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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
This work investigates the relative contributions to strengthening from twinning, solid-solution, precipitation, and irradiation hardening mechanisms in sputtered Cu–W thin films irradiated to different doses. A nanograin solid solution strengthening mechanism with a linear compositional dependence is observed for the as-grown alloys and for the alloy samples irradiated to 0.5 dpa. Solid solution strengthening is the major strengthening mechanism for Cu99.5W0.5 at all irradiation doses. Irradiation induces precipitation in samples with W concentrations greater than or equal to 1% at doses above ≈0.5 dpa. The growth of 1–4 nm precipitates enhances the hardness of these alloys, and the degree of strengthening is determined by the interparticle spacing. While the alloys exhibit steady-state properties after a relatively low dose (≈1 dpa), the different time scales associated with detwinning and damage accumulation in pure Cu lead transients at higher doses (>5 dpa).
Cu90Ag10 alloys were subjected to severe plastic deformation at temperatures ranging from 25 to 400 °C and strain rates ranging from 0.1 to 6.25 s−1 using high-pressure torsion. The deformed samples were characterized by x-ray diffraction, transmission electron microscopy, and atom-probe tomography. A dynamic competition between shear-induced mixing and thermally activated decomposition led to the self-organization of the Cu–Ag system at length scales varying from a few atomic distances at room temperature to ≈50 nm at 400 °C. Steady-state microstructural length scales were minimally affected by varying the strain rate, although at 400 °C, the grain morphology did depend on strain-rate. Our results show that diffusion below 300 °C is dominated by nonequilibrium vacancies, and by comparison with previous Kinetic Monte Carlo simulations [D. Schwen et al., J. Mater. Res.28, 2687–2693 (2013)], their concentration could be obtained.
The Murchison Widefield Array is a new low-frequency interferometric radio telescope built in Western Australia at one of the locations of the future Square Kilometre Array. We describe the automated radio-frequency interference detection strategy implemented for the Murchison Widefield Array, which is based on the aoflagger platform, and present 72–231 MHz radio-frequency interference statistics from 10 observing nights. Radio-frequency interference detection removes 1.1% of the data. Radio-frequency interference from digital TV is observed 3% of the time due to occasional ionospheric or atmospheric propagation. After radio-frequency interference detection and excision, almost all data can be calibrated and imaged without further radio-frequency interference mitigation efforts, including observations within the FM and digital TV bands. The results are compared to a previously published Low-Frequency Array radio-frequency interference survey. The remote location of the Murchison Widefield Array results in a substantially cleaner radio-frequency interference environment compared to Low-Frequency Array’s radio environment, but adequate detection of radio-frequency interference is still required before data can be analysed. We include specific recommendations designed to make the Square Kilometre Array more robust to radio-frequency interference, including: the availability of sufficient computing power for radio-frequency interference detection; accounting for radio-frequency interference in the receiver design; a smooth band-pass response; and the capability of radio-frequency interference detection at high time and frequency resolution (second and kHz-scale respectively).
Depression is characterized by poor executive function, but – counterintuitively – in some studies, it has been associated with highly accurate performance on certain cognitively demanding tasks. The psychological mechanisms responsible for this paradoxical finding are unclear. To address this issue, we applied a drift diffusion model (DDM) to flanker task data from depressed and healthy adults participating in the multi-site Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC) study.
One hundred unmedicated, depressed adults and 40 healthy controls completed a flanker task. We investigated the effect of flanker interference on accuracy and response time, and used the DDM to examine group differences in three cognitive processes: prepotent response bias (tendency to respond to the distracting flankers), response inhibition (necessary to resist prepotency), and executive control (required for execution of correct response on incongruent trials).
Consistent with prior reports, depressed participants responded more slowly and accurately than controls on incongruent trials. The DDM indicated that although executive control was sluggish in depressed participants, this was more than offset by decreased prepotent response bias. Among the depressed participants, anhedonia was negatively correlated with a parameter indexing the speed of executive control (r = −0.28, p = 0.007).
Executive control was delayed in depression but this was counterbalanced by reduced prepotent response bias, demonstrating how participants with executive function deficits can nevertheless perform accurately in a cognitive control task. Drawing on data from neural network simulations, we speculate that these results may reflect tonically reduced striatal dopamine in depression.
We estimated the excess risk of in-patient hospitalization in a large cohort of persons diagnosed with hepatitis C virus (HCV) infection, controlling for social deprivation. A total of 20 749 individuals diagnosed with HCV in Scotland by 31 December 2006 were linked to the Scottish hospital discharge database, and indirectly standardized hospitalization rates, adjusting for sex, age, year and deprivation were calculated. We observed significant excess morbidity considering episodes for: any diagnosis [standardized morbidity ratio (SMR) 3·4, 95% CI 3·3–3·5]; liver-related diagnoses (SMR 41·3, 95% CI 39·6–43·0); and only non-liver-related diagnoses (SMR 2·14, 95% CI 2·08–2·19). Cox regression analyses of the 2000–2006 data indicated increased relative risks of hospitalization for males [hazard ratio (HR) 1·1, 95% CI 1·0–1·2], older age (per 10 years) (HR 1·55, 95% CI 1·5–1·6), and those testing HIV-positive (HR 1·6, 95% CI 1·3–1·8). This study has revealed substantial excess all-cause and liver-related morbidity in the Scottish HCV-diagnosed population, even after allowing for deprivation.
