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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.
OBJECTIVES/SPECIFIC AIMS: To build a multisite de-identified database of female adolescents, aged 12–21 years (January 2011–December 2012), and their subsequent offspring through 24 months of age from electronic health records (EHRs) provided by participating Community Health. METHODS/STUDY POPULATION: We created a community-academic partnership that included New York City Community Health Centers (n=4) and Hospitals (n=4), The Rockefeller University, The Sackler Institute for Nutrition Science and Clinical Directors Network (CDN). We used the Community-Engaged Research Navigation model to establish a multisite de-identified database extracted from EHRs of female adolescents aged 12–21 years (January 2011–December 2012) and their offspring through 24 months of age. These patients received their primary care between 2011 and 2015. Clinical data were used to explore possible associations among specific measures. We focused on the preconception, prenatal, postnatal periods, including pediatric visits up to 24 months of age. RESULTS/ANTICIPATED RESULTS: The analysis included all female adolescents (n=122,556) and a subset of pregnant adolescents with offspring data available (n=2917). Patients were mostly from the Bronx; 43% of all adolescent females were overweight (22%) or obese (21%) and showed higher systolic and diastolic blood pressure, blood glucose levels, hemoglobin A1c, total cholesterol, and triglycerides levels compared with normal-weight adolescent females (p<0.05). This analysis was also performed looking at the nonpregnant females and the pregnant females separately. Overall, the pregnant females were older (mean age=18.3) compared with the nonpregnant females (mean age=16.5), there was a higher percentage of Hispanics among the pregnant females (58%) compared with the nonpregnant females (43.9%). There was a statistically significant association between the BMI status of mothers and infants’ birth weight, with underweight/normal-weight mothers having more low birth weight (LBW) babies and overweight/obese mothers having more large babies. The odds of having a LBW baby was 0.61 (95% CI: 0.41, 0.89) lower in obese compared with normal-weight adolescent mothers. The risk of having a preterm birth before 37 weeks was found to be neutral in obese compared with normal-weight adolescent mothers (OR=0.81, 95% CI: 0.53, 1.25). Preliminary associations are similar to those reported in the published literature. DISCUSSION/SIGNIFICANCE OF IMPACT: This EHR database uses available measures from routine clinical care as a “rapid assay” to explore potential associations, and may be more useful to detect the presence and direction of associations than the magnitude of effects. This partnership has engaged community clinicians, laboratory, and clinical investigators, and funders in study design and analysis, as demonstrated by the collaborative development and testing of hypotheses relevant to service delivery. Furthermore, this research and learning collaborative is examining strategies to enhance clinical workflow and data quality as well as underlying biological mechanisms. The feasibility of scaling-up these methods facilitates studying similar populations in different Health Systems, advancing point-of-care studies of natural history and comparative effectiveness research to identify service gaps, evaluate effective interventions, and enhance clinical and data quality improvement.
Experiments and large eddy simulation (LES) were performed to study the development of the Rayleigh–Taylor instability into the saturated, nonlinear regime, produced between two gases accelerated by a rarefaction wave. Single-mode two-dimensional, and single-mode three-dimensional initial perturbations were introduced on the diffuse interface between the two gases prior to acceleration. The rarefaction wave imparts a non-constant acceleration, and a time decreasing Atwood number,
are the densities of the heavy and light gas, respectively. Experiments and simulations are presented for initial Atwood numbers of
. Nominally two-dimensional (2-D) experiments (initiated with nearly 2-D perturbations) and 2-D simulations are observed to approach an intermediate-time velocity plateau that is in disagreement with the late-time velocity obtained from the incompressible model of Goncharov (Phys. Rev. Lett., vol. 88, 2002, 134502). Reacceleration from an intermediate velocity is observed for 2-D bubbles in large wavenumber,
, experiments and simulations, where
is the wavelength of the initial perturbation. At moderate Atwood numbers, the bubble and spike velocities approach larger values than those predicted by Goncharov’s model. These late-time velocity trends are predicted well by numerical simulations using the LLNL Miranda code, and by the 2009 model of Mikaelian (Phys. Fluids., vol. 21, 2009, 024103) that extends Layzer type models to variable acceleration and density. Large Atwood number experiments show a delayed roll up, and exhibit a free-fall like behaviour. Finally, experiments initiated with three-dimensional perturbations tend to agree better with models and a simulation using the LLNL Ares code initiated with an axisymmetric rather than Cartesian symmetry.
