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OBJECTIVES/SPECIFIC AIMS: The knee injury osteoarthritis and outcomes survey (KOOS) is a commonly used instrument to measure patient-reported quality of life (QOL) post-ACLR. The purpose is to evaluate the psychometric properties of the QOL subscale of the KOOS. METHODS/STUDY POPULATION: Rasch analysis of KOOS QOL subscale from 39 individuals 1–2 years post ACLR was conducted. Measurement properties and model fit of the rating scale, items, and persons were evaluated. Relationship of item difficulties and person measures was evaluated using probability curves and item maps. Reliability indicators were also examined. RESULTS/ANTICIPATED RESULTS: All items demonstrated infit and outfit mean squares and standard z-scores. The majority of persons (n=38, 97.4%) demonstrated fit to the Rasch model. However, ceiling effects were noted (n=4, 10.26%), indicating some participants report higher QOL than is measurable. The mean person measure was 1.73 logits higher than the mean item measure: this sample is skewed toward higher QOL. Person reliability was adequate (0.67) and person separation was 1.42. Calculation of person strata revealed that the KOOS QOL separated participants into 2 strata. DISCUSSION/SIGNIFICANCE OF IMPACT: Although all items of the KOOS QOL fit the model, not all categories of the rating scale were used. Overall, this sample reported high QOL, which is to be expected given the time since ACLR. If participants with a broader range of time since ACLR were included, that the KOOS QOL could identify additional person strata.
Misdiagnosis of asymptomatic bacteriuria as catheter-associated urinary tract infection (CAUTI) leads to unnecessary tests and other low-value care. We used this topic as the prototype to develop a clinical pathways program to promote evidence-based decision making in a multi-hospital system.
We convened a task force including hospital and critical care physicians, nurses, laboratory staff, and informatics specialists. Our Health Technology Asessment (HTA) center completed a rapid systematic review on guidelines and algorithms for diagnosing CAUTI. Additional rapid reviews were completed as necessary to address specific follow-up questions. A draft pathway based on the guidelines was developed, and then the task force edited it in an iterative process.
We used the Dorsata platform (Dorsata Inc., Washington, DC) to create, distribute and maintain the pathway. Dorsata has both desktop and mobile interfaces that guide clinicians through decision algorithms. Individual pathways include links to references and a portal for direct user feedback. Pathway owners have access to a real-time pathway utilization dashboard.
A standardized order set with the pathway was added to our electronic health record system. We also held educational meetings for residents and provided “huddle sheets” to nurse educators at each hospital. Posters and computer screen savers were also used to raise awareness of the new pathway.
We now have a total of 111 pathways on Dorsata, developed following the same model as the CAUTI evaluation pathway. Some topics, like breast cancer, have as many as sixteen pathways, addressing different clinical questions like first- and second-line therapy. Over 600 individuals have registered for the mobile app, including attending and resident physicians, nurses, and medical students. The pathway site had 1,619 views in December 2016, the most recent month for which complete records are available. The pathways are proving to have an effect on clinical decision making. For example, the annualized number of unnecessary urine cultures avoided as a result of the pathway is 4,474; resulting in estimated direct cost savings of USD67,110.
Using pathways to present HTA information at the point of care is feasible and can improve the value of care.
Background: Therapist self-practice, in its various forms, is common across therapeutic modalities, but a measure of its impact on participants does not yet exist. Aims: This paper describes the development and reliability testing of the ‘Self-focused Practice Questionnaire’ (SfPQ), a measure of self-perceived impact of one's self-focused practice. Method: Exploratory factor analysis (EFA), internal consistency and reliability were assessed in a convenience sample of 112 trainee therapists. Results: Five factors, rating impacts on therapist Personal-self (Awareness of Developmental experiences, Experience of Personal Change and Felt-sense/Self-awareness), and Therapist-self (Internalization of the Model, and Development of Empathy) were identified, with good internal consistency and acceptable to good test–retest reliability. Conclusions: Though more work is needed, these preliminary results support the SfPQ's reliability and validity. The SfPQ is an important measure, which may enhance routine rating of self-focused practice in training institutions.
To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections.
Epidemiologic investigation of the outbreak.
Oncology clinic (clinic A).
Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012–May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility’s water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis.
Twelve cases were identified; median (range) age was 65 (41–78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates.
Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed.
