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To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
In Australia, free-range egg production pullets are typically reared indoors, but adult layers get outdoor access. This new environment may be challenging to adapt to, which could impair egg production and/or egg quality. Adaptation might be enhanced through rearing enrichments. We reared 1386 Hy-Line Brown® chicks indoors with three treatments across 16 weeks: (1) a control group with standard litter housing conditions, (2) a novelty group providing novel objects that changed weekly, and (3) a structural enrichment group with custom-designed structures to partially impair visibility across the pen and allow for vertical movement. Pullets were transferred to a free-range system at 16 weeks of age with daily outdoor access provided from 25 until 64 weeks. Daily egg production at different laying locations (large nests, small nests and floor), weekly egg weights and egg abnormalities were recorded from 18 to 64 weeks old. External and internal egg quality parameters of egg weight, shell reflectivity, albumen height, haugh unit, yolk colour score, shell weight and shell thickness were measured at 44, 52, 60 and 64 weeks. There was a significant interaction between rearing treatment and nest box use on hen-day production from weeks 18 to 25 (P < 0.0001) with the novelty hens laying the most eggs and the control hens the fewest eggs in the nest box. Similarly, from 26 to 64 weeks, the novelty hens laid more eggs in the large nest boxes and fewer eggs on the floor than both the structural and control hens (P < 0.0001). Egg weight and abnormalities increased with age (P < 0.0001), but rearing treatment had no effect on either measure (both P ≥ 0.19). Rearing treatment affected shell reflectivity and yolk colour with the control hens showing paler colours across time relative to the changes observed in the eggs from enriched hens. The novelty hens may have established nest box laying patterns as they were more accustomed to exploring new environments. The differences in egg quality could be related to stress adaptability or ranging behaviour. This study shows that enriching environments during rearing can have some impacts on production parameters in free-range hens.
Psychotherapies for depression are equally effective on average, but individual responses vary widely. Outcomes can be improved by optimizing treatment selection using multivariate prediction models. A promising approach is the Personalized Advantage Index (PAI) that predicts the optimal treatment for a given individual and the magnitude of the advantage. The current study aimed to extend the PAI to long-term depression outcomes after acute-phase psychotherapy.
Data come from a randomized trial comparing cognitive therapy (CT, n = 76) and interpersonal psychotherapy (IPT, n = 75) for major depressive disorder (MDD). Primary outcome was depression severity, as assessed by the BDI-II, during 17-month follow-up. First, predictors and moderators were selected from 38 pre-treatment variables using a two-step machine learning approach. Second, predictors and moderators were combined into a final model, from which PAI predictions were computed with cross-validation. Long-term PAI predictions were then compared to actual follow-up outcomes and post-treatment PAI predictions.
One predictor (parental alcohol abuse) and two moderators (recent life events; childhood maltreatment) were identified. Individuals assigned to their PAI-indicated treatment had lower follow-up depression severity compared to those assigned to their PAI-non-indicated treatment. This difference was significant in two subsets of the overall sample: those whose PAI score was in the upper 60%, and those whose PAI indicated CT, irrespective of magnitude. Long-term predictions did not overlap substantially with predictions for acute benefit.
If replicated, long-term PAI predictions could enhance precision medicine by selecting the optimal treatment for a given depressed individual over the long term.
We examined the prevalence and correlates of Helicobacter pylori (H. pylori) infection according to cytotoxin-associated gene A (CagA) phenotype, a main virulence antigen, among the ethnically diverse population groups of Jerusalem. A cross-sectional study was undertaken in Arab (N = 959) and Jewish (N = 692) adults, randomly selected from Israel's national population registry in age-sex and population strata. Sera were tested for H. pylori immunoglobulin G (IgG) antibodies. Positive samples were tested for virulence IgG antibodies to recombinant CagA protein, by enzyme-linked immunosorbent assay. Multinomial regression models were fitted to examine associations of sociodemographic factors with H. pylori phenotypes. H. pylori IgG antibody sero-prevalence was 83.3% (95% confidence interval (CI) 80.0%–85.5%) and 61.4% (95% CI 57.7%–65.0%) among Arabs and Jews, respectively. Among H. pylori positives, the respective CagA IgG antibody sero-positivity was 42.3% (95% CI 38.9%–45.8%) and 32.5% (95% CI 28.2%–37.1%). Among Jews, being born in the Former Soviet Union, the Middle East and North Africa, vs. Israel and the Americas, was positively associated with CagA sero-positivity. In both populations, sibship size was positively associated with both CagA positive and negative phenotypes; and education was inversely associated. In conclusion, CagA positive and negative infection had similar correlates, suggesting shared sources of these two H. pylori phenotypes.
