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Qualitative inorganic analysis is required for the identification of unknowns, the classification of type, and sometimes to decide what subsequent quantitative analysis is needed. The traditional way of performing qualitative XRF analysis on unknown materials is by subjecting the sample to a full spectral scan. This takes time and an experienced operator to interpret the spectra. Classifying the elements detected as major, minor or trace can also be person dependent. Round robin tests have confirmed this by showing considerable variation in results between laboratories.
Rapidly advancing technology often pulls the regulatory field along as it evolves to incorporate new concepts, better tools, and more finely honed equipment. When the area impacted by the technological advancement is regulated by the Food and Drug Administration (FDA), a gap develops between the technology and the guidelines that govern its application. Subsequently, there are challenges in determining appropriate regulatory pathways for evolving products at the initial research and developmental stages. Myriad factors necessitate several rounds of iterative review and the involvement of multiple divisions within the FDA. To better understand the regulatory science issues roiling around the area of additive manufacturing of medical products, a group of experts, led by a Clinical and Translational Science Award working group, convened the Regulatory Science to Advance Precision Medicine at the Fall Forum to discuss some of the current regulatory science roadblocks.
Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.
Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.
Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.
Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.
Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.
We compared sepsis “time zero” and Centers for Medicare and Medicaid Services (CMS) SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 of 80 (36%) cases. Perceived pass rates ranged from 9 of 80 cases (11%) to 19 of 80 cases (23%). Variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
Objectives: The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity. Methods: Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group. Results: Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects. Conclusions: Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176–187)
To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD)
Retrospective cohort study from January 2009 to December 2014
Neurology and neurosurgery intensive care unit of a large tertiary-care center
Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded.
We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions.
We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio’s definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements.
The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates.
A contradiction has existed in the literature as to the conditions favoring formation of “ablation hollows” (“suncups”) on a melting snow surface. Some experiments find that these features grow under direct sunlight and decay in overcast, windy weather; whereas others find just the opposite result, that they grow best under cloudy, windy conditions and decay if exposed to direct sunlight. We find that the hidden variable in past experiments, which acts as a switch to determine which mode of formation can operate, is the absence or abundance of dark insoluble impurities in the snow. Direct sunlight causes ablation hollows to grow in clean snow and to decay in dirty snow (for dirt content below a critical value), because the dirt migrates to the ridges between the hollows, lowering the albedo at the ridges. By contrast, when ablation is dominated by turbulent heat exchange, the presence of dirt favours development of ablation hollows because the dirt migrates to the ridges and insulates them; albedo reduction has a negligible effect on ablation.
This hypothesis is supported by an experiment which showed that the presence of a thin layer of volcanic ash on the snow inhibited formation of ablation hollows under direct sunlight.
To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria
Retrospective cohort study
A 1,250-bed academic tertiary referral center
This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.
During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).
Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.
The first meeting of the IntCal04 working group took place at Queen's University Belfast from April 15 to 17, 2002. The participants are listed as co-authors of this report. The meeting considered criteria for the acceptance of data into the next official calibration dataset, the importance of including reliable estimates of uncertainty in both the radiocarbon ages and the cal ages, and potential methods for combining datasets. This preliminary report summarizes the criteria that were discussed, but does not yet give specific recommendations for inclusion or exclusion of individual datasets.
New radiocarbon calibration curves, IntCal04 and Marine04, have been constructed and internationally ratified to replace the terrestrial and marine components of IntCal98. The new calibration data sets extend an additional 2000 yr, from 0–26 cal kyr BP (Before Present, 0 cal BP = AD 1950), and provide much higher resolution, greater precision, and more detailed structure than IntCal98. For the Marine04 curve, dendrochronologically-dated tree-ring samples, converted with a box diffusion model to marine mixed-layer ages, cover the period from 0–10.5 cal kyr BP. Beyond 10.5 cal kyr BP, high-resolution marine data become available from foraminifera in varved sediments and U/Th-dated corals. The marine records are corrected with site-specific 14C reservoir age information to provide a single global marine mixed-layer calibration from 10.5–26.0 cal kyr BP. A substantial enhancement relative to IntCal98 is the introduction of a random walk model, which takes into account the uncertainty in both the calendar age and the 14C age to calculate the underlying calibration curve (Buck and Blackwell, this issue). The marine data sets and calibration curve for marine samples from the surface mixed layer (Marine04) are discussed here. The tree-ring data sets, sources of uncertainty, and regional offsets are presented in detail in a companion paper by Reimer et al. (this issue).