Vital clues on life's origins within the galaxy exist here on present day Earth. Life is currently divided into the three domains Bacteria, Archaea and Eukarya based on the phylogeny of small ribosomal subunit RNA (16S/18S) gene sequences. The domains are presumed to share a “last universal common ancestor” (LUCA). Hyperthermophilic bacteria and archaea, which are able to thrive at 80°C or higher, dominate the bottom of the tree of life and are thus suggested to be the least evolved, or most “ancient”. Geochemical data indicates that life first appeared on Earth approximately 3.8 billion years ago in a hot environment. Due to these considerations, hyperthermophiles represent the most appropriate microorganisms to investigate the origins of metabolism. The central biochemical pathway of gluconeogenesis/glycolysis (the Embden-Meyerhof pathway) which produces six carbon sugars from three carbon compounds is present in all organisms and can provide important hints concerning the early development of metabolism. Significantly, there are a number of striking deviations from the textbook canonical reaction sequence that are found, particularly in hyperthermophilic archaea. In this paper the phylogenetic istribution of enzymes of the pathway is detailed; overall, the distribution pattern provides strong evidence for the pathway to have developed from the bottom-up.
We present techniques developed to calibrate and correct Murchison Widefield Array low-frequency (72–300 MHz) radio observations for polarimetry. The extremely wide field-of-view, excellent instantaneous (u, v)-coverage and sensitivity to degree-scale structure that the Murchison Widefield Array provides enable instrumental calibration, removal of instrumental artefacts, and correction for ionospheric Faraday rotation through imaging techniques. With the demonstrated polarimetric capabilities of the Murchison Widefield Array, we discuss future directions for polarimetric science at low frequencies to answer outstanding questions relating to polarised source counts, source depolarisation, pulsar science, low-mass stars, exoplanets, the nature of the interstellar and intergalactic media, and the solar environment.
The current generation of experiments aiming to detect the neutral hydrogen signal from the Epoch of Reionisation (EoR) is likely to be limited by systematic effects associated with removing foreground sources from target fields. In this paper, we develop a model for the compact foreground sources in one of the target fields of the MWA’s EoR key science experiment: the ‘EoR1’ field. The model is based on both the MWA’s GLEAM survey and GMRT 150 MHz data from the TGSS survey, the latter providing higher angular resolution and better astrometric accuracy for compact sources than is available from the MWA alone. The model contains 5 049 sources, some of which have complicated morphology in MWA data, Fornax A being the most complex. The higher resolution data show that 13% of sources that appear point-like to the MWA have complicated morphology such as double and quad structure, with a typical separation of 33 arcsec. We derive an analytic expression for the error introduced into the EoR two-dimensional power spectrum due to peeling close double sources as single point sources and show that for the measured source properties, the error in the power spectrum is confined to high k⊥ modes that do not affect the overall result for the large-scale cosmological signal of interest. The brightest 10 mis-modelled sources in the field contribute 90% of the power bias in the data, suggesting that it is most critical to improve the models of the brightest sources. With this hybrid model, we reprocess data from the EoR1 field and show a maximum of 8% improved calibration accuracy and a factor of two reduction in residual power in k-space from peeling these sources. Implications for future EoR experiments including the SKA are discussed in relation to the improvements obtained.
Ice rises play key roles in buttressing the neighbouring ice shelves and potentially provide palaeoclimate proxies from ice cores drilled near their divides. Little is known, however, about their influence on local climate and surface mass balance (SMB). Here we combine 12 years (2001–12) of regional atmospheric climate model (RACMO2) output at high horizontal resolution (5.5 km) with recent observations from weather stations, ground-penetrating radar and firn cores in coastal Dronning Maud Land, East Antarctica, to describe climate and SMB variations around ice rises. We demonstrate strong spatial variability of climate and SMB in the vicinity of ice rises, in contrast to flat ice shelves, where they are relatively homogeneous. Despite their higher elevation, ice rises are characterized by higher winter temperatures compared with the flat ice shelf. Ice rises strongly influence SMB patterns, mainly through orographic uplift of moist air on the upwind slopes. Besides precipitation, drifting snow contributes significantly to the ice-rise SMB. The findings reported here may aid in selecting a representative location for ice coring on ice rises, and allow better constraint of local ice-rise as well as regional ice-shelf mass balance.
