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We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and β-lactam–β-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.
Poor school connectedness (SC), defined as students’ feelings of belonging, safety, and fairness at school, is a risk factor for negative psychosocial outcomes. Few studies have examined the specific relationship between SC and anxiety. This study examined the relation between SC and anxiety within a group of 114 clinically anxious youth (mean age =10.82; SD = 2.93; 48.2% female; 70.2% White, non-Hispanic); age differences were also examined. Results indicated that SC was significantly negatively associated with age but unrelated to gender, race/ethnicity, socio-economic status, parent education, or presence of a comorbid disorder. Findings generally revealed that low SC was associated with greater total and domain specific anxiety. SC may play a unique role in the maintenance of global and domain specific anxiety symptoms.
The Asian elephant Elephas maximus is at risk of extinction as a result of anthropogenic pressures, and remaining populations are often small and fragmented remnants, occupying a fraction of the species' former range. Once widely distributed across China, only a maximum of 245 elephants are estimated to survive across seven small populations. We assessed the Asian elephant population in Nangunhe National Nature Reserve in Lincang Prefecture, China, using camera traps during May–July 2017, to estimate the population size and structure of this genetically important population. Although detection probability was low (0.31), we estimated a total population size of c. 20 individuals, and an effective density of 0.39 elephants per km2. Social structure indicated a strong sex ratio bias towards females, with only one adult male detected within the population. Most of the elephants associated as one herd but three adult females remained separate from the herd throughout the trapping period. These results highlight the fragility of remnant elephant populations such as Nangunhe and we suggest options such as a managed metapopulation approach for their continued survival in China and more widely.
Introduction: GridlockED is an educational (or “serious”) game recently developed by a team at McMaster to teach medical learners about patient flow in the emergency department (ED). Beyond patient flow, we were cognizant that the game could provide additional learning opportunities for learners. The goal of this program evaluation project was to investigate workshop attendees’ experiences and identify what areas they found most educational. Methods: A GridlockED board game workshop was developed and delivered in several locations over the fall of 2018. Workshops targeted medical learners and were organized by local emergency medicine interest groups. After a standardized video-based introduction to the game concept and rules, the learners played GridlockED for approximately 90 minutes. After the play session, learners completed an anonymous survey consisting of 7-point Likert scale questions about their experience. They were also asked to identify the learning domains for which GridlockED was developed (Patient Flow, Communication and Teamwork, and ED Basics), and were asked via free-text to identify learning objectives from their experience. We received an exemption for this study from our institutional review board. Results: We had 25 respondents (24 medical students and 1 resident). Trainees rated GridlockED as both enjoyable to play and as a meaningful educational experience, with an average rating of 6.56 (SD 0.94) for enjoyability and 6.44 (0.92) for education. When asked what targeted learning domain was most helpful, 45% of students identified patient flow, 37% teamwork and communication, and only 18% ED basics. When asked to identify their top three areas of learning in open-ended responses, students actually identified resource management most frequently (48%), with improved communication skills (40%) as the second most prominent learning objective. Other interesting self-identified learning points were: a greater appreciation of the role of various providers (24%), the unpredictability of ED care (12%), and how things can go wrong (12%). Conclusion: Medical learners find GridlockED to be both enjoyable and educational. In our targeted areas of learning they found patient flow to be the most educational, but self-identified multiple other areas for learning. Students identified resource management and communication as key areas of learning, suggesting that future workshops might be designed specifically to teach these skills.