Religious freedom in the United States is widely enjoyed and vigorously protected. Yet, a substantial percentage of Americans believe that their religious liberties are threatened. This article investigates the origins of these perceptions, focusing on the role of political orientations, religious identities and behaviors, social issues (i.e., gay marriage and abortion), and news attentiveness. We found that perceptions of threat are related to political orientations (i.e., partisan affiliation, ideology, and Tea Party identification) and issue positions (i.e., opposition to gay marriage). Consistent with theories of elite cue-taking, the effects of partisan affiliation are contingent on news attentiveness. Republicans who pay closer attention to the news are more likely to state that their religious liberties are threatened.
We trained local public health workers on disaster recovery roles and responsibilities by using a novel curriculum based on a threat and efficacy framework and a training-of-trainers approach. This study used qualitative data to assess changes in perceptions of efficacy toward Hurricane Sandy recovery and willingness to participate in future disaster recoveries.
Purposive and snowball sampling were used to select trainers and trainees from participating local public health departments in jurisdictions impacted by Hurricane Sandy in October 2012. Two focus groups totaling 29 local public health workers were held in April and May of 2015. Focus group participants discussed the content and quality of the curriculum, training logistics, and their willingness to engage in future disaster recovery efforts.
The training curriculum improved participants’ understanding of and confidence in their disaster recovery work and related roles within their agencies (self-efficacy); increased their individual- and agency-level sense of role-importance in disaster recovery (response-efficacy); and enhanced their sense of their agencies’ effective functioning in disaster recovery. Participants suggested further training customization and inclusion of other recovery agencies.
Threat- and efficacy-based disaster recovery trainings show potential to increase public health workers’ sense of efficacy and willingness to participate in recovery efforts. (Disaster Med Public Health Preparedness. 2016;10:615–622)
Emerging evidence from epidemiological studies supports the notion that maternal folate status regulated by dietary and genetic factors early in pregnancy may influence the risk of autism spectrum disorders (ASD). In this review, we provide an overview of what is known about the role of folate in the aetiology of neurodevelopmental disorders; summarise relevant biological, genetic and epigenetic mechanisms; and synthesise the evidence from human observational studies and randomised controlled trials that have examined the relationship between maternal folate and ASD or related traits. Much of the existing literature on this topic is subject to limitations such as potential confounding by healthy behaviours and other dietary factors, and exposure assessed within limited exposure windows. As the existing evidence is inconclusive, further research remains to be conducted in order to verify this hypothesis. Complete assessment of maternal functional folate status through the pre- and peri-conceptional periods requires biological measurement of folate, vitamin B12 and homocysteine and genetic variants involved in one-carbon metabolism and epigenetic mechanisms. In addition to more complete assessment of maternal functional folate status, careful consideration of potential confounding is warranted.
Additive manufacturing (AM) holds tremendous promise in terms of revolutionizing manufacturing. However, fundamental hurdles limit the widespread adoption of this technology. First, production rates are extremely low. Second, the physical size of the parts is generally small, less than a cubic foot. Third, the mechanical properties of the polymer parts are generally poor, limiting the potential for direct part replacement and functional use of the polymer components. This article describes various ways in which carbon fibers (CFs) can be used to address these fundamental hurdles. First, CF-reinforced polymers developed for AM have demonstrated specific strengths approaching aerospace-quality aluminum. Second, CF additions can radically reduce the distortion and warping of the material during deposition, which enables large-scale, out-of-the-oven, high deposition rate manufacturing. Finally, the complementary nature of CF technology and AM is discussed, showing how merging the two manufacturing processes enables the construction of complex components that would not be possible with either technology alone.
Scanning acoustic microscopy (SAM), when applied to biological samples has the potential to resolve the longitudinal acoustic wave speed and hence stiffness of discrete tissue components. The heterogeneity of biological materials combined with the action of cryosectioning and rehydrating can, however, create variations in section topography. Here, we set out to determine how variations in specimen thickness influence apparent acoustic wave speed measurements
Cryosections (5μm nominal thickness) of human skin biopsies were adhered to glass slides before washing and rehydrating in water. Multiple regions (200x200 μm; n = 3) were imaged by SAM to generate acoustic wave speed maps. Subsequently co-localised 30x30 μm sub-regions were imaged by atomic force microscopy (AFM) in fluid. The images were then registered using Image J. Each pixel was allocated both a height and wave speed value before their relationship was then plotted on a scattergram. The mean section thickness measured by AFM was 3.48 ± 1.12 (SD) μm. Regional height variations influenced apparent wave speed measurements. A 3.5 μm height difference was associated with a 400 ms-1 increase in wave speed. In the present study we show that local variations in specimen thickness influence apparent wave speed. We also show that a true measure of wave speed can be calculated if the thickness of the specimen is known at each sampling point.