We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.
The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.
From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.
The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.
New evolutionary correlations have been discovered to apply to the population of Planetary Nebulae (FN) in the Magellanic Clouds. Firstly, the age of the nebular shell is found to follow a relationship τ = 890[(Mneb/M⊙) (Vexp/km s−1)]0,6 yr, which is shown to be consistent with a model in which the total energy of the ionised and swept up gas drives the expansion down the density gradient in the precursor AGE wind. Secondly, a tight correlation is found between the expansion velocity and a combination of the Excitation Class and the Hβ flux. This appears to be determined by the mass of the planetary nebula nuclear star. These correlations provide strong observational support for the idea that the PN shells are ejected at low velocity during the Asymptotic Giant Branch phase of evolution, and that they are continually accelerated during their nebular lifetimes.
Evidence has accumulated that implicates childhood trauma in the aetiology of psychosis, but our understanding of the putative psychological processes and mechanisms through which childhood trauma impacts on individuals and contributes to the development of psychosis remains limited. We aimed to investigate whether stress sensitivity and threat anticipation underlie the association between childhood abuse and psychosis.
We used the Experience Sampling Method to measure stress, threat anticipation, negative affect, and psychotic experiences in 50 first-episode psychosis (FEP) patients, 44 At-Risk Mental State (ARMS) participants, and 52 controls. Childhood abuse was assessed using the Childhood Trauma Questionnaire.
Associations of minor socio-environmental stress in daily life with negative affect and psychotic experiences were modified by sexual abuse and group (all pFWE < 0.05). While there was strong evidence that these associations were greater in FEP exposed to high levels of sexual abuse, and some evidence of greater associations in ARMS exposed to high levels of sexual abuse, controls exposed to high levels of sexual abuse were more resilient and reported less intense negative emotional reactions to socio-environmental stress. A similar pattern was evident for threat anticipation.
Elevated sensitivity and lack of resilience to socio-environmental stress and enhanced threat anticipation in daily life may be important psychological processes underlying the association between childhood sexual abuse and psychosis.
We report on version 1.0 of the Edinburgh/AAO/Strasbourg catalogue of new and possible Planetary Nebulae (PN) distributed via cdrom at this meeting. We provide accurate positions, designations, images and other descriptive parameters for the PN. In future releases this will be supplemented by inclusion of spectra and related material such as line ratios, velocities etc.
The 900+ PN have been discovered solely from visual scrutiny of narrow-band exposures taken for the AAO/UKST H-alpha survey of the Southern Galactic Plane. Most have classic PN-type morphologies (i.e. bi-polar, rings, shells or ovals). SuperCOSMOS data will soon supersede our visual scanning but it proved an effective preliminary technique to identify candidate PN on the basis of morphology, isolation and identification as an H-alpha nebulosity. We already have confirmatory spectroscopy for ~ 700 objects. Much of our new sample are of very low surface brightness, with no obvious central star, and so have remained undetected in previous surveys. They are revealed here due to the excellent depth, resolution, coverage and uniformity of the H-alpha survey. Many PN are also well extended. The average angular size is 51″ with the median of 27″ but examples extend to several arcminutes. This may indicate many are in a highly evolved state where the central star has faded from easy optical detection and the nebula itself is dissipating into the ambient ISM. Large numbers of candidate PN have also been found in the Galactic Bulge region, most of which have been confirmed via UKST FLAIR/6dF MOS spectroscopy (Parker et al, in preparation and these proceedings).
By version 2.0 (release in 2002) we will have doubled the number of Galactic PN accrued from all sources over the last 75 years. This new catalogue should have a profound impact on many aspects of PN research.
We report on an unprecedented source of Planetary Nebulae (PN) discovered from AAO/UKST Hα survey images of the Southern Galactic Plane. A pristine region of PN discovery space is being sampled due to the excellent depth, coverage, resolution and uniformity of the Hα survey. Large numbers of new PN are being found (~1000 so far). They are typically more evolved, obscurred and of lower surface brightness than in most other surveys. The doubling of known PN should have a significant impact on many aspects of PN research.