Introduction: In 2016, a team at McMaster began developing GridlockED, an educational (or “serious”) board game designed to teach medical learners about patient flow in the emergency department. As serious board games are a relatively new phenomenon in medical education, there is little data on how marketed games are actually used once received by end-users. In this study our goal was to better understand the demographics and game usage for purchasers of the GridlockED board game, which will inform the further improvement or expansion of the game. Methods: Individuals who expressed interest in purchasing gridlockED via our online storefront were sent an anonymous online survey via Google Form. The survey collected demographic and qualitative data with a focus on the respondent's role in medicine, how they have used GridlockED, who they have played GridlockED with, and what changes or additions to GridlockED they would like to see. We also asked about changes for a potential mass-market version of the game targeted towards non-medical individuals. Individuals who did not purchase the game were asked about their barriers to purchase. We received an exemption for this study from our institutional review board. Results: 42 responses (out of 300 individuals on our mailing list, 14% response rate) were collected. Responding purchasers were from 16 different roles in healthcare and 11 different countries. The top 5 roles were: EM trainee, Community EM MD, Academic EM MD, Physicians from other specialties, and EM program director. The majority of respondents were Canadian (38%), with America (21%), New Zealand (10%), and Turkey (7%) the only other countries to have more than 2 respondents. 50% reported having played the game, with the most common use cases being for fun (76%), for teaching trainees (33%) or training with colleagues (19%). For those who did not purchase, price was the largest barrier (81%). 50% of respondents expressed interest in a disaster scenario expansion pack, with 33% interested in set lesson plans. Conclusion: GridlockED attracted interest from a wide range of medical professionals, both in terms or role and location. Users mainly reported using the game for fun, with fewer users using the game for teaching/training purposes. The main barrier to purchase was the game's price.
Although a number of studies have examined the relationship between depression and obesity, it is still insufficient to establish the specific pattern of relationship between depression and body mass index (BMI) categories. Thus, this study was aimed to investigate the relationship between depression and BMI categories.
A cross-sectional study was conducted for a cohort of 159,390 Korean based on Kangbuk Samsung Health Study (KSHS). Study participants were classified into 5 groups by Asian-specific cut-off of BMI (18.5, 23, 25 and 30 kg/m2). The presence of depression was determined by Center for Epidemiologic Studies-Depression scales (CES-D) = 16 and = 25. The adjusted odd ratios (ORs) for depression were evaluated by multiple logistic regression analysis, in which independent variable was 5 categories of BMI and dependent variable was depression. Subgroup analysis was conducted by gender and age.
When normal group was set as a reference, the adjusted ORs for depression formed U-shaped pattern of relationship with BMI categories [underweight: 1.31 (1.14–1.50), overweight: 0.94 (0.85–1.04), obese group: 1.01 (0.91–1.12), severe obese group: 1.28 (1.05–1.54)]. This pattern of relationship was more prominent in female and young age group than male and elderly subgroup. BMI level with the lowest likelihood of depression was 18.5 kg/m2 to 25 kg/m2 in women and 23 kg/m2 to 25 kg/m2 in men.
There was a U-shaped relationship between depression and BMI categories. This finding suggests that both underweight and severe obesity are associated with the increased risk for depression.
The Evolutionary Map of the Universe (EMU) is a proposed radio continuum survey
of the Southern Hemisphere up to declination + 30°, with the Australian
Square Kilometre Array Pathfinder (ASKAP). EMU will use an automated source
identification and measurement approach that is demonstrably optimal, to
maximise the reliability and robustness of the resulting radio source
catalogues. As a step toward this goal we conducted a “Data
Challenge” to test a variety of source finders on simulated images. The
aim is to quantify the accuracy and limitations of existing automated source
finding and measurement approaches. The Challenge initiators also tested the
current ASKAPsoft source-finding tool to establish how it could benefit from
incorporating successful features of the other tools. As expected, most finders
show completeness around 100% at ≈ 10σ dropping to about 10% by
≈ 5σ. Reliability is typically close to 100% at ≈
10σ, with performance to lower sensitivities varying between finders. All
finders show the expected trade-off, where a high completeness at low
signal-to-noise gives a corresponding reduction in reliability, and vice versa.
We conclude with a series of recommendations for improving the performance of
the ASKAPsoft source-finding tool.
Cryptosporidiosis and giardiasis have been recognized by the WHO as ‘Neglected Diseases’. Minimal attention has been paid to the spatial and temporal distribution of disease incidence patterns. Using disease notification data, we detected spatio-temporal clusters of cryptosporidiosis and giardiasis across three time periods: (i) 1997–2000, (ii) 2001–2004, (iii) 2005–2008. There was substantial variation in the geographical location and timing of recurrent cryptosporidiosis and giardiasis clusters. Statistically significant (P < 0·05) giardiasis clusters tended to occur in predominantly urban areas with little apparent seasonal influence, while statistically significant cryptosporidiosis clusters were detected in spring, in areas with high livestock land use. The location and timing of cryptosporidiosis clusters suggest an influence of livestock production practices, while urban exposures and host behaviour are likely to influence giardiasis clusters. This approach provides a resource-efficient method for public health authorities to prioritize future research needs and areas for intervention.
