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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.
We sought to explore factors associated with depressive symptom severity among older persons (≥60 years of age) and to compare the depressive symptoms commonly experienced by older elderly (≥75 years) with those commonly experienced by younger elderly (<75 years).
Secondary analysis was conducted on data from a nationally representative survey.
Four parishes in Jamaica.
A total of 2,943 older community dwellers participated.
The survey included the Zung Self-rating Depression Scale (ZSDS), the Mini Mental State Examination (MMSE), and items on age, sex, and educational level. Linear regression analysis was used to determine the association between ZSDS score and: age, sex, MMSE score, and educational level. Logistic regression analysis was used to determine, for each ZSDS item, whether particular responses were more associated with older or younger elderly.
Higher ZSDS scores were associated with increasing age (B = 0.13, p < 0.001), lower MMSE score (B = −0.42, p < 0.001), the female sex (B = 3.52, p < 0.001), and lower educational level (B = −1.27, p < 0.001). The ZSDS items that were endorsed significantly more (p < 0.05) by older elderly related to negative evaluations about their functionality and value. Hopelessness was also more prominent among the older elderly. The items that were endorsed significantly more (p < 0.05) by the younger elderly had less of a focus.
Among older persons, increasing age was associated with marginally higher levels of depressive symptoms. Female gender, cognitive deficits, preoccupations about value and functionality, and feelings of hopelessness may serve as useful screening parameters.
In this study, we describe a contained measles outbreak in a London prison, the second such outbreak in a custodial setting. Once vaccination commenced, just under a third of eligible prisoners were immunised due to a low uptake of the vaccine. We conducted a root-cause analysis in order to identify factors which may have prevented or altered the course of the outbreak. Our analysis revealed that many of the factors identified are those that cannot be easily changed. It is unlikely that mass vaccination at the time, even in the absence of some of the more easily rectifiable issues, could have fully avoided further cases in the event of a mass outbreak. Both measles outbreaks in a custodial setting started with a member of staff and immunisation status of the staff were largely unknown. We argue that mass vaccination following an outbreak in a prison is unlikely to fully prevent a mass outbreak, and that implementing opt-out testing, empirical vaccination and insisting on full immunisation of staff are most likely to both prevent and contain outbreaks in the future.
We have previously demonstrated that feeding red clover relative to grass silage results in meat characterised by higher levels of polyunsaturated fatty acids (PUFA) but reduced shelf life which was associated with lower levels of vitamin E in the muscle (Scollan et al., 2006). Colour shelf life could be ameliorated by feeding additional vitamin E (Scollan et al., 2006). Feeding red clover silage followed by finishing off pasture may help alleviate the problem of colour shelf life while maintaining the benefit of the legume in delivering higher PUFA into meat. Hence this study examined feeding red clover compared with grass silage during the winter, following by a summer finishing period at grass, on fatty acid composition, vitamin E content of meat, colour shelf life and sensory attributes of beef.
It is the practise for some farmers to supplement new season lambs with concentrates, often as a creep feed, in order to get them to market early before the price declines. This concentrate is usually based on cereals and would be high in n-6 fatty acids, diluting the beneficial effect of grass grazing which promotes the n-3 polyunsaturated fatty acid (PUFA) content in the meat (Fisher et al., 2000). The purpose of this trial was to assess the addition of linseed to the concentrate, fed in a creep-feed system, which would maintain or enhance the n-3 fatty acid composition of the meat of animals fed concentrates at grass during the finishing period (Cooper et al., 2004).
As part of the “America First” agenda discussed in his inaugural address, President Donald J. Trump promised that “[e]very decision” on trade, among other areas, would be “made to benefit American workers and American families.” During its first months, the Trump Administration made a number of trade moves apparently in connection with this “America First” trade agenda, including initiating national security investigations into steel and aluminum imports under Section 232 of the Trade Expansion Act of 1962 and preparing an “omnibus” report on trade deficits. The Trump Administration also took steps to alter U.S. treaty relationships, by withdrawing from the Trans-Pacific Partnership Agreement, announcing the renegotiation of the North American Free Trade Agreement, and requesting a special session of a joint committee created under the United States-Korea Free Trade Agreement. In August 2017, President Trump continued this course—and indicated a willingness to take unilateral action against U.S. trading partners—by signing a presidential memorandum directing the United States Trade Representative to determine whether China's treatment of U.S. intellectual property warranted investigation under Section 301 et seq. of the Trade Act of 1974.
