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Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study.
Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs).
Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention.
Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.
In the present study, the effect of training on inter-observer reliability was studied for a 5-category lameness scoring system used for routine on-farm surveys of welfare in dairy cattle. The inter-observer agreement between an experienced and an initially inexperienced observer was determined during an initial training phase and at specific time points in the course of data collection in 46 herds. During the training phase on three farms, inter-observer reliability increased to an acceptable level for both the 5-category gait scoring system and the distinction between lame and non-lame cows.
The 4th testing after 17 on-farm visits revealed a considerable increase in inter-observer reliability which was further improved in the course of the on-farm visits.
In conclusion, acceptable inter-observer agreement for differentiating between non-lame and lame cows was achieved after only a brief introduction. In order to obtain high inter-observer repeatability with the 5-category gait scoring system used in this study, (more) intensive training procedures are required.
Waterfall Bluff is a rock shelter in eastern Pondoland, South Africa, adjacent to a narrow continental shelf that limited coastline movements across glacial/interglacial cycles. The archaeological deposits are characterized by well-preserved stratigraphy, faunal, and botanical remains alongside abundant stone artifacts and other materials. A comprehensive dating protocol consisting of 5 optically stimulated luminescence ages and 51 accelerator mass spectrometry 14C ages shows that the record of hunter-gatherer occupations at Waterfall Bluff persisted from the late Pleistocene to the Holocene, spanning the last glacial maximum and the transition from the Pleistocene to the Holocene. Here, we provide detailed descriptions about the sedimentary sequence, chronology, and characteristics of the archaeological deposits at Waterfall Bluff. Remains of marine mollusks and marine fish also show, for the first time, that coastal foraging was a component of some hunter-gatherer groups’ subsistence practices during glacial phases in the late Pleistocene. The presence of marine fish and shellfish further demonstrates that hunter-gatherers selectively targeted coastal resources from intertidal and estuarine habitats. Our results therefore underscore the idea that Pondoland's coastline remained a stable and predictable point on the landscape over the last glacial/interglacial transition being well positioned for hunter-gatherers to access resources from the nearby coastline, narrow continental shelf, and inland areas.
Aim of the study was assessing motivation to change in a clinical sample of adolescents with anorexia nervosa and its relation to specific cognitions and behaviours.
N= 77 patients with anorexia nervosa (75 female, 2 males, mean age = 15.8, SD = 1.3) were evaluated with Anorexia Nervosa Stage of Change Questionnaire (ANSOCQ) measuring motivation to recover and further questionnaires evaluating treatment and course of the disorder. The latter included Eating Disorder Inventory (EDI-2), the Eating Attitude Test (EAT), the Pros and Cons of Anorexia nervosa questionnaire (PCAN), and the Body Image Questionnaire (FKAN). Data were collected at treatment onset (T1), follow-up was after 12 months (T2).
At T1 motivation to change was significantly related to the EDI subscale measuring drive for thinness (p < .001) and body dissatisfaction (p< .01), to the PCAN pros scales measuring appearance (p< .01) and safe/structure (p< .01), to the EAT scale measuring dieting (p< .001) and the FKAN subscale measuring the feeling of body massivity (p< .001).The stage of motivation to change at treatment onset was very low in the sample (67% in stage 1 = precontemplation or 2 = contemplation). There was no relation between motivation at T1 and BMI at T2 but the increase of motivation between T1 and T2 predicted a better outcome (BMI at T2).
Motivation to change is related to specific cognitions and behaviours in adolescent patients with anorexia nervosa. Increase of treatment motivation during the first months of treatment seems to be predictive for outcome.
The main objective was to examine agreement between the internet based Development and Well-Being Assessment (DAWBA) generated diagnoses and clinical diagnoses. Second, we aimed to explore how disclosure of the DAWBA-diagnosis before clinical decision making influenced the clinicians diagnosis. Third, whether there were differences of influence for different categories of disorders. Last, we examined how the use of DAWBA information affected identification of co-morbidities.