We estimated the extent of undiagnosed hepatitis C virus (HCV) infection in injecting drug users (IDUs) in Scotland. We used record-linkage to determine HCV diagnosis status for 41 062 current/former IDUs attending drug treatment and support services between 1 April 1995 and 31 March 2006; the extent of undiagnosed HCV infection was estimated by comparing the number HCV-diagnosed to the number HCV-infected (estimated from an unlinked anonymous testing survey of 2141 current/former IDUs). In all, 9145 IDUs (22%) were diagnosed HCV antibody-positive since first attendance at drug services (diagnosis rate of 33·6/1000 person-years, 95% CI 32·7–34·4). By 31 March 2006, of the 19 632 current/former IDUs who had attended drug services and were determined to be living with HCV, an estimated 58% (95% CI 45–62) had not been HCV-diagnosed. It is essential that the deployment of resources for identifying at-risk IDUs with a view to offering antiviral therapy is guided by evidence.
Highly porous Ni-8YSZ anodes supported by a thin and dense electrolyte layer of 8YSZ have been developed for solid oxide fuel cell applications by reducing a NiO-8YSZ anode/electrolye precursor structure in a gas mixture of 5% H2-95% Ar at 800°C for selected time periods up to 8 h. It appears that 2 h of exposure to the reducing conditions is enough to reduce∼80% of NiO. XRD and SEM analyses in the reduced samples disclose the formation of the Ni-8YSZ cermet structure with desired porosity and microstructure. The porosity in the anode samples, which increases with the increase in the fraction of reduced NiO, severely affects the hardness and elastic moduli of the anode samples. Vickers indentation tests show that a hardness value of 5.5 GPa in the unreduced anode samples (12% porosity) reduces to less than 1 GPa in the 8 h reduced samples (36.68 % porosity). Similarly, a decrease of ˜44% in the Young's modulus and ˜40% in shear modulus is observed in the 8 h reduced samples through impulse excitation techniques, in comparison to the unreduced anode precursor. Since the elastic properties of fully dense Ni, NiO and YSZ are comparable to each other, the decrease in the magnitude in elastic moduli and hardness is attributed to the colossal increase in porosity as a result of the reduction of NiO in H2 atmosphere.
An overview is given of the development of advanced nanoporous carbons as storage ma-terials for natural gas (methane) and molecular hydrogen in on-board fuel tanks for next-generation clean automobiles. The carbons are produced in a multi-step process from corncob, have surface areas of up to 3500 m2/g, porosities of up to 0.8, and reversibly store, by physisorp-tion, record amounts of methane and hydrogen. Current best gravimetric and volumetric storage capacities are: 250 g CH4/kg carbon and 130 g CH4/liter carbon (199 V/V) at 35 bar and 293 K; and 80 g H2/kg carbon and 47 g H2/liter carbon at 47 bar and 77 K. This is the first time the DOE methane storage target of 180 V/V at 35 bar and ambient temperature has been reached and exceeded. The hydrogen values compare favorably with the 2010 DOE gravimetric and volu-metric targets for hydrogen. A prototype adsorbed natural gas (ANG) tank, loaded with carbon monoliths produced accordingly and currently undergoing a road test in Kansas City, is de-scribed. A preliminary analysis of the surface and pore structure is given that may shed light on the mechanisms leading to the extraordinary storage capacities of these materials. The analysis includes pore-size distributions from nitrogen adsorption isotherms; spatial organization of pores across the entire solid from small-angle x-ray scattering (SAXS); pore entrances from scanning electron microscopy (SEM) and transmission electron microscopy (TEM); H2 binding energies from temperature-programmed desorption (TPD); and analysis of surface defects from Raman spectra. For future materials, expected to have higher H2 binding energies via appropriate sur-face functionalization, preliminary projections of H2 storage capacities based on molecular dy-namics simulations of adsorption of H2 on graphite, are reported.
Experimental wet chemical approaches to complex an iron atom with two C60 fullerenes, representing a new molecule, dubbed a “bucky dumbbell,” have been demonstrated. The structure of this molecule has been determined by 13C solid-state nuclear magnetic resonance (NMR) and electron paramagnetic resonance (EPR). Furthermore, this structure has been shown to have unique binding sites for dihydrogen molecules with the technique of temperature programmed desorption (TPD). The new adsorption sites have binding energies that are stronger than that observed for hydrogen physisorbed on planar graphite, but significantly weaker than a chemical C-H bond. Further development of these molecules could make them ideal candidates for onboard vehicular hydrogen storage.
To enhance the visible light absorption of anatase TiO2 photo-electrodes, the material was doped with carbon by two different methods: i) by spray pyrolysis under a CO2 atmosphere, and ii) by a post-deposition thermal treatment in a hexane-containing environment. For the hexane-treated samples, most of the carbon is located at the surface, from which it can be removed by re-oxidation at elevated temperatures. In addition, both methods seem to result in the presence of small amounts of carbon in the bulk of the material, as deduced from a small red-shift of the absorption edge of TiO2.