Martian Meteorite ALH84001 contains four unusual features which have been interpreted as possible signatures of relic biogenic activity. After six years of intense study by the world's scientific community, the current status of the biogenic hypothesis is reviewed and shown to still be valid. Furthermore additional features have been observed in two younger Martian meteorites. The strongest argument for possible evidence of biogenic activity within the ALH84001 meteorite is the presence of truncated hexa-octahedral magnetite crystals which are only known on Earth to be the products of biology.
Background: Approximately 12-15% of patients with intracranial aneurysms (IA) have affected first-degree relatives, and are considered to have familial intracranial aneurysms (FIA). Individuals with FIA are at higher risk for aneurysm formation and subarachnoid hemorrhage. THSD1 is the only gene to be associated with nonsyndromic FIA at this time. Our study aims to find rare DNA variants that are major risk factors for FIA in our cohort of patients. Methods: To date we have enrolled 37 affected and 31 unaffected people from 16 families. We have done exome or genome sequencing on at least 1 person from each of 12 families. Results: A rare p.(R686W) variant in THSD1 was found in 1/12 families, but did not cosegregate fully with disease. While less attractive as the primary cause of FIA, we cannot rule out the potential modifying effects of THSD1 p.(R686W) in this family. A second candidate, an extracellular matrix gene within a chromosomal region previously implicated by familial mapping studies, contains rare variants in 4/12 of our families. All four variants are predicted to be damaging. Conclusions: Alongside environmental risk factors, individual FIA families may also have complex rare variant contributions to their disease, such as digenic and multi-locus contributions.
The content of omega-3 long-chain polyunsaturated fatty acids (n−3 LCPUFA) in chicken meat can be boosted by feeding broilers a diet containing α-linolenic acid (ALA, from flaxseed oil), some of which is converted by hepatic enzymes to n−3 LCPUFA. However, most of the accumulated n−3 polyunsaturated fatty acid (PUFA) in meat tissues is still in the form of ALA. Despite this, the levels of chicken diets are being enhanced by the inclusion of vegetable and marine sources of omega-3 fats. This study investigated whether the capacity of chicken for n−3 LCPUFA accumulation could be enhanced or inhibited by exposure to an increased supply of ALA or n−3 LCPUFA in ovo. Breeder hens were fed either flaxseed oil (High-ALA), fish oil (high n−3 LCPUFA) or tallow- (low n−3 PUFA, Control) based diets. The newly hatched chicks in each group were fed either the High-ALA or the Control diets until harvest at 42 days’ post-hatch. The n−3 PUFA content of egg yolk and day-old chick meat closely matched the n−3 PUFA composition of the maternal diet. In contrast, the n−3 PUFA composition of breast and leg meat tissues of the 42-day-old offspring closely matched the diet fed post-hatch, with no significant effect of maternal diet. Indeed, there was an inhibition of n−3 LCPUFA accumulation in meat of the broilers from the maternal Fish-Oil diet group when fed the post-hatch High-ALA diet. Therefore, this approach is not valid to elevate n-3 LCPUFA in chicken meat.
We present an in-depth study of metal-poor stars, based high resolution spectra combined with newly released astrometric data from Gaia, with special attention to observational uncertainties. The results are compared to those of other studies, including Gaia benchmark stars. Chemical evolution models are discussed, highlighting few puzzles that are still affecting our understanding of stellar nucleosynthesis and of the evolution of our Galaxy.
We aimed to determine the prevalence of alcohol use among older Jamaicans as well as to explore among this population the relationships between alcohol use and: age, sex, depressive symptoms, and life satisfaction. Although the nature of these relationships among the proposed study population were uncertain, in other settings alcohol use has tended to decline with increasing age, occur more commonly among men than women, and show non-linear relationships with depressive symptoms and life satisfaction.
Data gathered by two-stage cluster sampling for a nationally representative health and lifestyle survey of 2,943 community-dwelling older Jamaicans, aged 60 to 103 years, were subjected to secondary analysis using the Student's t-test and χ2 test as appropriate.
Current alcohol use was reported by 21.4% of the participants. It steadily declined with age and was six times more prevalent among men (37.6%) than women (6.2%). These findings were statistically significant as were associations of current alcohol use with comparatively lower levels of depressive symptoms. Current alcohol use was also more prevalent among persons who were either highly satisfied or highly dissatisfied with their lives, compared to others who had levels of life satisfaction between these two extremes.