Glucagon-like peptide (GLP)-1 is an incretin hormone with several antidiabetic functions including stimulation of glucose-dependent insulin secretion, increase in insulin gene expression and beta-cell survival. Despite the initial technical difficulties and profound inefficiency of direct gene transfer into the pancreas that seriously restricted in vivo gene transfer experiments with GLP-1, recent exploitation of various routes of gene delivery and alternative means of gene transfer has permitted the detailed assessment of the therapeutic efficacy of GLP-1 in animal models of type 2 diabetes (T2DM). As a result, many clinical benefits of GLP-1 peptide/analogues observed in clinical trials involving induction of glucose tolerance, reduction of hyperglycaemia, suppression of appetite and food intake linked to weight loss have been replicated in animal models using gene therapy. Furthermore, GLP-1-centered gene therapy not only improved insulin sensitivity, but also reduced abdominal and/or hepatic fat associated with obesity-induced T2DM with drastic alterations in adipokine profiles in treated subjects. Thus, a comprehensive assessment of recent GLP-1-mediated gene therapy approaches with detailed analysis of current hurdles and resolutions, is discussed.
DX Cha (HD 104237) is a southern, optically bright Herbig Ae star with an infrared excess, that is part of a small stellar group younger than 5 Myr. We used the APEX and ASTE submillimeter telescopes in Chile to search for continuum and gas emission around this system. Using LABOCA on APEX we detect strong continuum emission around HD104237-A and system component HD104237-E. Our ASTE spectrum detects a double-peaked 12CO(3-2) line profile towards the system, typical of a rotating disk. The new data are used as constraints with MCFOST to produce a disk model that fits the entire SED as well as the observed CO line profile.
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
Exposure to intrauterine growth restriction (IUGR) is an important risk factor for impaired learning and memory, particularly in males. Although the basis of IUGR-associated learning and memory dysfunction is unknown, potential molecular participants may be insulin-like growth factor 1 (Igf1) and its receptor, IGF1r. We hypothesized that transcript levels and protein abundance of Igf1 and IGF1r in the hippocampus, a brain region critical for learning and memory, would be lower in IUGR male rats than in age-matched male controls at birth (postnatal day 0, P0), at weaning (P21) and adulthood (P120). We also hypothesized that changes in messenger Ribonucleic acid (mRNA) transcript levels and protein abundance would be associated with specific histone marks in IUGR male rats. Lastly, we hypothesized that IUGR male rats would perform poorer on tests of hippocampal function at P120. IUGR was induced by bilateral ligation of the uterine arteries in pregnant dams at embryonic day 19 (term is 21 days). Hippocampal Igf1 mRNA transcript levels and protein abundance were unchanged in IUGR male rats at P0, P21 or P120. At P0 and P120, IGF1r expression was increased in IUGR male rats. At P21, IGF1r expression was decreased in IUGR male rats. Increased IGF1r expression was associated with more histone 3 lysine 4 dimethylation (H3K4Me2) in the promoter region. In addition, IUGR male rats performed poorer on intermediate-term spatial working memory testing at P120. We speculate that altered IGF1r expression in the hippocampus of IUGR male rats may play a role in learning and memory dysfunction later in life.
This study describes the epidemiology of human salmonellosis in New Zealand using notified, hospitalized and fatal cases over a 12-year period (1997–2008). The average annual incidence for notifications was 42·8/100 000 population and 3·6/100 000 population for hospitalizations. Incidence was about twice as high in summer as in winter. Rural areas had higher rates than urban areas (rate ratio 1·23, 95% confidence interval 1·22–1·24 for notifications) and a distinct spring peak. Incidence was highest in the 0–4 years age group (154·2 notifications/100 000 and 11·3 hospitalizations/100 000). Hospitalizations showed higher rates for Māori and Pacific Island populations compared to Europeans, and those living in more deprived areas, whereas notifications showed the reverse, implying that notifications are influenced by health-seeking behaviours. Salmonella Typhimurium was the dominant serotype followed by S. Enteritidis. For a developed country, salmonellosis rates in New Zealand have remained consistently high suggesting more work is needed to investigate, control and prevent this disease.
