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Recent years have seen an exponential increase in the variety of healthcare data captured across numerous sources. However, mechanisms to leverage these data sources to support scientific investigation have remained limited. In 2013 the Pediatric Heart Network (PHN), funded by the National Heart, Lung, and Blood Institute, developed the Integrated CARdiac Data and Outcomes (iCARD) Collaborative with the goals of leveraging available data sources to aid in efficiently planning and conducting PHN studies; supporting integration of PHN data with other sources to foster novel research otherwise not possible; and mentoring young investigators in these areas. This review describes lessons learned through the development of iCARD, initial efforts and scientific output, challenges, and future directions. This information can aid in the use and optimisation of data integration methodologies across other research networks and organisations.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
Quantifying historic changes in glacier size and mass balance is important for understanding how the cryosphere responds to climate variability and change. Airborne photogrammetry enables glacier extent and equilibrium line altitudes (ELAs) to be monitored for more glaciers at lower cost than traditional mass-balance programs and other remote-sensing techniques. Since 1977, end-of-summer-snowlines, which are a proxy for annual ELAs, have been recorded for 50 glaciers in the Southern Alps of New Zealand using oblique aerial photographs. In this study, we use structure from motion photogrammetry to estimate the camera parameters, including position, for historic photographs, which we then use to measure glacier change. We apply this method to a small maritime New Zealand glacier (Brewster Glacier, 1670–2400 m a.s.l.) to derive annual ELA and length records between 1981 and 2017, and quantify the uncertainties associated with the method. Our length reconstruction shows largely continuous terminus retreat of 365 ± 12 m for Brewster Glacier since 1981. The ELA record, which compares well with glaciological mass-balance data measured between 2005 and 2015, shows pronounced interannual variability. Mean ELAs range from 1707 ± 6 to 2303 ± 5 m a.s.l., with the highest ELAs occurring in the last decade.
Short-term glacier velocity variations typically occur when a water input is accommodated by an increase in the subglacial water pressure. Although these velocity variations have been well documented on many glaciers, few studies have considered them on glaciers where heavy rain and glacier melt occur year-round. This study investigates the relationship between water inputs and glacier velocity on Franz Josef Glacier, New Zealand. We installed six GNSS stations across the lower glacier during austral summer 2010/11 and one station during summer 2012/13. Glacier velocity remained elevated at all stations for ∼7 days following large rain events. During diurnal melt events, we find velocity variations in the early afternoon (12:00–16:00) at 600 m a.s.l. and in the late evening (20:00–01:00) at 400 m a.s.l. We hypothesize that the late-evening velocity variations occurred as an upstream region of high subglacial water pressures and accelerated ice motion propagated downstream. This mechanism may also explain the increased longitudinal compression and transverse extension across the lower glacier during speed-up events. Our results indicate that the subglacial drainage system likely decreases in efficiency upstream and that the water input variability can still cause short-term velocity variations despite the large year-round water inputs.
Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty-four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on-screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single-bout and 3-month exercise intervention. Significant group × time interactions were found after a single-bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge. (JINS, 2015, 21, 768–779)
The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs.
The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility study of measuring the final set of indicators using current Canadian administrative databases was conducted.
A total of 170 candidate indicators were generated from the literature; these were assessed based on scientific soundness and their relevance or importance. Using predefined scoring criteria in two rounds of surveys, indicators were coded as “retained” (53), “discarded” (78), or “borderline” (39). A final set of 48 retained indicators was selected and grouped in nine categories (patient satisfaction, ED operations, patient safety, pain management, pediatrics, cardiac conditions, respiratory conditions, stroke, and sepsis or infection). Gap analysis suggested the need for new indicators in patient satisfaction, a healthy workplace, mental health and addiction, elder care, and community-hospital integration. Feasibility analysis found that 13 of 48 indicators (27%) can be measured using existing national administrative databases.
A broadly representative modified Delphi panel process resulted in a consensus on a set of 48 evidencebased quality of care indicators for EDs. Future work is required to generate technical definitions to enable the uptake of these indicators to support benchmarking, quality improvement, and accountability efforts.
A novel, water-soluble AB-block copolymer of diethylaminoethyl methacrylate (DEAEM) and poly(ethylene glycol) (PEG) was synthesized by anionic polymerization. Poly(ethylene glycol) methyl ether (PEGME) was converted into the corresponding potassium salt by reacting with potassium metal. The PEG salt was used as a macroinitiator for the polymerization of DEAEM to yield a PEG-b-PDEAEM block copolymer. Carbon dioxide was used to terminate DEAEM polymerization with a carboxylic acid group. This polymer, loaded with dye, was tested for pH sensitivity by release studies into solutions of various pH.
High-throughput synthesis of the ferroelectric solid solution Pb(Zr1−xTix)O3 (PZT) on single Pt/Ti/SiO2/Si substrates was demonstrated using a modified molecular beam epitaxy (MBE) system. The PZT films exhibited a phase transition from rhombohehdral (R) to tetragonal (T) symmetry as a function of Zr:Ti ratio, across the substrate diagonal. This was consistent with the presence of a morphotropic phase boundary (MPB) at a Zr:Ti ratio of 0.64:0.36, different from the value of 0.53:0.47 observed for bulk ceramics. All points on the films exhibited ferroelectric hysteresis loops. The results demonstrate the feasibility of high-throughput MBE for deposition of complex ferroelectric oxides, and pave the way for further materials discovery, in particular Pb-free piezoceramics.
This case report describes a melanin-containing neurofibroma involving a spinal nerve root. Electron microscopy of the tumor shows that neoplastic Schwann cells are capable of melanogene-sis. Although this capability is suggested in the literature, few reports provide ultra-structural confirmation.
The likely identity between reported “cellular blue nevi of spinal nerve roots” and nerve sheath tumors is discussed. It is possible that pigmented nerve sheath tumors behave more aggressively than nonpigmented ones, although it is debatable.
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