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OBJECTIVES/GOALS: As hospitals across the nation respond to the need to address community violence, there is a dearth of Hospital-based Violence Intervention Programs (HVIPs) in the South despite having disproportionate rates. This research aims to identify key factors and strategies for implementation of an HVIP among rural patient populations in a southern state. METHODS/STUDY POPULATION: Semi-structured interviews will be conducted with medical providers, social service organizations, and patients transferred from four high-risk rural areas in Arkansas. Data will be analyzed using Framework Analysis, a rapid analysis approach involving framework development, code application, impactful statement identification, and content analysis. Evidence- Based Quality Improvement (EBQI), a group consensus making process, will be conducted to identify key implementation strategies and factors to adapt based interview findings. Priority areas for adaptation will be identified via systematic rating. The EBQI team, including researchers and key rural stakeholders will engage in a series of discussion, vote on final strategies, and develop a guide for future HVIP implementation and pilot testing. RESULTS/ANTICIPATED RESULTS: Findings from this study will result in a prioritized list of barriers and facilitators across sample groups. Factors will be rated by level of importance. Cluster maps will display the relationships among factors. Go and no-go zones will be identified based on importance and feasibility. Implementation strategies will be mapped to barriers and facilitators. DISCUSSION/SIGNIFICANCE: The findings will result in a culturally and geographically relevant HVIP model and package of implementation strategies to test in future hybrid trials (feasibility pilot & multi-site RCT); and shape the future of violence prevention efforts in healthcare settings across the rural South.
Mild cognitive impairment (MCI) is an etiologically nonspecific diagnosis including a broad spectrum of cognitive decline between normal aging and dementia. Several large-scale cohort studies have found sex effects on neuropsychological test performance in MCI. The primary aim of the current project was to examine sex differences in neuropsychological profiles in a clinically diagnosed MCI sample using clinical and research diagnostic criteria.
The current study includes archival data from 349 patients (age M = 74.7; SD = 7.7) who underwent an outpatient neuropsychological evaluation and were diagnosed with MCI. Raw scores were converted to z-scores using normative datasets. Sex differences in neurocognitive profiles including severity, domain-specific composites (memory, executive functioning/information processing speed, and language), and modality-specific learning curves (verbal, visual) were examined using Analysis of Variance, Chi-square analyses, and linear mixed models. Post hoc analyses examined whether sex effects were uniform across age and education brackets.
Females exhibit worse non-memory domain and test-specific cognitive performances compared to males with otherwise comparable categorical MCI criteria and global cognition measured via screening and composite scores. Analysis of learning curves showed additional sex-specific advantages (visual Males>Females; verbal Females >Males) not captured by MCI subtypes.
Our results highlight sex differences in a clinical sample with MCI. The emphasis of verbal memory in the diagnosis of MCI may result in diagnosis at more advanced stages for females. Additional investigation is needed to determine whether these profiles confer greater risk for progressing to dementia or are confounded by other factors (e.g., delayed referral, medical comorbidities).
The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Background: Antibiotic-resistant organisms (AROs) are associated with greater disease severity and poor outcomes. Previous studies have investigated AROs and healthcare-associated infections (HAIs) within larger urban acute-care settings, but similar data for rural settings are scarce. In this stud, we aimed to fill this gap. Methods: Data on antimicrobial resistance (AMR), additional precautions and HAI were collected from 8 rural Alberta acute-care facilities over a 24-hour period from February 4–28, 2019. Data were gathered as part of the national Canadian, Rural, and Northern Acute Care Point Prevalence (CNAPP) survey. All inpatients on included units were reviewed. CNAPP protocol surveillance definitions were used. Results: In total, 961 patients were surveyed, of whom 94 of 961 (9.8%) were on additional precautions. Contact precautions only were most common (54 of 94, 57.4%) and were predominantly in place for MRSA (30 of 94, 31.9%). Of 961 patients, 100 (~10%) met the surveillance definitions for any infection. The most common infections were skin and soft-tissue infections (29 of 100, 29.0%) and bloodstream infections (28 of 100, 28.0%). An HAI occurred in 30 of 961 patients (3.1%); the most common HAIs were surgical site infections (8 of 30, 26.7%) and urinary tract infections (8 of 30, 26.7%). An antimicrobial was prescribed to 333 of 961 patients (34.6%) at the time of the survey, with ceftriaxone the most commonly prescribed (68 of 333, 20.4%). Most patients receiving an antimicrobial (237 of 333, 71.2%) did not meet the surveillance definition for any infection. The most common reason for any antimicrobial administration was empiric therapy (167 of 333, 50.1%). Conclusions: Investigations into antimicrobial use and the burden of HAIs in rural acute-care settings have been limited. In this study, we (1) established provincial baseline data for burden of disease in these facilities due to HAIs and (2) demonstrated that antimicrobial use is common, though most patients who were prescribed an antimicrobial did not meet study definitions for infection. It will be important to continue this type of surveillance in this understudied population to monitor the burden of HAIs over time, to establish antimicrobial utilization trends, and to continue to identify potential antimicrobial stewardship initiatives.