From the 1950s through the 1970s, American policymakers engaged in an extensive campaign against illegal gambling in an effort to turn the tide in the government’s crusade against organized crime. At the grassroots, however, voters endorsed a different form of state expansion to beat back the mob menace. Between 1963 and 1977, fourteen northeastern and Rust Belt states enacted the first government-run lotteries in the twentieth-century United States on the belief that legalized gambling would undercut the mob’s gambling profits. While gambling opponents pointed to Las Vegas as proof that organized crime would flourish following legalization, supporters argued that illegal gambling was already pervasive, so the state may as well profit from this irrepressible activity. The history of gambling legalization challenges narratives on the popularity of law-and-order politics and offers a new perspective on crime policy in the post–World War II period.
In this report, we explore a case of symptoms consistent with menstrual psychosis. In order to do this, a review of the literature relating to this topic was conducted and a report was written. This is a case of a previously well adolescent female who experienced psychotic symptoms in the pre-menstrual phase of her cycle and became well soon after her menstrual period began. These episodes were prevented by aripiprazole, but recurred once medication was withdrawn. We conclude that psychosis in some women may have a relationship with the menstrual cycle. In women presenting with psychosis, it may be appropriate to note menstrual variation in symptoms. This could have a potential role in individualisation of treatment for women with psychotic disorders.
The search for life in the Universe is a fundamental problem of astrobiology and modern science. The current progress in the detection of terrestrial-type exoplanets has opened a new avenue in the characterization of exoplanetary atmospheres and in the search for biosignatures of life with the upcoming ground-based and space missions. To specify the conditions favourable for the origin, development and sustainment of life as we know it in other worlds, we need to understand the nature of global (astrospheric), and local (atmospheric and surface) environments of exoplanets in the habitable zones (HZs) around G-K-M dwarf stars including our young Sun. Global environment is formed by propagated disturbances from the planet-hosting stars in the form of stellar flares, coronal mass ejections, energetic particles and winds collectively known as astrospheric space weather. Its characterization will help in understanding how an exoplanetary ecosystem interacts with its host star, as well as in the specification of the physical, chemical and biochemical conditions that can create favourable and/or detrimental conditions for planetary climate and habitability along with evolution of planetary internal dynamics over geological timescales. A key linkage of (astro)physical, chemical and geological processes can only be understood in the framework of interdisciplinary studies with the incorporation of progress in heliophysics, astrophysics, planetary and Earth sciences. The assessment of the impacts of host stars on the climate and habitability of terrestrial (exo)planets will significantly expand the current definition of the HZ to the biogenic zone and provide new observational strategies for searching for signatures of life. The major goal of this paper is to describe and discuss the current status and recent progress in this interdisciplinary field in light of presentations and discussions during the NASA Nexus for Exoplanetary System Science funded workshop ‘Exoplanetary Space Weather, Climate and Habitability’ and to provide a new roadmap for the future development of the emerging field of exoplanetary science and astrobiology.
This paper is a revised version of a plenary prompted by the upsurge of interest in the role of pragmatics in teaching, learning, and assessment, and has as its purpose to take a fresh look at recent developments in the assessment of target-language (TL) pragmatics in spoken language. The first issue considered is the question of whether to attempt to assess pragmatics as it unfolds naturally in interactions, and if so, how to do it. Next, micro-level and macro-level factors in the assessment of TL pragmatics are considered. Third, a close look is given to the specific elements of TL pragmatics to assess. Fourth, there is attention to the matter of which instruments are most appropriate for collecting the desired data in the given context. Fifth, issues relating to data analysis are discussed. Finally, matters pertaining to the assessment of classroom instruction are looked at. Recommendations are given as to potentially viable directions for dealing with these issues both in terms of research studies and for assessment of classroom instruction.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
A design and manufacturing method is described for creating a motor tendon–actuated soft foam robot. The method uses a castable, light, and easily compressible open-cell polyurethane foam, producing a structure capable of large (~70% strain) deformations while requiring low torques to operate (<0.2 N·m). The soft robot can change shape, by compressing and folding, allowing for complex locomotion with only two actuators. Achievable motions include forward locomotion at 13 mm/s (4.3% of body length per second), turning at 9◦/s, and end-over-end flipping. Hard components, such as motors, are loosely sutured into cavities after molding. This reduces unwanted stiffening of the soft body. This work is the first demonstration of a soft open-cell foam robot locomoting with motor tendon actuators. The manufacturing method is rapid (~30 min per mold), inexpensive (under $3 per robot for the structural foam), and flexible, and will allow a variety of soft foam robotic devices to be produced.