Background: Under ideal circumstances, multiplex molecular respiratory panels can support early all discontinuation of unnecessary antibiotics by facilitating diagnosis of viral infection. Our goal was to identify clinic situations in which a positive respiratory panel was associated with antibiotic de-escalation. We focused on gram-negative antibiotics in recognition of the urgent threat posed by gram-negative resistance. Methods: The sample included hospitalized adults tested by respiratory panel while receiving gram-negative antibiotics at the University of Maryland Medical Center from 2015 to 2020. Only the first respiratory panel performed during hospitalization was included. The primary outcome was the combination of a positive result on respiratory panel indicating detection of a viral pathogen and de-escalation of gram-negative antibiotics. De-escalation was assessed based on antibiotics administered on day 3 after testing and was defined by discontinuation or switch to an agent with a narrower spectrum of activity. Least absolute shrinkage and selection operator (LASSO) regression was used to construct the multivariable logistic regression model. Classification and regression tree (CART) analysis was used to identify subgroups with a higher likelihood of the primary outcome. Results: Of 8,326 patients, 1,462 (17.6%) tested positive by respiratory panel. The most common pathogen was rhinovirus (7.9% of the sample). Gram-negative–targeted antibiotics were de-escalated in 4,456 cases (53.5% of the sample), including 887 patients with a positive result on respiratory panel indicating a viral pathogen (60.7% of patients with a positive viral result). LASSO regression was used to select 12 variables (Table 1). Admitting diagnosis of pneumonia (OR, 1.42), comorbid substance abuse (OR, 1.39), chronic pulmonary disease (OR, 1.39), and admission from home (OR, 1.34) were associated with antibiotic de-escalation in conjunction with a positive respiratory panel. Leukocytosis (OR, 0.59), hematologic malignancy (OR, 0.64), mechanical ventilation at time of testing (OR, 0.68), and hypotension (OR, 0.77) were associated with decreased likelihood of antibiotic de-escalation in conjunction with a positive respiratory panel. CART analysis identified patients tested within 40 hours of admission as having a higher likelihood of a positive result in conjunction with antibiotic de-escalation. Among patients tested within 40 hours of admission, the probability of a positive result followed by antibiotic de-escalation was 11.9% (95% CI, 11.1%–12.8%). For patients tested >40 hours after admission, the probability was 6.0% (95% CI, 4.8%–7.2%). Conclusions: Targeted use of respiratory panel testing may increase the likelihood of an informative result that can drive decision making related to antibiotic use. Our exploratory analysis suggests that respiratory panel testing in the first 2 days

Funding: None

Disclosures: None

Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.

One of the main capabilities of atom probe tomography (APT) is the ability to not only identify but also characterize early stages of precipitation at length scales that are not achievable by other techniques. One of the most popular methods to identify nanoscale clustering in APT data, based on the density-based spatial clustering of applications with noise (DBSCAN), is used extensively in many branches of research. However, it is common that not all of the steps leading to the selection of certain parameters used in the analysis are reported. Without knowing the rationale behind parameter selection, it may be difficult to compare cluster parameters obtained by different researchers. In this work, a simple open-source tool, PosgenPy, is used to justify cluster search parameter selection via providing a systematic sweep through parameter values with multiple randomizations to minimize a false-positive cluster ratio. The tool is applied to several different microstructures: a simulated material system and two experimental datasets from a low-alloy steel . The analyses show how values for the various parameters can be selected to ensure that the calculated cluster number density and cluster composition are accurate.

The 1960s-era, Nashville nonviolent civil rights movement—with its iconic lunch counter sit-ins—was not only an exemplary local movement that dismantled Jim Crow in downtown public accommodations. It was by design the chief vehicle for the intergenerational mentoring and training of activists that led to a dialogical diffusion of nonviolence praxis throughout the Southern civil rights movement of this period. In this article, we empirically derive from oral-history interviews with activists and archival sources a new “intergenerational model of movement mobilization” and assess its contextual and bridge-leading sustaining factors. After reviewing the literatures on dialogical diffusion and bridge building in social movements, we describe the model and its sustaining conditions—historical, demographic, and spatial conditions—and conclude by presenting a research agenda on the sustainability and generalizability of the Nashville model.

The vehicle exterior design conveys a variety of visual information. Among these are the brand identity, assumed characteristics, and the vehicle's age or newness. While previous research focusses mainly on the first two attributes, we broaden the perspective by examining the age perception for vehicle model portfolios across brands.

Information of age is embedded not only in branding but also in the entirety of a vehicle's exterior design features. Therefore, this paper examines how participants of a self-reported study perceive individual models inside successive product portfolios without typical branding. The stimulus patterns were derived from 12 different series of BMW, Mercedes-Benz and Audi and edited accordingly. A total of 67 models from the years 1968 to 2019 were presented and evaluated in terms of perceived age, model and brand recognition.

The results show that most vehicles are perceived as newer than their actual age, successive model generations are clearly distinguishable and participants were able to sort all models in their correct chronological order. Finally, design-related age perception and knowledge-based age perception are introduced as possible underlying concepts of the visual perception of product age.

During March 27–July 14, 2020, the Centers for Disease Control and Prevention’s National Healthcare Safety Network extended its surveillance to hospital capacities responding to COVID-19 pandemic. The data showed wide variations across hospitals in case burden, bed occupancies, ventilator usage, and healthcare personnel and supply status. These data were used to inform emergency responses.