Since our earliest days as a profession, regularities of politics have been described in terms of laws of political behavior (Bryce 1909), but not without controversy. Reviewing a century of efforts to identify laws of politics yields numerous offerings, including Duverger's (1954) and Michels' (1915) well-known contributions. Following the structure embodied in Newton's Laws of Motion, I propose three general laws of politics and government in America: (1) political objects in motion tend to stay in motion, (2) the relationship between a candidate and his or her political force is the product of campaign funding and personal likability or appeal to the press, and (3) for every political action, there is an equal and opposite reaction (i.e., “Craig Leonard Brians Law of Unintended Political Consequences”). Each law is illustrated and discussed using examples drawn from US politics. Finally, I note several potential research limitations of these proposed laws, as well as their possible utility in teaching introductory political science courses.
We consider the neglected importance of temperature as an explanatory variable. We show that: (1) colder states have turnout that is high relative to the national average; (2) the coldest states in the United States were more likely to adopt Election Day Registration (EDR) than other states, and very hot states never did so; and (3) those who live in colder states live longer.
Two-Photon initiated polymerization (TPIP) has shown great promise for fabrication of complex micro- and nano-structures. The method has been used to fabricate such structures over small areas (< 1 mm2) because of slow fabrication speeds and resulting long fabrication times. In order for TPIP to reach practical application in a commercial setting fabrication times need to be reduced by orders of magnitude. We report results on a highly photosensitive initiation system for photoresists based on free radical and cationic polymerization, where photosensitivity is increased 102- to 103-fold compared to previously reported photoinitiation systems. Threshold writing speeds are determined for critical exposure conditions, including laser power, type and concentration of photoinitiation system, and photoresist type. Surface roughness, a critical parameter in applications such as optics and microfluidics, for example, is also used to determine threshold writing speed. The utility of the approach is demonstrated by making a cell phone keypad light guide from a microreplication tool fabricated using the highly photosensitive photoresist.
In 1967, all London medical schools were separate institutions based on their teaching hospitals, many of which had moved from their original central sites. Successive attempts at merger met resistance, but by 2000 there were just five undergraduate schools, all incorporated in large multi-faculty colleges with the exception of St George's.
IMPERIAL COLLEGE LONDON
In the north-west, Imperial College absorbed St Mary's Hospital in 1989 and in 1997 also took in Charing Cross and Westminster Hospitals (already merged in 1983).
Charing Cross Hospital
Early development of general practice teaching
Charing Cross Hospital medical school started in the mid-nineteenth century at the hospital building near The Strand, London. It was small, taking twenty to thirty new students annually. General practice teaching started in the 1950s when students were invited to stay with a general practitioner (usually an alumnus) for three weeks in their final year. Most practices were outside London (often rural), enabling students to experience the daily life of a general practitioner, including out of hours work and living with his family.
Charing Cross Hospital moved to Fulham in 1974, and the annual school intake increased to 120. The final-year general practice attachment expanded accordingly and the Dean, Professor Glenister, initiated plans for an undergraduate general practice teaching unit. The education committee of the north and west London faculty of the RCGP took great interest in the developments, especially as the GMC was threatening to remove accreditation from schools that did not have departments of general practice.
To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.
Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.
Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.
A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003).
These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.
α-Dodecatungstosilicate (α-SiW12O404−) anions form ordered monolayers on Ag(111) and Au(111) surfaces. In-situ STM images reveal that the silicotungstate ion forms a square adlattice with an intermolecule spacing of 10.2 ± 0.5 Å on both Ag and Au surfaces. Additional structures exhibiting either row or rhombic motifs are observed on Au electrodes. The structure of the adlattices can be modeled using a simple model which maximizes the coordination of the silicotungstate ion to the electrode while maintaining van der Waals contacts between terminal oxygens of adjacent silicotungstates.
We present results of extremely short carrier lifetime measurements on a series of hydrogenated nanocrystalline silicon (nc-Si:H) thin films by a novel, non-destructive, non-contact method. Transmission modulated photoconductive decay (TMPCD) is a newly developed technique which appears to have high enough sensitivity and time resolution to measure the extremely short carrier lifetimes on the order of a nanosecond. As a proof of this, we measure various nc-Si:H samples of varying crystalline volume fraction as well as a fully amorphous sample. To ascribe an effective lifetime to the materials, we use a simple model which assumes a single exponential decay. By using this model, effective lifetimes can be deconvoluted from our pump beam giving nanosecond lifetimes. Lifetimes of between 1.9 and 0.9 nanoseconds are reported and trend to decreasing lifetimes as crystalline volume fraction is increased.