315 patients from outpatient clinics were randomised into two groups. In 177 cases the clinician was informed about DAWBA diagnosis, in 155 cases the clinican was blind to DAWBA information. DAWBA is an internet based package of questionnaires and rating techniques designed to generate psychiatric ICD10 or DSM IV diagnoses for 5- 17 year old children and adolescents. Information from parents, teachers and self-reports are brought together by a computer programme that predicts likely diagnoses. An expert rater decides on the diagnosis by synopsis of these different inputs.
DAWBA diagnoses and clinical diagnosis without information from DAWBA showed acceptable agreement with Cohens kappa 0,26 for emotional disorders, kappa of 0,29 for hyperactive disorders and kappa of 0.31 for disruptive disorders.
There was a significant effect on clinical diagnoses for emotional disorders for disclosure of DAWBA (kappa of 0.26 without DAWBA information versus kappa of 0,52 with information, Fishers z of p< 0,05)
There was no significant effect of information about DAWBA-diagnosis considering comorbidities.
DAWBA showed the most pronounced effect on clinical diagnoses for emotional disorders in children and adolescents.
The aim of the study was assessing differences in selected psychosocial and behavioural variables between a referred sample of patients with an eating disorder, a non-referred risk sample with eating problems, and a healthy control group.
There were N=100 patients (95 females and 5 males, Mean age = 15.8, SD = 1.3) in the referred sample. The two matched non-referred groups of each N=215 participants (95% females, 5% males; Mean age =16.1, SD = 1.5) stem from the Zurich Adolescent Psychology- and Psychopathology-Study (ZAPPS). Emotional and behavioural problems were assessed using the Youth Self Report (YSR) and a depression scale. In addition, the participants responded to questionnaires covering life events, self-related cognitions, coping capacities, perceived parental behaviour, and family climate.
Compared to both non-referred groups, the referred sample had significantly higher scores on the social withdrawn, anxious/depressed and thought problems scale of the YSR, on the depression and the life events scales, and significantly lower scores on the self esteem scale. Compared to the referred sample, the non-referred risk sample had significantly higher scores on the YSR-scale measuring externalizing problems and the perceived parental rejection scale, but lower scores on the family climate scales measuring cohesion and adaptability.
The three groups were differentiated by various psychosocial and behavioural variables. Externalizing problems and indicators of a poor family climate were more common in a non-referred high-risk group with eating problems than in a referred sample with clinical eating disorders.
We have studied the structures of Al/Si disordered leucite and bicchulite with a quantum mechanical version of the virtual crystal approximation, VCA. In leucite, the average tetrahedron has a composition of (AlSi2)O4, while bicchulite represents an extreme case with (Al2Si)O4 tetrahedra. Both structures are well described with the VCA. In conjunction with an earlier study, where we have shown that the (AlSi)O4 tetrahedra in gehlenite and Al,Si-disordered octahedra are also well reproduced, we have now established that the VCA gives a reliable description of the averaged structure of disordered aluminosilicates over the whole compositional range. The current calculations confirm that Al/Si ordering is not driving the cubic to tetragonal phase transformation in leucite. In bicchulite, the model calculations are consistent with hydrogen on Wyckoff position 8c, in agreement with the result of a single crystal X-ray diffraction study, but in variance with results based on a neutron powder diffraction study.
The infrared (IR) spectra of almandine-grossular and almandine-pyrope garnet solid solutions have been measured using the powder method. Frequency shifts of a band related to internal vibrations associated with the 8-co-ordinate dodecahedral site are nonlinear in almandine-grossular garnets and mimic the form of its molar volume of mixing curve. Almandine-pyrope solid solutions have nearly ideal molar volumes of mixing and the frequency shift of this same 8-co-ordinate site-related band is linear. The IR data support the empirically based crystal chemical model of Equivalent Site (ES) behaviour (Newton and Wood, 1980). The IR spectra give no indication of long-range ordering between Ca and Fe2+ in garnet, but thermodynamic calculations involving Ca-poor garnets might be affected by small volume or short-range ordering anomalies.
