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Collaborative quality improvement and learning networks have amended healthcare quality and value across specialities. Motivated by these successes, the Pediatric Acute Care Cardiology Collaborative (PAC3) was founded in late 2014 with an emphasis on improving outcomes of paediatric cardiology patients within cardiac acute care units; acute care encompasses all hospital-based inpatient non-intensive care. PAC3 aims to deliver higher quality and greater value care by facilitating the sharing of ideas and building alignment among its member institutions. These aims are intentionally aligned with the work of other national clinical collaborations, registries, and parent advocacy organisations. The mission and early work of PAC3 is exemplified by the formal partnership with the Pediatric Cardiac Critical Care Consortium (PC4), as well as the creation of a clinical registry, which links with the PC4 registry to track practices and outcomes across the entire inpatient encounter from admission to discharge. Capturing the full inpatient experience allows detection of outcome differences related to variation in care delivered outside the cardiac ICU and development of benchmarks for cardiac acute care. We aspire to improve patient outcomes such as morbidity, hospital length of stay, and re-admission rates, while working to advance patient and family satisfaction. We will use quality improvement methodologies consistent with the Model for Improvement to achieve these aims. Membership currently includes 36 centres across North America, out of which 26 are also members of PC4. In this report, we describe the development of PAC3, including the philosophical, organisational, and infrastructural elements that will enable a paediatric acute care cardiology learning network.
Powder X-ray diffraction has become a routine procedure for the quantification of phases in mixtures. The most common method for this measurement is the Rietveld method, which generally returns the relative weight percentages of the crystalline components within the mixture. However, in many instances, it is also desirable to obtain an estimate of the amorphous content of a sample. There are several methods that may be used for this measurement and their accuracy has been assessed previously with a number of ideal, synthetic mixtures. Many samples, especially in the mineralogy sphere, are far from ideal and contain multiple phases of varying absorption contrast. This creates a microabsorption problem which affects the accuracy of the determination of both the crystalline and amorphous components. This paper assesses commonly used methods of amorphous determination with a series of synthetic samples designed to create a considerable microabsorption problem.
OBJECTIVES/SPECIFIC AIMS: Issues with recruiting the targeted number of participants in a timely manner often results in underpowered studies, with more than 60% of clinical studies failing to complete or requiring extensions due to enrollment issues. The objective of this study is to develop and implement a scalable, organization wide platform to enhance accrual into clinical research studies. METHODS/STUDY POPULATION: We are developing and evaluating an informatics platform called Utah Utility for Research Recruitment (U2R2). U2R2 consists of 2 components: (i) Semantic Matcher: an automated trial criterion to patient matching component that also reports uncertainty associated with the match, and (ii) Match Delivery: mechanisms to deliver the list of matched patients for different research and clinical settings. As a first step, we limited the Semantic Matcher to utilize only structured data elements from the patient record and trial criteria. We are now including distributional semantic methods to match complete patient records and trial criteria as documents. We evaluated the first phase of U2R2 based on a randomized trial with a target enrollment of 220 participants that compares 2 treatment strategies for managing back pain (physical therapy and usual care) for individuals consulting a nonsurgical provider and symptomatic <90 days. RESULTS/ANTICIPATED RESULTS: U2R2 identified 9370 patients from the University of Utah Hospitals and Clinics as potential matches. Of these 9370, 1145 responded to the Back Pain study research team’s email or phone communications, and were further screened by phone. In total, 250 participants completed a screening visit, resulting in the current study enrollment of 130 participants. Forty-three of 1145 patients refused to participate, and 50 participants no-showed their screening visit. DISCUSSION/SIGNIFICANCE OF IMPACT: A recruitment platform can enhance potential participant identification, but requires attention to multiple issues involved with clinical research studies. Clinical eligibility criteria are usually unstructured and require human mediation and abstraction into discrete data elements for matching against patient records. In addition, key eligibility data are often embedded within text in the patient record. Distributional semantic approaches, by leveraging this content, can identify potential participants for screening with more specificity. The delivery of the list of matched patient results should consider characteristics of the research study, population, and targeted enrollment (eg, back pain being a common disorder and the possibility of the patient visiting different types of clinics), as well as organizational and socio-technical issues surrounding clinical practice and research. Embedding the delivery of match results into the clinical workflow by utilizing user-centered design approaches and involving the clinician, the clinic, and the patient in the recruitment process, could yield higher accrual indices.
