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To increase knowledge of National Library of Medicine resources by using a train-the-trainer approach.
Workshops were held in spring 2016 to increase knowledge of 4 National Library of Medicine tools. Data were collected before the workshop and immediately, 3 months, and 1 year after the workshop. Knowledge questions were scored as 1 point per question; an aggregated knowledge score could range from 0 to 16 points. A paired t test assessed the change in knowledge from before to after the workshop.
Four workshops were hosted, with a total of 74 attendees. The response rate for the surveys ranged from 50% to 100%. Knowledge scores changed significantly from 7.2 to 11.9 (t = 15, P < .001). One year after the workshop, more of the participants reported having informally trained others (56.8%) than reported providing 1 or more formal training session (8.1%)(P < .001).
Objective measures of knowledge and information dissemination showed that the National Library of Medicine workshop was successful and resulted in both short- and long-term gains. This workshop could be repeated with other populations to further disseminate information regarding the National Library of Medicine tools, which could help improve disaster response.
Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment.
This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions.
A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions.
Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.
A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.
A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.
This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
This paper reports scanning microwave microscopy of CMOS interconnect aluminum lines both bare and buried under oxide. In both cases, a spatial resolution of 190 ± 70 nm was achieved, which was comparable or better than what had been reported in the literature. With the lines immersed in water to simulate high-k dielectric, the signal-to-noise ratio degraded significantly, but the image remained as sharp as before, especially after averaging across a few adjacent scans. These results imply that scanning microwave microscopy can be a promising technique for non-destructive nano-characterization of both CMOS interconnects buried under oxide and live biological samples immersed in water.
Political science is in large part the study of power, but power itself is difficult to measure. We argue that we can use newspaper coverage—in particular, the relative amount of space devoted to particular subjects in newspapers—to measure the relative power of an important set of political actors and offices. We use a new dataset containing nearly 50 million historical newspaper pages from 2,700 local US newspapers over the years 1877–1977. We define and discuss a measure of power we develop based on observed word frequencies, and we validate it through a series of analyses. Overall, we find that the relative coverage of political actors and of political offices is a strong indicator of political power for the cases we study. To illustrate its usefulness, we then apply the measure to understand when (and where) state party committees lost their power. Taken together, the paper sheds light on the nature of political news coverage and offers both a new dataset and a new measure for studying political power in a wide set of contexts.
X-ray micro-computed tomography (μCT) is a technique which can obtain three-dimensional images of a sample, including its internal structure, without the need for destructive sectioning. Here, we review the capability of the technique and examine its potential to provide novel insights into the lifestyles of parasites embedded within host tissue. The current capabilities and limitations of the technology in producing contrast in soft tissues are discussed, as well as the potential solutions for parasitologists looking to apply this technique. We present example images of the mouse whipworm Trichuris muris and discuss the application of μCT to provide unique insights into parasite behaviour and pathology, which are inaccessible to other imaging modalities.
The breeding areas of the Critically Endangered Slender-billed Curlew Numenius tenuirostris are all but unknown, with the only well-substantiated breeding records being from the Omsk province, western Siberia. The identification of any remaining breeding population is of the highest priority for the conservation of any remnant population. If it is extinct, the reliable identification of former breeding sites may help determine the causes of the species’ decline, in order to learn wider conservation lessons. We used stable isotope values in feather samples from juvenile Slender-billed Curlews to identify potential breeding areas. Modelled precipitation δ2H data were compared to feather samples of surrogate species from within the potential breeding range, to produce a calibration equation. Application of this calibration to samples from 35 Slender-billed Curlew museum skins suggested they could have originated from the steppes of northern Kazakhstan and part of southern Russia between 48°N and 56°N. The core of this area was around 50°N, some way to the south of the confirmed nesting sites in the forest steppes. Surveys for the species might be better targeted at the Kazakh steppes, rather than around the historically recognised nest sites of southern Russia which might have been atypical for the species. We consider whether agricultural expansion in this area may have contributed to declines of the Slender-billed Curlew population.
Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently described life-threatening autoimmune disorder associated with a characteristic multi-stage neuropsychiatric syndrome. Although it is known that the majority of patients experience neuropsychological disturbance post-treatment, some aspects of the cognitive profile remain unclear. Methods: This study sought to investigate patterns of cognitive functioning in a sample of anti-NMDAR encephalitis patients. Seven (6F:1M; mean age, 26.4 years; range, 16–37 years) treated patients completed a comprehensive set of neurocognitive and social functioning measures. Performance was analyzed using normative data (where available), and comparison with matched controls (10F:4M; mean age, 25.8 years; range, 16–38 years). Results: Individual cognitive profiles ranged from within normal limits to extensive dysfunction. Relative to controls, the patient group’s performance was affected in the domains of verbal/ visual memory, working memory, attention, processing speed, executive functioning, and social cognition. The patient group also reported significantly higher levels of anxiety compared to controls. Conclusions: These results add to the accumulating evidence that neurocognitive deficits, consistent with the distribution and functions of the NMDAR system can persist during recovery from anti-NMDAR encephalitis. This is the first study to provide evidence of performance decrements on measures of social cognition, including some involving theory of mind. (JINS, 2016, 22, 828–838)
Many jurisdictions in the USA and globally are considering raising the prices of sugar-sweetened beverages (SSB) through taxes as a strategy to reduce their consumption. The objective of the present study was to identify whether the rationale provided for an SSB price increase affects young adults’ behavioural intentions and attitudes towards SSB.
Participants were randomly assigned to receive one of eight SSB price increase rationales. Intentions to purchase SSB and attitudes about the product and policy were measured.
A forty-six-item cross-sectional Internet survey.
Undergraduate students (n 494) at a large US Midwestern university.
Rationale type was significantly associated with differences in participants’ purchasing intentions for the full sample (F7,485=2·53, P=0·014). Presenting the rationale for an SSB price increase as a user fee, an effort to reduce obesity, a strategy to offset health-care costs or to protect children led to lower SSB purchasing intentions compared with a message with no rationale. Rationale type was also significantly associated with differences in perceptions of soda companies (F7,485=2·10, P=0·043); among low consumers of SSB, messages describing the price increase as a user fee or tax led to more negative perceptions of soda companies.
The rationale attached to an SSB price increase could influence consumers. However, these message effects may depend on individuals’ level of SSB consumption.
Many studies use radiocarbon dates on estuarine shell material to build age-depth models of sediment accumulation in estuaries in California, USA. Marine 14C ages are typically older than dates from contemporaneous terrestrial carbon and local offsets (ΔR) from the global average marine offset need to be calculated to ensure the accuracy of calibrated dates. We used accelerator mass spectrometry (AMS) 14C dating on 40 pre-1950 salt marsh snail and clam shells previously collected from four California estuaries. The average ΔR and standard deviation of 217 ± 129 14C yr is consistent with previous calculations using mixed estuarine and marine samples, although the standard deviation and resulting age uncertainty was higher for our estuarine calculations than previous studies. There was a slight but significant difference (p = 0.024) in ΔR between epifaunal snails (ΔR = 171 ± 154 14C yr) and infaunal clams (ΔR = 263 ± 77 14C yr), as well as between samples from individual estuaries. However, a closer examination of the data shows that even for the same species, at the same estuary, ΔR can vary as much as ∼500 14C yr. In some cases, the bulk of this variation occurs between samples collected by different collectors at different times, potentially indicating time dependence in carbon sources and ΔR variation. These variations could also be attributed to differences in collection location within a single estuary and resulting spatial differences in carbon sources. Intertidal specimens located in the high marsh may have lower ΔR than fully marine counterparts because of increased terrestrial 14C input. The large variations in ΔR here highlight the need for conservative chronological interpretations, as well as the assumption of wide uncertainties, when dating samples from estuarine sources.
Metal hydrides present a feasible means of energy storage and hydrogen sensing but have several performance criteria that must be addressed, including the hysteresis effect during hydrogen loading and unloading. We present the results of a theoretical and experimental study which demonstrates the possibility to control or eliminate hysteresis during metal-hydride transformation in epitaxial Pd thin films. Theoretical analysis predicts stabilization of two-phase metal-hydride state in film due to its elastic interaction with the substrate. It is shown, by atomic force and scanning electron microscopy, that transformation in 100nm thick epitaxial Pd films on Al2O3 substrate proceeds by the formation of transversely modulated two-phase nanostructure. Morphology and crystallographic orientation of the metal-hydride interface corresponds to the theoretically predicted characteristics of coherent phases.
To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.
Retrospective and prospective observational study.
Two outpatient hemodialysis units.
All patients receiving chronic hemodialysis.
The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.
Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.
Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.