The Isaac Newton Photometric H-Alpha Survey (IPHAS) provides (r′-Hα)-(r′-i′) colors, which can be used to select AV0-5 Main Sequence star candidates (age~20-200 Myr). By combining a sample of 23050 IPHAS-selected A-type stars with 2MASS, GLIMPSE and MIPSGAL photometry we searched for mid-infrared excesses attributable to dusty circumstellar disks. Positional cross-correlation yielded a sample of 2692 A-type stars, of which 0.6% were found to have 8-μm excesses above the expected photospheric values. The low fraction of main sequence stars with mid-IR excesses found in this work indicates that dust disks in the terrestrial planet zone of Main Sequence intermediate mass stars are rare. Dissipation mechanisms such as photo-evaporation, grain growth, collisional grinding or planet formation could possibly explain the depletion of dust detected in the inner regions of these disks.
We report the first large-scale outbreak of echovirus 19 infection. It occurred in the north-east of England during the summer and autumn of 1974. The virus was isolated from 268 patients in the region. The infection spread from the urban to more rural areas, reaching a peak in mid-August. Males were affected more often than females in the ratio 1·6:1. Half of the patients were under eight years of age, relatively few were over 35 years. Aseptic meningitis and upper respiratory infections were the commonest presentations, though a wide range of other diseases occurred including gastroenteritis, myalgia, pericarditis, undifferentiated pyrexia, rashes and a syndrome analagous to bacteraemic shock. There was no evidence that the pattern or severity of the disease changed during the outbreak. Infants under the age of six months were more seriously affected than older children and adults. All patients except one made an uneventful recovery. Of the routine tissue culture cells HEp2 and HeLa were by far the most satisfactory for virus isolation.
Several prior reports have found that some young children with autism spectrum disorder [ASD; including autism and Asperger's syndrome and pervasive developmental disorder – not otherwise specified (PDD-NOS)] have a significant increase in head size and brain weight. However, the findings from older children and adults with ASD are inconsistent. This may reflect the relatively small sample sizes that were studied, clinical heterogeneity, or age-related brain differences.
Hence, we measured head size (intracranial volume), and the bulk volume of ventricular and peripheral cerebrospinal fluid (CSF), lobar brain, and cerebellum in 114 people with ASD and 60 controls aged between 18 and 58 years. The ASD sample included 80 people with Asperger's syndrome, 28 with autism and six with PDD-NOS.
There was no significant between-group difference in head and/or lobar brain matter volume. However, compared with controls, each ASD subgroup had a significantly smaller cerebellar volume, and a significantly larger volume of peripheral CSF.
Within ASD adults, the bulk volume of cerebellum is reduced irrespective of diagnostic subcategory. Also the significant increase in peripheral CSF may reflect differences in cortical maturation and/or ageing.
In recent years, the importance of fibre provision within the horse’s diet has been realised (Ralston 2005). Consideration of the evolutionary design of the animal, combined with a greater understanding of the aetiology of metabolic disorders, has re-iterated the need for horses to be fed diets high in fibre, especially those horses on maintenance rations. It has been acknowledged that although older horses can survive on maintenance rations, they are often at risk of weight loss (Ralston, 2005), a factor that is increased if dentition is poor (Dacre, 2005). Therefore nutritional management is vital to optimise nutrient provision. In dentally compromised animals, diet type and feed availability should be managed to promote ease of consumption, and subsequent factors compromising such consumption should be eliminated. Various methods of enhancing voluntary feed intake (VFI) have been devised (Dacre, 2005). Soaking hay may alleviate some problems associated with the ingestion and mastication of a course forage product, but can lead to consequences with decreased nutrient intake. Provision of softer fibre sources (haylage, silage) could also be considered, but will, conversely, increase nutrient intake. Short chopped fibre may decrease the overall need to chew. Other products, such as fibre pellets, may be fed soaked to horses with the most serious dental problems, thus removing the need for mastication. Currently there exists little information relating to VFI of various forage sources offered to older horses with compromised dentition. The aim of this study was to investigate dry matter intake (DMI), VFI and consumption rates of three fibre sources, hay (H), DM– 915g/kg, short-chop forage (SF), DM -860g/kg and soaked fibre pellets (FP), DM – 900g/kg, in veteran horses with poor dentition. SF and FP were both commercially available preparations consisting of high temperature dried grass and alfalfa (SF) and sugar beet and alfalfa (FP).