Current alcohol use among older Jamaicans occurs primarily among men, declines with increasing age, and is associated with a relatively low likelihood of depression. It is also associated with very high and very low levels of life satisfaction.
Several speakers at this symposium have alluded to the zeroth-order agreement between the Type II supernovae (SNe) stellar yields, as predicted by the models of those most responsible for driving progress in the field - i.e. Arnett (1991,1996); Maeder (1992); Woosley & Weaver (1995); Langer & Henkel (1995); Thielemann et al. (1996), hereafter referred to as A91, A96, M92, WW95, LH95, and TNH96, respectively. It is important though for those entering (or indeed, already involved in!) the chemical evolution field to be cognizant of the fact that there are important first- and second-order differences between the yield compilations.
Objectives: Individuals with schizophrenia have difficulties on measures of executive functioning such as initiation and suppression of responses and strategy development and implementation. The current study thoroughly examines performance on the Hayling Sentence Completion Test (HSCT) in individuals with schizophrenia, introducing novel analyses based on initiation errors and strategy use, and association with lifetime clinical symptoms. Methods: The HSCT was administered to individuals with schizophrenia (N=77) and age- and sex-matched healthy controls (N=45), along with background cognitive tests. The standard HSCT clinical measures (initiation response time, suppression response time, suppression errors), composite initiation and suppression error scores, and strategy-based responses were calculated. Lifetime clinical symptoms [formal thought disorder (FTD), positive, negative] were calculated using the Lifetime Dimensions of Psychosis Scale. Results: After controlling for baseline cognitive differences, individuals with schizophrenia were significantly impaired on the suppression response time and suppression error scales. For the novel analyses, individuals with schizophrenia produced a greater number of initiation errors and subtly wrong errors, and produced fewer responses indicative of developing an appropriate strategy. Strategy use was negatively correlated with FTD symptoms in individuals with schizophrenia. Conclusions: The current study provides further evidence for deficits in the initiation and suppression of verbal responses in individuals with schizophrenia. Moreover, an inability to attain a strategy at least partly contributes to increased semantically connected errors when attempting to suppress responses. The association between strategy use and FTD points to the involvement of executive deficits in disorganized speech in schizophrenia. (JINS, 2016, 22, 735–743)
The methodology involved in deriving the Hubble Constant via the calibration of the corrected peak luminosities of Type Ia supernovae (SNe) is reviewed. We first present a re-analysis of the Calán-Tololo (C-T) and Center for Astrophysics (CfA) Type Ia SN surveys. Bivariate linear least squares and quadratic boot-strapped fits in peak apparent magnitude and light curve shape are employed to correct this heterogeneous sample of peak apparent magnitudes, resulting in an homogeneous (and excellent) secondary distance indicator: the so-called corrected peak luminosity. We next provide an empirical calibration for this corrected luminosity, using Cepheid-based distances for seven nearby spiral galaxies host to Type Ia SNe. Included in this sample is the spectroscopically peculiar SN 1991T (in NGC 4527), whose corrected peak luminosity is shown to be indistinguishable from that of so-called “normal” SNe. A robust value of the Hubble Constant is derived and shown to be H0=73±2(r)±7(s)km s-1 Mpc-1.
We investigate the chemo-dynamical evolution of elliptical galaxies, to understand the origin of the mass-dependence of photometric properties such as the colour-magnitude relation (CMR). Our three-dimensional TREE N-body/SPH numerical simulation takes into account both Type II and Type Ia supernovae and follows the evolution of the abundances of several chemical elements. We derive the photometric properties of the simulation end-products and compare them with the observed CMR.
We present results from our Parkes Multibeam H I survey of 3 loose groups of galaxies that are analogous to the Local Group. This is a survey of groups containing only spiral galaxies with mean separations of a few hundred kpc, and total areas of approximately 1 Mpc2; groups similar to our own Local Group. We present a census of the H I-rich objects in these groups down to a 1σ MHI sensitivity ~7×105M⊙, as well as the detailed properties of these detections from follow-up Compact Array observations. We found 7 new H I-rich members in the 3 groups, all of which have stellar counterparts and are, therefore, typical dwarf galaxies. The ratio of low-mass to high-mass gas-rich galaxies in these groups is less than in the Local Group meaning that the “missing satellite” problem is not unique. No high-velocity cloud analogs were found in any of the groups. If HVCs in these groups are the same as in the Local Group, this implies that HVCs must be located within ~300-400 kpc of the Milky Way.