We increase the number of remote halo tracers by using blue horizontal branch (BHB) stars out to Galactocentric distances of 130 kpc. We use SDSS EDR photometry and the VLT to detect 16 BHB stars at Galactocentric distances 70 <r < 130 kpc, and to measure their radial velocities. We find the mass of the Milky Way is M = 1.7+3.0–0.6 × 1012M⊙. When completed this survey will: (i) substantially reduce the errors in the total mass and extent of the Milky Way halo, and (ii) map the velocity space in a hitherto unexplored region of the halo.
The binary X-ray source GX 1 + 4 was observed during a balloon flight in 1986, November. The source was in a relatively high intensity state. Time analysis of the data shows that the pulsation period was 111.8 ± 1.0 s indicating that one or more episodes of spin-down occurred between 1980 and 1986. Folded pulse profiles are very broad with an indication of a notch at the peak. Evidence has been found for a correlation between hard X-ray intensity and phase of the proposed 304 day orbital period. The time averaged intensity since 1980 is an order of magnitude lower than during the 1970’s. A survey of the post 1980 data shows that several reversals of the period derivative have occurred. Spin-up at the rates typical of the 1970’s has been followed by a dramatic spin-down episode with dP/dt>2.4 × 10−7 s/s.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.
Quantitative data on lycopsid and aquatic fern megaspore taxa recovered from Carboniferous, Mesozoic, and Tertiary strata have been compiled in order to analyze the changes in diversity of the two groups of fossil plants that produced them. Numbers of species of lycopsid megaspores are similar in the Carboniferous and Mesozoic, whereas the diversity of megafossils is much lower in post-Paleozoic deposits. Our data suggest that lycopsids were more diverse in the Mesozoic than previously thought and that there is a preservational bias against the megafossils, because the plants were probably mainly herbaceous. Heterosporous aquatic ferns first appeared in the Neocomian and gradually diversified until the early Late Cretaceous, after which their numbers remained relatively stable, whereas the variety of lycopsids declined dramatically during the Late Cretaceous. These changes occurred at a time of rapid angiosperm diversification. The reduced diversity of the lycopsids may have been caused by the invasion of their aquatic and damp forest-floor habitats by heterosporous ferns and by aquatic and herbaceous angiosperms. These diversity changes do not seem to be directly related to the global events at the Cretaceous-Tertiary boundary, but the relatively few samples available and the resulting range truncation would make detection of such correlations difficult.
Urban riparian plant communities exist at the interface between terrestrial and aquatic habitats, and they are rich sources of species biodiversity and ecosystem services. The periodic floods that promote species diversity in riparian plant communities also increase their vulnerability to nonnative plant invasions. Plant invasions are constrained by seed and suitable habitat availability. However, how seed dispersal and establishment limitations interact to shape nonnative plant invasions in riparian communities is poorly understood. We use Stream Visual Assessment Protocol data to evaluate the hydrological and geomorphological parameters that influence the seeding and establishment of six common nonnative species in urban riparian habitats: garlic mustard, purple loosestrife, reed canarygrass, common reed, Japanese knotweed, and multiflora rose. To address this objective, we analyzed stream reach data collected during a basin-wide environmental assessment of the extensively urbanized upper Niagara River watershed. We found limited support for our prediction that propagule limitation constrains the distribution of nonnative riparian species, likely because these species are well established in the study area. Instead, we found that opportune stream reach characteristics better predict the distribution of the common invasive riparian species—most notably open tree canopy. Given that there is widespread investment in urban riparian forest restoration to improve water quality, increase stream-bank stability, enhance wildlife habitat and promote recreation, our data suggest that riparian forests may provide the additional benefit of reducing the abundance of some, but not all, invasive plants.
The solar absorptance αs of nanostructured selective surface (NSS) for solar thermal energy is improved. The NSS are prepared by AC electrochemical impregnation of metal inclusions (MI) into porous anodized aluminum oxide (AAO). The dependence of the NSS performance with composition depth profile and MI is studied by numeric simulations based in a gradient index model and effective medium theory. The results are compared with experimental NSS prepared varying three control parameters and MI (Ni, Cu, Ag). The αs is improved to > 85% (keeping thermal emittance εT relatively low) for Ni MI, mainly by increasing MI content. Increasing AAO thickness or MI molecular weight (for a given experimental composition profile) also improves the performance. For Ag the αs was further improved to 90%.