Background: Healthcare services are increasingly shifting from inpatient to outpatient settings. Outpatient settings such as emergency departments (EDs), oncology clinics, dialysis clinics, and day surgery often involve invasive procedures with the risk of acquiring healthcare-associated infections (HAIs). As a leading cause of HAI, Clostridioides difficile infection (CDI) in outpatient settings has not been sufficiently described in Canada. The Canadian Nosocomial Infection Surveillance Program (CNISP) aims to describe the epidemiology, molecular characterization, and antimicrobial susceptibility of outpatient CDI across Canada. Methods: Epidemiologic data were collected from patients diagnosed with CDI from a network of 47 adult and pediatric CNISP hospitals. Patients presenting to an outpatient setting such as the ED or outpatient clinics were considered as outpatient CDI. Cases were considered HAIs if the patient had had a healthcare intervention within the previous 4 weeks, and they were considered community-associated if there was no history of hospitalization within the previous 12 weeks. Clostridioides difficile isolates were submitted to the National Microbiology Laboratory for testing during an annual 2-month targeted surveillance period. National and regional rates of CDI were stratified by outpatient location. Results: Between January 1, 2015, and June 30, 2019, 2,691 cases of outpatient-CDI were reported, and 348 isolates were available for testing. Most cases (1,475 of 2,691, 54.8%) were identified in outpatient clinics, and 72.8% (1,960 of 2,691) were classified as community associated. CDI cases per 100,000 ED visits were highest in 2015, at 10.3, and decreased to 8.1 in 2018. Rates from outpatient clinics decreased from 3.5 in 2016 to 2.7 in 2018 (Fig. 1). Regionally, CDI rates in the ED declined in Central Canada and increased in the West after 2016. Rates in outpatient clinics were >2 times higher in the West compared to other regions. RT027 associated with NAP1 was most common among ED patients (26 of 195, 13.3%), whereas RT106 associated with NAP11 was predominant in outpatient clinics (22 of 189, 11.6%). Overall, 10.4% of isolates were resistant to moxifloxacin, 0.5% were resistant to rifampin, and 24.2% were resistant to clindamycin. No resistance was observed for metronidazole, vancomycin, or tigecycline. Compared to CNISP inpatient CDI data, outpatients with CDI were younger (51.8 ± 23.3 vs 64.2 ± 21.6; P < .001), included more females (56.4% vs 50.9%; P < .001), and were more often treated with metronidazole (63.0% vs 56.1%; P < .001). Conclusions: For the first time, CDI cases identified in outpatient settings were characterized in a Canadian context. Outpatient CDI rates are decreasing overall, but they vary by region. Predominant ribotypes vary based on outpatient location. Outpatients with CDI are younger and are more likely female than inpatients with CDI.
Disclosures: Susy Hota reports contract research for Finch Therapeutics.
Background: Carbapenemase-producing Enterobacterales (CPE) have rapidly become a global health concern and are associated with substantial morbidity and mortality due to limited treatment options. Travel to endemic areas, especially healthcare exposure in these areas, is an important risk factor for acquisition. We describe the evolving epidemiology, molecular features, and outcomes of CPE in Canada through surveillance by the Canadian Nosocomial Infection Surveillance Program (CNISP). Methods: CNISP has conducted surveillance for CPE among inpatients and outpatients of all ages since 2010. Participating acute-care facilities submit eligible specimens to the National Microbiology Laboratory for detection of carbapenemase production, and epidemiological data are collected. Incidence rates per 10,000 patient days are calculated based on inpatient data. Results: In total, 59 CNISP hospitals in 10 Canadian provinces representing 21,789 beds and 6,785,013 patient days participated in this surveillance. From 2010 to 2018, 118 (26%) CPE-infected and 547 (74%) CPE-colonized patients were identified. Few pediatric cases were identified (n = 18). Infection incidence rates remain low and stable (0.02 per 10,000 patient days in 2010 to 0.03 per 10,000 patient days in 2018), and colonization incidence rates have increased by 89% over the surveillance period. Overall, 92% of cases were acquired in a healthcare facility: 61% (n = 278) in a Canadian healthcare facility and 31% (n = 142) in a healthcare facility outside Canada. Of the 8% of cases not acquired in a healthcare facility, 50% (16 of 32) reported travel outside of Canada in the 12 months prior to positive culture. The distribution of carbapenemases varied by region; New Delhi metallo-B-lactamase (NDM) was dominant (59%) in western Canada and Klebsiella pneumoniae carbapenemase (KPC) (66%) in central Canada. NDM and class D carbapenemase OXA-48 were more commonly identified among those who traveled outside of Canada, whereas KPC was more commonly identified among patients without travel. In addition, 30-day all-cause mortality was 14% (25 of 181) among CPE infected patients and 32% (14 of 44) among those with bacteremia. Conclusions: CPE rates remain low in Canada; however, national surveillance data suggest that the increase in CPE in Canada is now being driven by local nosocomial transmission as well as travel and healthcare within endemic areas. Changes in screening practices may have contributed to the increase in colonizations; however, these data are currently lacking and will be collected moving forward. These data highlight the need to intensify surveillance and coordinate infection control measures to prevent further spread of CPE in Canadian acute-care hospitals.
