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Targeted screening for carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing organisms (CPOs), remains limited; recent data suggest that existing policies miss many carriers.
Our objective was to measure the prevalence of CRO and CPO perirectal colonization at hospital unit admission and to use machine learning methods to predict probability of CRO and/or CPO carriage.
We performed an observational cohort study of all patients admitted to the medical intensive care unit (MICU) or solid organ transplant (SOT) unit at The Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. Admission perirectal swabs were screened for CROs and CPOs. More than 125 variables capturing preadmission clinical and demographic characteristics were collected from the electronic medical record (EMR) system. We developed models to predict colonization probabilities using decision tree learning.
Evaluating 2,878 admission swabs from 2,165 patients, we found that 7.5% and 1.3% of swabs were CRO and CPO positive, respectively. Organism and carbapenemase diversity among CPO isolates was high. Despite including many characteristics commonly associated with CRO/CPO carriage or infection, overall, decision tree models poorly predicted CRO and CPO colonization (C statistics, 0.57 and 0.58, respectively). In subgroup analyses, however, models did accurately identify patients with recent CRO-positive cultures who use proton-pump inhibitors as having a high likelihood of CRO colonization.
In this inpatient population, CRO carriage was infrequent but was higher than previously published estimates. Despite including many variables associated with CRO/CPO carriage, models poorly predicted colonization status, likely due to significant host and organism heterogeneity.
As depression has a recurrent course, relapse and recurrence prevention is essential.
In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.
Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.
Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.
Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.
Declaration of interest
C.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.
Using samples collected for VRE surveillance, we evaluated unit admission prevalence of carbapenem-resistant Enterobacteriaceae (CRE) perirectal colonization and whether CRE carriers (unknown to staff) were on contact precautions for other indications. CRE colonization at unit admission was infrequent (3.9%). Most CRE carriers were not on contact precautions, representing a reservoir for healthcare-associated CRE transmission.
In space and astrophysical plasmas, turbulence is responsible for transferring energy from large scales driven by violent events or instabilities, to smaller scales where turbulent energy is ultimately converted into plasma heat by dissipative mechanisms. The nonlinear interaction between counterpropagating Alfvén waves, denoted Alfvén wave collisions, drives this turbulent energy cascade, as recognized by early work with incompressible magnetohydrodynamic (MHD) equations. Recent work employing analytical calculations and nonlinear gyrokinetic simulations of Alfvén wave collisions in an idealized periodic initial state have demonstrated the key properties that strong Alfvén wave collisions mediate effectively the transfer of energy to smaller perpendicular scales and self-consistently generate current sheets. For the more realistic case of the collision between two initially separated Alfvén wavepackets, we use a nonlinear gyrokinetic simulation to show here that these key properties persist: strong Alfvén wavepacket collisions indeed facilitate the perpendicular cascade of energy and give rise to current sheets. Furthermore, the evolution shows that nonlinear interactions occur only while the wavepackets overlap, followed by a clean separation of the wavepackets with straight uniform magnetic fields and the cessation of nonlinear evolution in between collisions, even in the gyrokinetic simulation presented here which resolves dispersive and kinetic effects beyond the reach of the MHD theory.
A variable rate drip irrigation (VRDI) system was implemented in early 2013 in a 4.05-ha area inside a drip-irrigated Cabernet Sauvignon vineyard measuring 12.5 total ha. The VRDI area was split into 140 15×15-meter irrigation zones which were watered independently during three seasons with weekly schedules based on estimated actual ET. Irrigation was scheduled with the objective of decreasing spatial variability while maintaining high yields. Compared to an adjacent, 4.05-ha, conventionally drip irrigated section of the vineyard (CDI); VRDI increased yield and water use efficiency in all three years and decreased spatial dependency and structure in 2013 and 2015.
The first ice-core record of both the Holocene and Wisconsin/Würm Late Glacial Stage (LGS) from the subtropics has been extracted from three ice cores to bedrock from the Dunde ice cap on the north-central Qinghai-Tibetan Plateau. Ice thicknesses at the ice-cap summit average 138 m, the bedrock surface is relatively flat, surface and basal temperatures are −7.3 and −4.7°C, respectively and the ice cap exhibits radial flow away from the summit dome. These records reveal a major change in the climate of the plateau ∼10 000 years ago and suggest that LGS conditions were colder, wetter and dustier than Holocene conditions. This is inferred from the more negative δ18O ratios, increased dust content, decreased soluble aerosol concentrations, and reduced ice-crystal sizes, which characterize the LGS part of the cores. Total β radioactivity from shallow ice cores indicates that over the last 24 years the average accumulation rate has been ∼400 mm a−1 at the summit. The ice cores have been dated using a combination of annual layers in the insoluble dust and δ18O in the upper sections of core, visible dust layers which are annual, and ice-flow modeling. The oxygen-isotope record which serves as a temperature proxy indicates that the last 60 years have been the warmest in the entire record.