Ab initio total energy calculations based on the local density approximation (LDA) and using a conjugate-gradient solver for the Kohn-Sham equations have been performed for cordierite, brucite, (Mg(OH)2) and diaspore (AlOOH). The calculated fractional coordinates of all structures are in good agreement with experimental diffraction data. The angle of the non-linear hydrogen bond in diaspore is reproduced well. The Raman active OH stretching frequency in brucite has been calculated using the frozen phonon approach and the calculated stretching frequency is in very good agreement with the observed value. The energetically most favourable calculated orientation of the proton-proton vector of an H2O molecule incorporated in the structural channels of cordierite agrees with findings deduced from spectroscopic data, and the calculated energy of hydration is in reasonable agreement with calorimetric data. It is therefore concluded that ab initio total energy calculations can confidently be used to predict properties of hydrogen bonded structures, which is difficult with conventional parameterized static lattice energy minimization calculations. An extension to the model is necessary to improve the agreement of the predicted to the observed lattice parameters for small structures.
The structure of a synthetic sample of analcime has been determined as a function of temperature between 30–300 K by high-resolution neutron powder diffraction. Although there are some reports of samples of analcime having non-cubic structures, the sample in our experiments remained cubic (space group la3d), and hence disordered, down to low temperatures. The absence of phase transitions involving ordering of the orientations of the water molecules, ordering of the sodium positions, or a displacive instability as in leucite and related materials, is discussed. We speculate that part of the reason for the absence of ordering of the water molecules or sodium cations is associated with the Al/Si disorder, which cannot order at low temperatures. We also discuss the likely distribution of the orientations of the water molecules at low temperatures, and propose that the water diads lie close to any of the crystal diads with the H-H Vectors lying close to the triads.
Background: External ventricular drain (EVD) insertion is a common neurosurgical procedure performed in patients with life-threatening conditions, but can be associated with complications. The objectives of this study are to evaluate data on national practice patterns and complications rates in order to optimize clinical care Methods: The Canadian Neurosurgery Research Collaborative conducted a prospective multi-centre registry of patients undergoing EVD insertions at Canadian residency programs Results: In this interim analysis, 4 sites had recruited 46 patients (mean age: 53.9 years, male:female 2:1). Most EVD insertions occurred outside of the operating theatre, using free-hand technique, and performed by junior neurosurgery residents (R1-R3). The catheter tip was in the ipsilateral frontal horn or body of the lateral ventricle in 76% of cases. Suboptimally placed catheters did not have higher rates of short-term occlusion. EVD-related hemorrhage occurred in 6.5% (3/45) with only 1 symptomatic patient. EVD-related infection occurred in 13% (6/46) at a mean of 6 days and was associated with longer duration of CSF drainage (P=0.039; OR: 1.13) Conclusions: Interim results indicate rates of EVD-related complications may be higher than previously thought. This study will continue to recruit patients to confirm these findings and determine specific risk factors associated with them
A recent theoretical literature highlights the role of endogenous firm entry as an internal amplification mechanism of business cycle fluctuations. The amplification mechanism works through the competition effect (CE) and the variety effect (VE). This paper tests the significance of this amplification mechanism, quantifies its importance, and disentangles the CE and VE. To this end, we estimate a medium-scale real business cycle model with firm entry for the U.S. economy. The CE and VE are estimated to be statistically significant. Together, they amplify the volatility of output by 8.5% relative to a model in which both effects are switched off. The CE accounts for most amplification, whereas the VE only plays a minor role.
Background: No standardized method of resident operative-case logging exists. Our study sought to develop a standardized form used by residents to log operative-cases. Methods: Members of the Canadian Neurosurgery Research Collaborative (CNRC), a national resident-led research organization have created a standardized document based on the current Royal College objectives for operative procedures (section 5). Modifications to structure and content will be guided via consensus from Canadian neurosurgery program-directors. Results: Program directors in each CNRC collaborative institution will be asked to modify the standardized form. The CNRC currently involves thirteen of the fourteen Canadian neurosurgery residency programs. Additional consensus, if necessary, can be reached at the Royal College meeting for program directors of neurosurgery March 20th 2017. Conclusions: A standardized operative-case log represents the first step in a prospective study towards compiling operative volume of all Canadian neurosurgical residents over one academic year. Such data will be essential to guide informed decisions with regard to Royal College requirements as Canadian neurosurgical programs transition to a competency based framework.