OBJECTIVES/SPECIFIC AIMS: Key factors causing irreproducibility of research include those related to inappropriate study design methodologies and statistical analysis. In modern statistical practice irreproducibility could arise due to statistical (false discoveries, p-hacking, overuse/misuse of p-values, low power, poor experimental design) and computational (data, code and software management) issues. These require understanding the processes and workflows practiced by an organization, and the development and use of metrics to quantify reproducibility. METHODS/STUDY POPULATION: Within the Foundation of Discovery – Population Health Research, Center for Clinical and Translational Science, University of Utah, we are undertaking a project to streamline the study design and statistical analysis workflows and processes. As a first step we met with key stakeholders to understand the current practices by eliciting example statistical projects, and then developed process information models for different types of statistical needs using Lucidchart. We then reviewed these with the Foundation’s leadership and the Standards Committee to come up with ideal workflows and model, and defined key measurement points (such as those around study design, analysis plan, final report, requirements for quality checks, and double coding) for assessing reproducibility. As next steps we are using our finding to embed analytical and infrastructural approaches within the statisticians’ workflows. This will include data and code dissemination platforms such as Box, Bitbucket, and GitHub, documentation platforms such as Confluence, and workflow tracking platforms such as Jira. These tools will simplify and automate the capture of communications as a statistician work through a project. Data-intensive process will use process-workflow management platforms such as Activiti, Pegasus, and Taverna. RESULTS/ANTICIPATED RESULTS: These strategies for sharing and publishing study protocols, data, code, and results across the spectrum, active collaboration with the research team, automation of key steps, along with decision support. DISCUSSION/SIGNIFICANCE OF IMPACT: This analysis of statistical methods and process and computational methods to automate them ensure quality of statistical methods and reproducibility of research.
Around 70% of total seed phosphorus is represented by phytate which must be hydrolysed to be bioavailable in non-ruminant diets. The limited endogenous phytase activity in non-ruminant animals make it common practice to add an exogenous phytase source to most poultry and pig feeds. The mature grain phytase activity (MGPA) of cereal seeds provides a route for the seeds themselves to contribute to phytate digestion, but MGPA varies considerably between species and most varieties in current use make negligible contributions. Currently, all phytases used for feed supplementation and transgenic improvement of MGPA are derived from microbial enzymes belonging to the group of histidine acid phosphatases (HAP). Cereals contain HAP phytases, but the bulk of MGPA can be attributed to phytases belonging to a completely different group of phosphatases, the purple acid phosphatases (PAPhy). In recent years, increased MGPAs were achieved in cisgenic barley holding extra copies of barley PAPhy and in the wheat HIGHPHY mutant, where MGPA was increased to ~6200 FTU/kg. In the present study, the effect of replacing 33%, 66% and 100% of a standard wheat with HIGHPHY wheat was compared with a control diet with and without 500 FTU of supplemental phytase. Diets were compared by evaluating broiler performance, ileal Ca and P digestibility and tibia development, using nine replicate pens of four birds per diet over 3 weeks from hatch. There were no differences between treatments in any tibia or bird performance parameters, indicating the control diet did not contain sufficiently low levels of phosphorus to distinguish effect of phytase addition. However, in a comparison of the two wheats, the ileal Ca and P digestibility coefficients for the 100% HIGHPHY wheat diets are 22.9% and 35.6% higher, respectively, than for the control diet, indicating the wheat PAPhy is functional in the broiler digestive tract. Furthermore, 33% HIGHPHY replacement of conventional wheat, significantly improved Ca and P digestibility over the diet-supplemented exogenous phytase, probably due to the higher phytase activity in the HIGHPHY diet (1804 v. 1150 FTU). Full replacement by HIGHPHY gave 14.6% and 22.8% higher ileal digestibility coefficients for Ca and P, respectively, than for feed supplemented with exogenous HAP phytase at 500 FTU. This indicates that in planta wheat PAPhys has promising potential for improving P and mineral digestibility in animal feed.
Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.
We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.
We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32).
Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
The objectives of this study were to investigate the individual variation, repeatability and correlation of methane (CH4) production from dairy cows measured during 2 different years. A total of 21 dairy cows with an average BW of 619±14.2 kg and average milk production of 29.1±6.5 kg/day (mean±s.d.) were used in the 1st year. During the 2nd year, the same cows were used with an average BW of 640±8.0 kg and average milk production of 33.4±6.0 kg/day (mean±s.d.). The cows were housed in a loose housing system fitted with an automatic milking system (AMS). A total mixed ration was fed to the cows ad libitum in both years. In addition, they were offered concentrate in the AMS based on their daily milk yield. The CH4 and CO2 production levels of the cows were analysed using a Gasmet DX-4030. The estimated dry matter intake (EDMI) was 19.8±0.96 and 23.1±0.78 (mean±s.d.), and the energy-corrected milk (ECM) production was 30.8±8.03 and 33.7±5.25 kg/day (mean±s.d.) during the 1st and 2nd year, respectively. The EDMI and ECM had a significant influence (P<0.001) on the CH4 (l/day) yield during both years. The daily CH4 (l/day) production was significantly higher (P<0.05) during the 2nd year compared with the 1st year. The EDMI (described by the ECM) appeared to be the key factor in the variation of CH4 release. A correlation (r=0.54) of CH4 production was observed between the years. The CH4 (l/day) production was strongly correlated (r=0.70) between the 2 years with an adjusted ECM production (30 kg/day). The diurnal variation of CH4 (l/h) production showed significantly lower (P<0.05) emission during the night (0000 to 0800 h). The between-cows variation of CH4 (l/day, l/kg EDMI and l/kg ECM) was lower compared with the within-cow variation for the 1st and 2nd years. The repeatability of CH4 production (l/day) was 0.51 between 2 years. In conclusion, a higher EDMI (kg/day) followed by a higher ECM (kg/day) showed a higher CH4 production (l/day) in the 2nd year. The variations of CH4 (l/day) among the cows were lower than the within-cow variations. The CH4 (l/day) production was highly repeatable and, with an adjusted ECM production, was correlated between the years.
Physical inactivity and low birth weight (LBW) may lead to an increased risk for developing type 2 diabetes. The extent to which LBW individuals may benefit from physical exercise training when compared with those with normal birth weight (NBW) controls is uncertain. We assessed the impact of an outdoor exercise intervention on body composition, insulin secretion and action in young men born with LBW and NBW in rural India. A total of 61 LBW and 56 NBW healthy young men were recruited into the study. The individuals were instructed to perform outdoor bicycle exercise training for 45 min every day. Fasting blood samples, intravenous glucose tolerance tests and bioimpedance body composition assessment were carried out. Physical activity was measured using combined accelerometry and heart rate monitoring during the first and the last week of the intervention. Following the exercise intervention, the LBW group displayed an increase in physical fitness [55.0 ml (O2)/kg min (52.0−58.0)−57.5 ml (O2)/kg min (54.4−60.5)] level and total fat-free mass [10.9% (8.0−13.4)−11.4% (8.0−14.6)], as well as a corresponding decline in the ratio of total fat mass/fat-free mass. In contrast, an increase in total fat percentage as well as total fat mass was observed in the NBW group. After intervention, fasting plasma insulin levels, homoeostasis model assessments (HOMA) of insulin resistance (HOMA-IR) and insulin secretion (HOMA-IS), improved to the same extent in both the groups. In summary, young men born with LBW in rural India benefit metabolically from exercise training to an extent comparable with NBW controls.