Susy Hota reports contracted research for Finch Therapeutics. Allison McGeer reports funds to her institution for projects for which she is the principal investigator from Pfizer and Merck, as well as consulting fees from the following companies: Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.
To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe).
An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS).
A tertiary-care neonatal unit in Melbourne, Australia.
Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined.
Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9–35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak.
Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.
Within the growing field of publications on El Sistema and Sistema-inspired programmes around the world, a marked divide can be observed between the findings of critical academic studies and commissioned evaluations. Using evaluations of El Sistema in Venezuela and Aotearoa New Zealand as our principal case studies, we argue that this gulf can be explained at least partly by methodological problems in the way that some evaluations are carried out. We conclude that many Sistema evaluations display an alignment with advocacy rather than explorative research, and that the foundation for El Sistema's claims of social transformation is thus weak.
A model of a High Voltage CMOS (HV-CMOS) Monolithic Active Pixel Sensor (MAPS) has been modelled using Technology Computer Aided Design (TCAD). The model has incorporated both the active region and the on-pixel readout circuits which were comprised of a source follower amplifier and an integrated charge amplifier. The simulation has examined the electrical characteristics and response output of a HV-CMOS MAPS sensor using typical dimensions, levels of doping in the structural layers and bias conditions for this sensor. The performance of two alternate designs of amplifier have been examined as a function of the operating parameters. The response of the sensor to the incidence of Minimum Ionizing Particles (MIPs) at different energies has been included in the model.
It is Always rather risky to ask old people to talk about what things were like when they were young. Having turned on the tap you may not see how to turn it off again. Fortunately there is a circumstance which keeps this trouble under control. Old people remember a lot of things when there is no call for them to do so but seldom when there is. That is the reason why I have written down most of what I can say for this lecture.
I cannot attempt to give a complete or an objective picture of aeronautical science when I started thinking about it. The best I can do is to describe a few of the things which happened to me in those days to try to convey some picture of our primitive ideas.
To determine trends, patient characteristics, and outcome of patients with healthcare-associated influenza in Canadian hospitals.
Prospective surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012. Adults with positive test results at or after admission to the hospital were assessed. Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility. Baseline characteristics of influenza patients were collected. Patients were reassessed at 30 days to determine the outcome.
Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program.
A total of 570 (17.3%) of 3,299 influenza cases were healthcare associated; 345 (60.5%) were acquired in a long-term care facility (LTCF), and 225 (39.5%) were acquired in an acute care facility (ACF). There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF. Patients with LTCF-associated cases were older, had a higher proportion of chronic heart disease, and were less likely to be immunocompromised compared with patients with ACF-associated cases; there was no significant difference in 30-day all-cause and influenza-specific mortality.
Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals, but the proportion of cases that are healthcare associated varies markedly from year to year, as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF.
On 1 December 2011 the West Antarctic Ice Sheet (WAIS) Divide ice-core project reached its final depth of 3405 m. The WAIS Divide ice core is not only the longest US ice core to date, but is also the highest-quality deep ice core, including ice from the brittle ice zone, that the US has ever recovered. The methods used at WAIS Divide to handle and log the drilled ice, the procedures used to safely retrograde the ice back to the US National Ice Core Laboratory (NICL) and the methods used to process and sample the ice at the NICL are described and discussed.
The way in which identity is understood in contemporary society is the result of the application of a double perspective composed of figures which do not simply add up but instead present us with a set of tensions: a reflection on the crisis in the forms of media discourse as the principal locus of present-day identity, and the urgent need to construct experiential discourses that can suture the deficit of legitimation in the anonymous discourses which address us […]. Narratives of identity come up against the fact that they are constructions in which there is not merely some mechanical actuation of codes but also a production of meaning. This is why there can be no question of extolling situations of marginality or exoticism as reservoirs of such narratives, but rather of analysing the extent to which the very brokenness of classic models of identity itself generates new narratives, in which modes of integration and rebellion are negotiated.