The stellar associations are defined as loose unbound concentrations of young stars with a bright OB stellar component, mainly located at the most recent star forming regions, representing the smallest units in the hierarchy of stellar systems in galaxies. The definition of the associations is discussed and the main properties of their stellar content are summarized. Using plates taken with the 1.2m UK Schmidt Telescope a method is developed to detect all stellar associations in the LMC and to find their spatial distribution relative to the LMC's recent star formation history. In 40% of the LMC region, the number of “single peak” associations has increased considerably (~ 3x). A very interesting result is that the faint limit, where the identified associations are revealed, varies by about 3 mag. This indicates not only extinction differences but also the presence of pre-main sequence stars at a wide range of masses.
We have compiled a catalogue of H ii regions detected with the Murchison Widefield Array between 72 and 231 MHz. The multiple frequency bands provided by the Murchison Widefield Array allow us identify the characteristic spectrum generated by the thermal Bremsstrahlung process in H ii regions. We detect 306 H ii regions between 260° < l < 340° and report on the positions, sizes, peak, integrated flux density, and spectral indices of these H ii regions. By identifying the point at which H ii regions transition from the optically thin to thick regime, we derive the physical properties including the electron density, ionised gas mass, and ionising photon flux, towards 61 H ii regions. This catalogue of H ii regions represents the most extensive and uniform low frequency survey of H ii regions in the Galaxy to date.
A circular letter was sent out to all members of the Commission in December 1937, to which the majority have replied. While work is going on steadily in the Observatories where meridian observations are carried out, comparatively few catalogues have been published since 1935. In view of the very full report made three years ago it is only necessary to draw attention to the progress which has been made in the interval.
The inability to obtain information about work in other countries, under present world conditions, necessarily makes this report incomplete. The conditions since the 1938 meeting have interfered seriously with major programmes of observation, and have delayed reductions, such that there are now several series of observations of the Sun, Moon, and Planets, and many catalogues of stars awaiting final reduction and publication.
The Sun, Moon, and Planets. Fundamental observations of these objects and of the fundamental stars have been carried on regularly at Cape and Washington, and at Greenwich except for part of the time during the war. The Greenwich and Cape results 1925–44 have been reduced; and summaries of the results have been published in reports. The Washington series 1928–32 is published; the series 1925–40 is about reduced; and the series 1935–45 is to be printed this year.
The U.K. 1.2 metre Schmidt Telescope acquired its first full aperture objective prism in 1975. This was a very low dispersion prism (2400 Å/mm at 4300 Å) which has been found to be particularly useful in searching for faint QSO’s.
The capabilities of the X-ray Timing Explorer (XTE) are described with particular attention paid to current scientific problems it will address from galactic neutron star systems to active galactic nuclei. It features a low-background continuous 2-200 keV response with large apertures (a 0.63-m2 proportional counter array and a 0.16-m2 dual rocking NaI/CsI scintillation array). Rapid response (in hours) to temporal phenomena, e.g. transients, is obtained by virtue of a scanning all-sky monitor and rapid maneuverability. XTE will carry out detailed energy-resolved studies of phenomena close to neutron stars (e.g. QPO’s) because of its sub-millisecond timing (to 10 μs), its high telemetry rates (to 256 kb/s), and the high throughput of its data system (to ≳ 2 × 105 c s−1).
MOST (Microvariability & Oscillations of STars / Microvariabilite et Oscillations STellaire) is a Canadian microsatellite mission intended to detect rapid photometric oscillations at the μmag level in stars brighter than V ∼ 6. This limit is set primarily by the 15-cm aperture of the MOST telescope. The small size and mass of the MOST bus (similar to a suitcase) sets a limit on the pointing accuracy of about ±10 arcsec. To achieve the required photometric precision under these conditions, the MOST focal plane features a set of Fabry microlenses which can spread the target starlight into a pupil image of the telescope onto a CCD. The large size (∼1600 pixels) and positional stability (±0.1 pixel) of these images makes MOST insensitive to CCD flat-fielding errors. MOST is currently on schedule to be launched in early 2002.