The formation and decomposition of silico-ferrite of calcium and aluminium (SFCA) and SFCA-I iron ore sinter bonding phases have been investigated using in situ synchrotron and laboratory X-ray diffraction (XRD) and neutron diffraction (ND). An external standard approach for determining absolute phase concentrations via Rietveld refinement-based quantitative phase analysis is discussed. The complementarity of in situ XRD and ND in characterising sinter phase formation and decomposition is also shown, with the volume diffraction afforded by the neutron technique reducing errors in the quantification of magnetite above ~1200 °C. Finally, by collecting 6 s laboratory XRD datasets and using a heating rate of 175 °C min−1, phase formation and decomposition have been monitored under heating rates more closely approximating those encountered in industrial iron ore sintering.
Acquired resistance against Ascaridia galli infection was studied in seventy-two 18-week-old white Leghorn chickens allocated to six groups (G1–G6). In order to understand the population dynamics following trickle-infection (100 eggs per chicken twice weekly), chickens of subgroups of G1 were necropsied 3 days after 1, 6 or 12 inoculations (G1A, G1B and G1C respectively), while G2–G4 were inoculated for 6 weeks. G2 was necropsied 4 weeks after the last inoculation. The number of established larvae increased initially (between G1A and G1B) but decreased after repeated inoculations (G1C, G2). G3, G4 and G5 were used to measure the efficacy of anthelminthic treatment and to monitor the acquisition of resistance following a challenge infection. At week 7 G3, G4 and G5 were treated with flubendazole for 7 days in the feed. Two weeks after treatment the chickens in G4 and G5 were challenged with 500 eggs. G6 was left as uninfected control. Necropsy at week 10 after first inoculation revealed a lower establishment rate, an impaired development and a more posterior localization of the larvae in G4 (trickle-infected-treated-challenged) compared with G5 (treated-challenged). IgY level in serum reached noticeable level at 14 dpi in G2 and G4 chickens, and in G4 chickens IgY level further increased after challenge infection. The study provides evidence that acquired resistance against A. galli in chickens leads to a significant yet incomplete protection against re-infection.
Alligatorweed, waterhyacinth, and hydrilla are three nonnative aquatic species of concern in the Ross Barnett Reservoir near Jackson, MS. Point-intercept surveys were conducted on the reservoir from 2005 to 2010 to monitor native and nonnative species' distributions and assess herbicide treatment efficacy across the reservoir. Foliar applications of 2,4-D, glyphosate, imazapyr, and diquat were made during summer months for emergent and free-floating vegetation, whereas submersed applications of liquid copper and granular fluridone were applied in spring and late summer for subsurface hydrilla populations. American lotus is the native species that has been observed the most throughout the survey years, with occurrence frequencies averaging between 17 and 27%. Alligatorweed populations significantly decreased from 21% in 2005 to 4% in 2006; however, they consistently increased in the next 4 yr to 12% occurrence in 2010. Waterhyacinth occurrence has remained relatively constant over the study period, averaging below 10% occurrence. Hydrilla was discovered in the reservoir in late 2005 and has remained below 2% in frequency of occurrence since 2006. Suppression of these nonnative species has been attributed to rigorous monitoring and herbicide applications conducted on the reservoir since 2005. A logistic regression model indicated that as native species richness increased, the likelihood of a nonnative species occurring also increased.
