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We compared sepsis “time zero” and Centers for Medicare and Medicaid Services (CMS) SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 of 80 (36%) cases. Perceived pass rates ranged from 9 of 80 cases (11%) to 19 of 80 cases (23%). Variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals.
Secondary analysis of publicly available HAI data for calendar year 2013.
We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC).
Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy).
HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs.
OBJECTIVES/SPECIFIC AIMS: The Institute for Transnational Sciences (ITS) has developed novel methods to ethically engage stakeholders across the transnational research spectrum, up to and including public health practice and policy. METHODS/STUDY POPULATION: In 2014, the ITS co-founded The Research, Education, And Community Health (REACH), the mission of which was to facilitate communication, collaborative research, and service activities between faculty and scientists and area community leaders. The intent was to identify and meet the needs of our communities without gaps and/or redundancies, thus better leveraging time, funding, and efforts. RESULTS/ANTICIPATED RESULTS: REACH now boasts 23 Centers, Departments, and Institutes, as well as 39 community organizations, including public and mental health agencies, clinicians, policy makers, family service centers, cultural and faith-based organizations, business, and local schools/colleges. We offer 3 methods for consideration as best practices: (1) a comprehensive community health needs assessment, (2) an “Offer and Ask” community/campus partnership mechanism, and (3) Community Science Workshops, based on the European Union’s Science Shops. DISCUSSION/SIGNIFICANCE OF IMPACT: Results of REACH’s work have been used to provide guidance for enhanced, data-driven programs and allocation of resources for local and statewide initiatives. The organization has evolved into an independent coalition seeking 501(c)3 status and is planning to expand its scope to 5 counties. REACH thus serves as model for successful replication across applicable CTSA hubs.
In this contribution I provide a brief summary of the contents of Gaia DR1. This is followed by a discussion of studies in the literature that attempt to characterize the quality of the Tycho-Gaia Astrometric Solution parallaxes in Gaia DR1, and I point out a misconception about the handling of the known systematic errors in the Gaia DR1 parallaxes. I highlight some of the more unexpected uses of the Gaia DR1 data and close with a look ahead at the next Gaia data releases, with Gaia DR2 coming up in April 2018.
OB associations are prime sites for the study of star formation processes and of the interaction between young massive stars with the interstellar medium. Furthermore, the kinematics and structure of the nearest OB associations provide detailed insight into the properties and origin of the Gould Belt. In this context, the Orion complex has been extensively studied. However, the spatial distribution of the stellar population is still uncertain: in particular, the distances and ages of the various sub-groups composing the Orion OB association, and their connection to the surrounding interstellar medium, are not well determined. We used the first Gaia data release to characterize the stellar population in Orion, with the goal to obtain new distance and age estimates of the numerous stellar groups composing the Orion OB association. We found evidence of the existence of a young and rich population spread over the entire region, loosely clustered around some known groups. This newly discovered population of young stars provides a fresh view of the star formation history of the Orion region.
We report a significant hardening of the Fermi-LAT gamma-ray spectrum from the core of Cen A at E > 2.4 GeV, suggesting there is a source of high energy particles in the core of Cen A which is in addition to the jet component. We show that the observed gamma-ray spectrum is compatible with either a spike in the dark matter halo profile or a population of millisecond pulsars. This work gives a strong indication of new gamma-ray production mechanisms in active galactic nuclei and could even provide evidence for the clustering of heavy dark matter particles around black holes.
Hospital-acquired infection (HAI) data are reported to the public on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. We previously found that public understanding of these data is poor. Our objective was to develop an improved method for presenting HAI data that could be used on the CMS website.
Randomized controlled trial comparing understanding of data presented using the current CMS presentation strategy versus a new strategy.
A 760-bed tertiary referral hospital.
A total of 61 patients were randomly selected within 24 hours of admission.
Participants were shown HAI data as presented on the CMS Hospital Compare website (control arm) or data formatted using a new method (experimental arm).
No statistically significant demographic differences were identified between study arms. Although 47% percent of participants said a website for comparing hospitals would have been helpful, only 10% had ever used such a website. Participants viewing data using the new presentation strategy compared hospitals correctly 56% of the time, compared with 32% in the control arm (P=.0002).
Understanding of HAI data increased significantly with the new data presentation method compared to the method currently used on the CMS Hospital Compare website. Many participants expressed interest in a website for comparing hospitals. Improved methods for presenting CMS HAI data, such as the one assessed here, should be adopted to increase public understanding.
To compare the energy, nutrient and food group compositions of three sources of school-day lunches among students in five secondary schools in the Republic of Ireland (ROI).
Cross-sectional study conducted between October 2012 and March 2013. Students completed self-report food diaries over two school days. The energy, nutrient, nutrient density and food group composition of school-day lunches from home, school and ‘out’ in local food outlets were compared using ANCOVA and Tukey’s Honest Significant Difference post hoc analysis.
Five secondary schools in the ROI.
Male and female students aged 15–17 years (n 305).
Six hundred and fifteen lunches (376 home lunches, 115 school lunches and 124 lunches sourced ‘out’ in the local environment) were analysed. School and ‘out’ purchased lunches were significantly higher than packed lunches from home in energy (2047 kJ (489 kcal), 2664 kJ (627 kcal), 1671 kJ (399 kcal), respectively), total fat (23·5 g, 30·1 g, 16·6 g, respectively) and free (added) sugars (12·6 g, 19·3 g, 7·4 g, respectively). More home lunches contained more fruit, wholemeal breads, cheese and red meat than lunches from school or ‘out’. Meat products, chips and high-calorie beverages were sourced more frequently at school or ‘out’ than home. Fibre and micronutrient contents of lunches from all sources were low.