(Marinas 1995: 75–78)
The return of identity and the exhaustion of storytelling
Breaking with the sterile cycle that leads from the affirmation of identity as an immutable essence to its negation in the supposed inevitability of homogenization, contemporary thought proposes identity as a construction which emerges through narration. This new way of thinking about identity aims to account both for the changes which traverse mono-identities and the emergence of multiculturalities which exceed ethnic, racial and national categories.
In this chapter I address the meaning and representativity of the term ‘Cuban popular culture’ through two rather different test-cases, the first of which is the film Aventuras de Juan Quinquín (1967) by the Cuban film director Julio García-Espinosa (b. 1926), and the second the religious social phenomenon of santería. In each case I ask the question of the extent to which the energy of popular culture is co-opted into a new (revolutionary) value-system or whether, ultimately, it escapes that hermeneutic net. It is legitimate to argue that García-Espinosa's films as much as santería as we nowadays understand the phenomenon came into being as a result of the Cuban Revolution. The experience of a revolution in Cuba in 1959 was as decisive for its generation as the French Revolution had been for European intellectuals in the 1790s. As Hobsbawm puts it: ‘It was now known that social revolution was possible; that nationals existed as something independent of states, peoples as something independent of their rulers, and even that the poor existed as something independent of the ruling classes’ (1962: 91). Hobsbawm's last point about the ‘poor’ existing ‘as something independent of the ruling classes’ is particularly relevant to the Cuban context. Hugh Thomas provides a sense of Fidel Castro's particular personal impact among the popular sectors of Cuban society soon after the Revolution:
A month after Batista's flight, Castro had established a personal hold over the Cuban masses such as no Latin American leader had ever had. […] Castro appeared so often on the television screen (the State Department was already beginning to curse the salesmen of those 400,000 sets) that he resembled less a De Gaulle or a Kennedy (others who used television to effect) than a kind of permanent confessor or a resident revolutionary medicine man. (1971: 1193)
It is the ‘inter’ – the cutting edge of translation and negotiation, the in-between space – that carries the burden of the meaning of culture. It makes it possible to begin envisaging national, anti-nationalist histories of the ‘people’ [, … to] elude the politics of polarity and emerge as the others of our selves.
(Bhabha 1994: 38–9)
It should not be enough to oppose to the elitism of those positions most critical of mass culture, simply their symmetrical inversion under the figure of a neo-populism seduced by the charms of industrial culture.
(Sarlo 2001: 55)
‘Popular culture’ has always represented a fulcrum within social, cultural and anthropological discourses in Latin America. It has often been imagined as inhabiting interstitial and heterogeneous spaces that have represented a challenge to the dominant cultural paradigms of the ‘lettered city’ since at least Colonial times, and has repeatedly been mapped on to political, economic and even libidinal boundaries – between the country and the city, between the folk and the street, between the ‘masses’ and elite national/political structures. Yet since at least the turn of the millennium, concepts of the ‘folk’, the ‘mass', the ‘people’ and the ‘multitude’ have exploded in the face of new cultural and informational technologies, with cinematic, televisual, narrative, musical and cybernetic manifestations of popular culture at the forefront of social processes which mediate between the national and the global in a see-sawing climate of technocratic neoliberal economic ideology, financial crises marked by new and intensified social problems, boom and bust cycles in commodities and resource-extraction, and the rise of demagogic, mediatic neo-populisms.
In this chapter I would like to reflect on the ways in which the Magdalena river has figured both in the imaginary production of a Colombian national-popular body, and in its dissolution, and at key moments in Colombian history from the mid-nineteenth century to the beginning of the twenty-first. I do so not to reclaim the river and its landscape, in a Romantic vein, as the wellspring of some authentic national ‘spirit’. Instead I am more interested in how instances of the articulation of such a thing occur in both real and imagined spaces where the nation's integrity is most questionable and the porosity of its borders most conspicuous.
As the principal route for the traffic of people, ideas and capital between colonial times and the early twentieth century, the Magdalena was for a long time central to the construction of the nation. Even today, as flows of global capital and information have displaced the organic motif of the river as an index of historical time and of the nation's temporal unfolding (see Appadurai 1996; Castells 2000), the Magdalena retains an affectively loaded presence in works of Colombian art and literature. Thus, in texts such as Fernando Vallejo's El río del tiempo (1998), where nature's collapse mirrors the entropy of Colombian public life, or films such as Bolívar soy yo (Jorge Alí Triana 2002), where history dissolves into the two dimensionality of the spectacle, the Magdalena continues to perform a labour of figuration, albeit of the nation's destiny as pipedream or curse.