). Cultures are taken almost always by 28.2%, half the time or less by 33.9%, never by 11.6%, and if MRSA is suspected by 33.9%. Follow-up instructions are with FP (56.7%), ED at 24 hours (5.91 %) or 48 hours (17.74 %), or not required (24.7%). Most EPs (90.9%) report having no standardized protocol for abscess management in their ED. EPs with fewer years in practice are more likely to make cruciate incisions (p=0.009), to generally not irrigate incisions (p=0.02), to culture if MRSA is suspected (p=0.02), and to prescribe antibiotics when suspecting MRSA (p=0.02) immune-compromised host (p=0.03), and in case of spontaneous treatment failure or recurrence (p=0.0004). EPs with more years in practice are more likely to pack with ribbon gauze (p=0.06), and to almost always swab for C&S (p=0.04) Conclusion: Practice variability and deviations from practice guidelines (i.e. IDSA, Choosing Wisely Canada) are noted. A knowledge translation exercise based on the guidelines for Canadian EPs would be useful.
We introduce a forcing technique to construct three-dimensional arrays of generic extensions through FS (finite support) iterations of ccc posets, which we refer to as 3D-coherent systems. We use them to produce models of new constellations in Cichoń’s diagram, in particular, a model where the diagram can be separated into 7 different values. Furthermore, we show that this constellation of 7 values is consistent with the existence of a
well-order of the reals.
The characteristic time of low-Reynolds-number fluid–structure interaction scales linearly with the ratio of fluid viscosity to solid Young’s modulus. For sufficiently large values of Young’s modulus, both time and length scales of the viscous-elastic dynamics may be similar to acoustic time and length scales. However, the requirement of dominant viscous effects limits the validity of such regimes to micro-configurations. We here study the dynamics of an acoustic plane wave impinging on the surface of a layered sphere, immersed within an inviscid fluid, and composed of an inner elastic sphere, a creeping fluid layer and an external elastic shell. We focus on configurations with similar viscous-elastic and acoustic time and length scales, where the viscous-elastic speed of interaction between the creeping layer and the elastic regions is similar to the speed of sound. By expanding the linearized spherical Reynolds equation into the relevant spectral series solution for the hyperbolic elastic regions, a global stiffness matrix of the layered elastic sphere was obtained. The maximal pressure difference induced by the acoustic wave on the creeping region was found to occur for identical viscous-elastic and acoustic length scales. Comparing an elastic sphere with an embedded creeping layer to a fully elastic sphere, a significant reduction in magnitude and fluctuations (with regard to wavelength) are observed for both the displacements of the solid and target strength of the sphere. This effect was most significant for identical viscous-elastic and acoustic time scales. This work relates viscous-elastic dynamics to acoustic scattering and may pave the way to the design of novel metamaterials with unique acoustic properties.
The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions.
The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network.
Results and Conclusions
Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.
Jurisprudential regime theory is a legal explanation of decision-making on the U.S. Supreme Court that asserts that a key precedent in an area of law fundamentally restructures the relationship between case characteristics and the outcomes of future cases. In this article, we offer a multivariate multiple change-point probit model that can be used to endogenously test for the existence of jurisprudential regimes. Unlike the previously employed methods, our model does so by estimating the locations of many possible change-points along with structural parameters. We estimate the model using Markov chain Monte Carlo methods, and use Bayesian model comparison to determine the number of change-points. Our findings are consistent with jurisprudential regimes in the Establishment Clause and administrative law contexts. We find little support for hypothesized regimes in the areas of free speech and search-and-seizure. The Bayesian multivariate change-point model we propose has broad potential applications to studying structural breaks in either regular or irregular time-series data about political institutions or processes.
This analysis assessed the utility of the limiting antigen avidity assay (LAg). Samples of people who inject drugs (PWID) in Greece with documented duration of HIV-1 infection were tested by LAg. A LAg-normalized optical density (ODn) ⩽1·5 corresponds to a recency window period of 130 days. The proportion true recent (PTR) and proportion false recent (PFR) were estimated in 28 seroconverters and in 366 samples collected >6 months after HIV diagnosis, respectively. The association between LAg ODn and HIV RNA level was evaluated in 232 persons. The PTR was 85·7%. The PFR was 20·8% but fell to 5·9% in samples from treatment-naive individuals with long-standing infection (>1 year), and to 0 in samples with the circulating recombinant form CRF35 AD. A LAg-based algorithm with a PFR of 3·3% estimated a similar incidence trend to that calculated by analyses based on HIV-1 seroconversions. In recently infected persons indicated by LAg, the median log10 HIV RNA level was high (5·30, interquartile range 4·56–5·90). LAg can help identify highly infectious HIV(+) individuals as it accurately identifies recent infections and is correlated with the HIV RNA level. It can also produce reliable estimates of HIV-1 incidence.
The management of patients with a glioma is challenging and best achieved by a team approach encompassing a combination of chemotherapy, radiotherapy, immunotherapy, and surgical excision in a specialist Cancer Center - the balance of treatment depending on the site and grade of tumor. Survival rates are improving and care of patients with or recovering from gliomas is increasingly handled in the community under the care of local physicians. This book provides an authoritative, multi-disciplinary summary of glioma biology, genetics, management and social issues, based on the world-leading program at the Duke University Preston Robert Tisch Brain Tumor Center, one of the world's largest and most successful Centers to offer brain cancer treatment and translational research. The text is written by specialists from this Center, giving it a consistent approach and style. This is an important educational resource for neurologists, neurosurgeons, oncologists, psychiatrists, neurohospitalists and ancillary members of neuro-oncology teams.
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events (‘risk acts’), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
A survey of soft X-ray background observations in the 0.1–10 keV range is presented. In the region above 1 keV, recent results on point X-ray sources are discussed and their integrated contribution to the diffuse background is estimated. However, the average luminosity of various classes of extragalactic X-ray sources is still not sufficiently well known to permit this estimate to be made with any certainty. A discussion is given of recent observations at energies below 1 keV where the effects of interstellar absorption are important. It is argued that although some fraction of the background radiation in the 0.1–1 keV range must be galactic in origin, there is still substantial evidence for an extragalactic component. Proposed theories for generating both the galactic and extragalactic X-ray background are briefly reviewed.