We present preliminary results from a number of deep radio polarization surveys being made of the Magellanic Clouds at 2.3 GHz, 4.75 GHz and 8.55 GHz. Extended and linearly polarized radio emission has been found at 2.3 and 4.75 GHz from both the Large Magellanic Cloud (LMC) and the Small Magellanic Cloud (SMC). However, as the analysis of these data is not yet complete we present only some of the 4.75 GHz results at this time.
A K-band (18-25 GHz) reflected-wave ruby maser (Moore and Clauss 1979) has been borrowed from the National Radio Astronomy Observatory for radio astronomy use on the NASA 64-m antenna of the Deep Space Network at the Tidbinbilla Tracking Station, near Canberra. The purpose of the installation is to provide additional sensitive spectral line, continuum, and VLBI capabilities in the southern hemisphere. Previous measurements at 22.3 GHz (λ = 13.5 mm) determined that the Tidbinbilla 64-m antenna has a peak aperture efficiency of ˜22%, a well-behaved beam shape and consistent pointing (Fourikis and Jauncey 1979). Before installing the maser on the antenna a cooled (circulator) switch was added to provide a beam-switching capability, and a spectral line receiver following the maser was incorporated. The system was assembled and tested at JPL in late 1980 and installed at Tidbinbilla early in 1981. We give here a brief description and present some of the first line observations made in February and March 1981. Extensive line and continuum observations are planned with the present system and a program is under way to determine the telescope pointing characteristics.
Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years.
A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models.
DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years.
Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.
It is shown through the use of weighting functions that Jupiter's brightness temperature in the wavelength range 0.8–1.5 cm contains information on the thermal structure and abundance of ammonia in and above the tropopause in Jupiter's atmosphere. We present new data of Jupiter's brightness temperature in this wavelength range, and compare the results with theoretical spectra. The pressure in the Jovian atmosphere is estimated from these data to be 0.48 atm at 130K.
Although adolescence is marked by increased negative life events and internalizing problems, few studies investigate this association as an ongoing longitudinal process. Moreover, while there are considerable individual differences in the degree to which these phenomena are linked, little is known about the origins of these differences. The present study examines early life stress (ELS) exposure and early-adolescent longitudinal afternoon cortisol level as predictors of the covariation between internalizing symptoms and negative life events across high school. ELS was assessed by maternal report during infancy, and the measure of cortisol was derived from assessments at ages 11, 13, and 15 years. Life events and internalizing symptoms were assessed at ages 15, 17, and 18 years. A two-level hierarchical linear model revealed that ELS and cortisol were independent predictors of the covariation of internalizing symptoms and negative life events. Compared to those with lower levels of ELS, ELS-exposed adolescents displayed tighter covariation between internalizing symptoms and negative life events. Adolescents with lower longitudinal afternoon cortisol displayed tighter covariation between negative life events and internalizing symptoms, while those with higher cortisol demonstrated weaker covariation, partially due to increased levels of internalizing symptoms when faced with fewer negative life events.
Despite the inclusion of disruptive mood dysregulation disorder (DMDD) in DSM-5, little empirical data exist on the disorder. We estimated rates, co-morbidity, correlates and early childhood predictors of DMDD in a community sample of 6-year-olds.
DMDD was assessed in 6-year-old children (n = 462) using a parent-reported structured clinical interview. Age 6 years correlates and age 3 years predictors were drawn from six domains: demographics; child psychopathology, functioning, and temperament; parental psychopathology; and the psychosocial environment.
The 3-month prevalence rate for DMDD was 8.2% (n = 38). DMDD occurred with an emotional or behavioral disorder in 60.5% of these children. At age 6 years, concurrent bivariate analyses revealed associations between DMDD and depression, oppositional defiant disorder, the Child Behavior Checklist – Dysregulation Profile, functional impairment, poorer peer functioning, child temperament (higher surgency and negative emotional intensity and lower effortful control), and lower parental support and marital satisfaction. The age 3 years predictors of DMDD at age 6 years included child attention deficit hyperactivity disorder, oppositional defiant disorder, the Child Behavior Checklist – Dysregulation Profile, poorer peer functioning, child temperament (higher child surgency and negative emotional intensity and lower effortful control), parental lifetime substance use disorder and higher parental hostility.
A number of children met DSM-5 criteria for DMDD, and the diagnosis was associated with numerous concurrent and predictive indicators of emotional and behavioral dysregulation and poor functioning.