Home-sourced lunches had the healthiest nutritional profile in terms of energy and macronutrients. Foods high in energy, fat and free sugars associated with school and local food outlets are of concern given the public health focus to reduce their consumption. While school food should be improved, all sources of lunches need to be considered when addressing the dietary behaviours of secondary-school students.
Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.
All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity.
Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62).
Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.
HISAT, a multi-element heterodyne interferometer attached to Space Station Freedom, will provide spectroscopic images with unprecedented detail of those submillimeter lines of C,O and C+ which are critical diagnostics of UV excitation in the Galaxy. With the arcsecond angular resolution achievable from the space station, HISAT will reveal:
– The distribution of sources of ultraviolet radiation in the Galaxy;
–The effective temperature of the UV radiation as a function of galactocentric radius;
– The chemical and isotopic enhancement of atomic carbon and oxygen with galactic radius;
– The propagation of UV radiation in molecular clouds and its stimulative, or inhibitive, effect on star formation;
– The density structure, dumpiness or fragmentation, of molecular clouds throughout the Galaxy. HISAT has been selected by NASA for a concept-phase study.
In the context of the luminosity calibration of the nearer stars I discuss the Hipparcos results on distances to nearby OB associations and open clusters. The shortcomings and assumptions in the analyses used to derive these results are pointed out and for the open clusters a comparison is made with results obtained from main sequence fitting. I conclude that given the considerable uncertainties in the latter technique there is no convincing evidence that the Hipparcos based distances to open clusters beyond the Hyades should not be trusted.
The Hellenistic and Roman passion for founding, or renaming, Eastern cities in honour of their rulers abated only with the decline of urban life itself under the Byzantines, although it was never entirely forgotten. The last notable example seems to be the tragi-comic career of Tralles (Aydin) as Andronikopolis or Palaiologopolis in 1278–82. But the last emperor to have notably bestowed his (or his family’s) name on cities with the old gusto seems to have been Heraclius. It was perhaps part of a recognizable pattern of traits—the complex naming of his sons, the family groups on his coins, the concern for his own title, the quest for the True Cross, and the style of his victory despatch from Nineveh—in which one may glimpse in Heraclius a relentless and self-conscious sense of dynasty and historicity.
In the face of a supposed dearth of recorded responses to icons, historians of Byzantine art commonly infer these either from characteristics that they suppose to inhere in works of art themselves, or transfer to the personal and practical realm such theoretical attitudes as are proclaimed in the proceedings of church councils and similar documents. These methods of argumentation give rise to assumptions that (i) aesthetic reactions to images were unimportant or at least subordinate to attitudes born of piety, and (ii) artists used older works as models and the value of their artefacts was understood to be directly proportional to the fidelity of their copies to the ‘prototype’. Views of this sort can indeed be supported by texts that set out a variety of orthodox positions ranging from bodies of legal opinion to anecdotal accounts of devotion to icons. But to suppose that such readings represent immutable standards is to take part of the picture for the whole. The study of what seem at first sight to be aberrant attitudes can lend a new perspective on behaviour that is often treated as normative. Artists’ ‘deviations’, and highly emotive and even criminal reactions to their work, are still marginal to our perceptions of Byzantium formed by texts that present one or another official position, even while we are aware that styles of painting (as of writing) varied from one individual to another and that private passions and crimes flourished in this society as in any other.
Public reporting of hospital quality data is a key element of US healthcare reform. Data for hospital-acquired infections (HAIs) are especially complex.
To assess interpretability of HAI data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data.
We randomly selected inpatients at a large tertiary referral hospital from June to September 2014. Participants performed 4 distinct tasks comparing hypothetical HAI data for 2 hospitals, and the accuracy of their comparisons was assessed. Data were presented using the same tabular formats used by Centers for Medicare and Medicaid Services. Demographic characteristics and healthcare experience data were also collected.
Participants (N=110) correctly identified the better of 2 hospitals when given written descriptions of the HAI measure in 72% of the responses (95% CI, 66%–79%). Adding the underlying numerical data (number of infections, patient-time, and standardized infection ratio) to the written descriptions reduced correct responses to 60% (55%–66%). When the written HAI measure description was not informative (identical for both hospitals), 50% answered correctly (42%–58%). When no written HAI measure description was provided and hospitals differed by denominator for infection rate, 38% answered correctly (31%–45%).
Current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses. Research is needed to identify better ways to convey these data to the public.
Infect. Control Hosp. Epidemiol. 2016;37(2):182–187
Psychopharmacology is an increasingly important aspect of child and adolescent psychiatry. The evidence base for the psychopharmacological treatment of depression, anxiety, schizophrenia, bipolar disorder, obsessive—compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) is increasing. This article presents a synthesis of the information from randomised controlled trials, meta-analyses and the UK NICE guidelines as an aid to practical psychopharmacology.
Commission 8 has regularly published triennial reports in the past and the current OC therefore voted to adopt a traditional format also for this special Legacy issue of the IAU Transactions. The outgoing President is grateful for the support of many Commission members who contributed to this report. Our contribution consists of 3 parts: 1) this introduction, providing a general overview and highlights of recent research in astrometry, 2) a summary of the astrometry business & science meeting at the 2015 IAU General Assembly, and 3) the activity report of our Commisson covering the mid-2012 to mid-2015 period.