Foraminifera are important components of tropical marine benthic ecosystems and their recovery pattern from the end-Permian mass extinction can yield insights into the Mesozoic history of this group. Here we report the calcareous and agglutinated foraminifera recovered from five measured stratigraphic sections on the Great Bank of Guizhou, an uppermost Permian to Upper Triassic isolated carbonate platform in the Nanpanjiang Basin, south China. The material contains >100 Triassic species, including three that are newly described (Arenovidalina weii n. sp., Meandrospira? enosi n. sp., and Spinoendotebanella lehrmanni n. gen., n. sp.), ranging from Griesbachian (Induan) to Cordevolian (Carnian) age. The species belong to the classes Miliolata, Textulariata, Fusulinata, Nodosariata, and to an unknown class housing all aragonitic forms of the orders Involutinida and Robertinida. Based on previously established conodont zones and carbon isotope chemostratigraphy, the Griesbachian (early Induan) through Illyrian (late Anisian) interval has been subdivided into 12 foraminiferal zones and two unnamed intervals devoid of foraminifera. Following the extinction at the Permian-Triassic boundary, habitable ecological niches of Griesbachian age were invaded by disaster taxa that subsequently became extinct during the Dienerian (late Induan) and left no younger descendants. The disaster taxa were replaced by Lazarus taxa with Permian origins, which were then decimated by the Smithian-Spathian (mid-Olenekian) boundary crisis. The tempo of recovery appears to have been modulated by environmental changes during the Griesbachian through Smithian that involved both climate change and expansion of anoxic ocean bottom waters. Uninterrupted and lasting recovery of benthic foraminifera did not begin until the Spathian.

UUID: http://zoobank.org/2a6e9061-b163-402a-9098-8765a80576b3

The carrasco is a dense, shrubby vegetation type that covers the higher parts of table-top mountains in north-eastern Brazil. The vegetation of this phytophysiognomy is often considered to have biogeographical and ecological affinities with the cerrado of Central Brazil, but the biogeographical affinities of its avifauna remain unclear. In recent years, deforestation due to local economic activities has been particularly severe in some carrasco-dominated landscapes. In 2013, we initiated avian surveys at the Fazenda Pau D‘Arco, a privately owned property located on top of the Araripe Plateau, to evaluate the effects of a legal forest management program on the avifauna. Here, we present the results of four years of avian inventories to: i) characterize a well-preserved patch of carrasco vegetation; ii) assess avian biogeographical affinities of this vegetation type; iii) identify associations between managed/unmanaged areas and bird species; and iv) provide baseline data for future avian monitoring studies. Using different survey methods, we provide a list of 148 bird species, including several dry-forest specialists and caatinga endemics. Biogeographically, the avifauna of the carrasco represents a subsample of the Caatinga dry forest, lacking cerrado elements. Forest management significantly affected the distribution of several bird species in the study area. We found that 1/5 of the species (24) recorded during our standardized surveys were significantly associated with either unmanaged (14 species) or managed (10 species) areas. Species such as the Ceará Leaftosser Sclerurus cearensis, a globally vulnerable species, have only been detected in non-managed areas and therefore can be negatively affected by the management program. We also present data on 16 avian taxa with ecological and conservation concerns. By presenting a fairly complete and documented list of the avifauna, we characterize the carrasco avifauna and offer the tools to evaluate the effects of forest management on this poorly known vegetation type.

Data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC NHSN) were analyzed to understand the potential impact of the COVID-19 pandemic on central-line–associated bloodstream infections (CLABSIs) in acute-care hospitals. Descriptive analysis of the standardized infection ratio (SIR) was conducted by location, location type, geographic area, and bed size.

In this article, we discuss the backgrounds and technical details about several smart manufacturing projects in a tier-one electronics manufacturing facility. We devise a process to manage logistic forecast and inventory preparation for electronic parts using historical data and a recurrent neural network to achieve significant improvement over current methods. We present a system for automatically qualifying laptop software for mass production through computer vision and automation technology. The result is a reliable system that can save hundreds of man-years in the qualification process. Finally, we create a deep learning-based algorithm for visual inspection of product appearances, which requires significantly less defect training data compared to traditional approaches. For production needs, we design an automatic optical inspection machine suitable for our algorithm and process. We also discuss the issues for data collection and enabling smart manufacturing projects in a factory setting, where the projects operate on a delicate balance between process innovations and cost-saving measures.

Functional benefits of the morphologies described by Bergmann's and Allen's rules in human males have recently been reported. However, the functional implications of ecogeographical patterning in females remain poorly understood. Here, we report the findings of preliminary work analysing the association between body shape and performance in female ultramarathon runners (n = 36) competing in hot and cold environments. The body shapes differed between finishers of hot and cold races, and also between hot race finishers and non-finishers. Variability in race performance across different settings supports the notion that human phenotype is adapted to different thermal environments as ecogeographical patterns have reported previously. This report provides support for the recent hypothesis that the heightened thermal strain associated with prolonged physical activity in hot/cold environments may have driven the emergence of thermally adaptive phenotypes in our evolutionary past. These results also tentatively suggest that the relationship between morphology and performance may be stronger in female vs. male athletes. This potential sex difference is discussed with reference to the evolved unique energetic context of human female reproduction. Further work, with a larger sample size, is required to investigate the observed potential sex differences in the strength of the relationship between phenotype and performance.