Common reed (Phragmites australis) is a nonnative invasive perennial grass that is problematic in aquatic and riparian environments across the United States. Common reed often forms monotypic stands that displace native vegetation which provide food and cover for wildlife. To help maintain native habitats and manage populations of common reed in the United States, an understanding of its life history and starch allocation patterns are needed. Monthly biomass samples were harvested from sites throughout the Mobile River delta in southern Alabama, USA from January 2006 to December 2007 to quantify seasonal biomass and starch allocation patterns. Total biomass of common reed throughout the study was between 1375 and 3718 g m−2 depending on the season. Maximum aboveground biomass was 2200 ± 220 g m−2 in October of 2006 and 1302 ± 88 g m−2 in December of 2007. Maximum belowground biomass was seen in November of 2006 and 2007 with 1602 ± 233 and 1610 ± 517 g m−2 respectively. Biomass was related to ambient temperature, in that, as temperature decreased aboveground biomass (p = 0.05) decreased. Decreases in aboveground biomass were followed by an increase in belowground biomass (p < 0.01). Starch comprised 1 to 10% of aboveground biomass with peak temporary storage occurring in July and August 2006 and September to November of 2007. Belowground tissues stored the majority of starch for common reed regardless of the time of year. Overall, belowground tissues stored 5 to 20% of total starch for common reed with peak storage occurring in December 2006 and October 2007. Starch allocation to belowground tissues increased as temperatures decreased. Understanding seasonal life history patterns can provide information to guide management strategies by identifying the vulnerable points in biomass and starch reserves in common reed.
Two-phase flow and heat transfer, such as boiling and condensing flows, are complicated physical phenomena that generally prohibit an exact solution and even pose severe challenges for numerical approaches. If numerical solution time is also an issue the challenge increases even further. We present here a numerical implementation and novel study of a fully distributed dynamic one-dimensional model of two-phase flow in a tube, including pressure drop, heat transfer, and variations in tube cross-section. The model is based on a homogeneous formulation of the governing equations, discretized by a high resolution finite difference scheme due to Kurganov and Tadmore.
The homogeneous formulation requires a set of thermodynamic relations to cover the entire range from liquid to gas state. This leads a number of numerical challenges since these relations introduce discontinuities in the derivative of the variables and are usually very slow to evaluate. To overcome these challenges, we use an interpolation scheme with local refinement.
The simulations show that the method handles crossing of the saturation lines for both liquid to two-phase and two-phase to gas regions. Furthermore, a novel result obtained in this work, the method is stable towards dynamic transitions of the inlet/outlet boundaries across the saturation lines. Results for these cases are presented along with a numerical demonstration of conservation of mass under dynamically varying boundary conditions. Finally we present results for the stability of the code in a case of a tube with a narrow section.
Common reed (Phragmites australis) is an invasive perennial grass in aquatic and riparian environments across the United States, forming monotypic stands that displace native vegetation that provides food and cover for wildlife. Genetic variation in global populations of common reed has given rise to two invasive haplotypes, I and M, in the United States. Our objectives were to (1) determine if any differences in herbicide efficacy exist with respect to common reed haplotypes I and M and (2) screen for other labeled aquatic herbicides that may have activity on common reed haplotypes I and M, most notably imazamox and diquat. A replicated outdoor mesocosm study was conducted in 1,136-L (300-gal) tanks using haplotypes I and M of common reed. Restriction fragment length polymorphism methodologies were used to verify the identification of I and M haplotypes used in this study. Diquat at 2.2 (1.9) and 4.5 (4.0) kg ai ha−1 (lb ai ac−1), glyphosate at 2.1 (1.8) and 4.2 (3.7) kg ae ha−1 (lb ae ac−1), imazamox at 0.6 (0.5) and 1.1 (0.9) kg ai ha−1 (lb ai ac−1), imazapyr at 0.8 (0.7) and 1.7 (1.5) kg ai ha−1 (lb ai ac−1), and triclopyr at 3.4 (3.0) and 6.7 (5.9) kg ae ha−1 (lb ae ac−1) were applied to the foliage of common reed. After 12 wk, no difference (P = 0.28) in herbicide tolerance was seen between the two haplotypes with respect to biomass. The 4.2-kg ae ha−1 rate of glyphosate and the 0.8- and 1.7 kg ai ha−1 rates of imazapyr reduced common reed by > 90% at 12 wk after treatment (WAT). Imazamox at 0.6 and 1.1 kg ai ha−1, and triclopyr at 3.4 and 6.7 kg ae ha−1 reduced common reed biomass (62–86%) at 12 WAT, though regrowth occurred. Diquat did not significantly reduce biomass by 12 wk. Glyphosate and imazapyr were the only herbicides that resulted in > 90% biomass reduction and corroborate control from previous studies.