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In patients with β-lactam allergies, administration of non–β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.
OBJECTIVES/SPECIFIC AIMS: Increased retinal protein O-GlcNAcylation occurs in response to hyperglycemia and contributes to diabetic retinopathy. Renin-angiotensin system (RAS) blockers reduce the incidence of diabetic retinopathy. Beneficial effects of RAS blockers are often attributed to production of angiotensin-(1-7) (Ang1-7). The objective here is to determine the impact of Ang1-7 on retinal protein O-GlcNAcylation. METHODS/STUDY POPULATION: C57/BL6 mice were fed a high-fat diet for 8 weeks and then treated for 3 weeks with either a vehicle control, the RAS blocker captopril, or captopril and the Ang1-7 receptor antagonist A779. R28 cells were used to assess levels of O-GlcNAcylated proteins in response to Ang1-7, and the role of cAMP was investigated with addition of forskolin, 6-Bnz-cAMP-AM, and 8-pCPT-2-O-Me-cAMP-AM to cell culture medium. RESULTS/ANTICIPATED RESULTS: Captopril attenuated retinal protein O-GlcNAcylation in mice fed a high-fat diet. This effect was reversed by A779. Ang1-7 attenuated protein O-GlcNAcylation and increased cAMP levels. Forskolin and the EPAC selective cAMP analog 8-pCPT-2-O-Me-cAMP-AM, but not the PKA selective cAMP analog 6-Bnz-cAMP-AM, attenuated O-GlcNAcylation. Inhibiting EPAC blocked the effect of forskolin, whereas inhibiting PKA did not. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates a novel role for Ang1-7 in the retina and identifies a potential EPAC-dependent mechanism that regulates protein O-GlcNAcylation. Thus, future therapeutics targeted at an Ang1-7/EPAC axis in retina may be used to address DR.
There is little debate that the health workforce is a key component of the health care system. Since the training of doctors and nurses takes several years, and the building of new schools even longer, projections are needed to allow for the development of health workforce policies. Our work develops a projection model for the demand of doctors and nurses by Organisation for Economic Co-operation and Development (OECD) countries in the year 2030. The model is based on a country’s demand for health services, which includes the following factors: per capita income, out-of-pocket health expenditures and the ageing of its population. The supply of doctors and nurses is projected using country-specific autoregressive integrated moving average models. Our work shows how dramatic imbalances in the number of doctors and nurses will be in OECD countries should current trends continue. For each country in the OECD with sufficient data, we report its demand, supply and shortage or surplus of doctors and nurses for 2030. We project a shortage of nearly 400,000 doctors across 32 OECD countries and shortage of nearly 2.5 million nurses across 23 OECD countries in 2030. We discuss the results and suggest policies that address the shortages.
In 2009, the Australian federal government decided to fund the construction of the National Broadband Network, or NBN. At a total projected cost of A$44 billion, it was the largest engineering and public infrastructure project in Australia's history, with the intention of laying 200 000 km of fibre optic cable to the doors of 93 per cent of Australian premises. For the remaining 7 per cent of people, who lived in rural and remote areas, wireless and satellite would replace fibre. However, in 2013, this fibre-tothe- premises [FttP] model was subsequently replaced by a much slower, hybrid model that used a mix of optic-fibre, co-axial cable and copper infrastructures alongside wireless and satellite in regional and remote areas (see Arnold et al. 2014 for installation history).
One of the stated key goals of the various plans for high speed broadband networks in Australia is to overcome the challenges of distance and the concomitant difficulties for transport implicit in distance. For example, in the initial scheme, the then Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, signalled broadband-enabled benefits relating to social inclusion, economic productivity and geographic connectivity. He stated that ‘every person and business in Australia, nomatter [sic] where they are located, will have access to affordable, fast broadband at their fingertips’, and that high speed broadband [HSB] ‘will help drive Australia's productivity, improve education and health service delivery and connect our big cities and regional centres’ (2009). Australian geography has had a major impact on the history of telecommunications in the nation (see, for example, Given 2010). The National Broadband Network [NBN] has been promoted as a way of overcoming the ‘tyranny of distance’ experienced by people in remote and rural regions (Swan & Conroy 2011).
In this chapter, we seek to examine the dynamics of this process, exploring what high speed broadband infrastructure means for overcoming (or ameliorating the effects of) the ‘tyranny of distance’ for those living in regional and remote areas, and what HSB means for the social and material significance of these places.
We explore the relationships among the geographic ranges of genera, the ranges and positions of their constituent species, and the number of species they contain, considering variation among coeval genera and changes within genera over time. Measuring range size as the maximal distance, or extent, between occurrences within a taxon, we find that the range of the most widespread species is a good predictor of the range of the genus, and that the number of species is a better predictor still. This analysis is complicated by a forced correlation: the range of a genus must be at least as large as that of each of its constituent species. We therefore focus on a second measure of range, the mean squared distance, or dispersion, of occurrences from the geographic centroid, which, by analogy to the analysis of variance, allows the total dispersion of a genus to be compared to the mean within-species dispersion and the dispersion among species centroids. We find that among-species dispersion is the principal determinant of genus dispersion. Within-species dispersion also plays a major role. The role of species richness is relatively small. Our results are not artifacts of temporal variation in the geographic breadth of sampled data. The relationship between changes in genus dispersion and changes in within- and among-species dispersion shows a symmetry, being similar in cases when the genus range is expanding and when it is contracting. We also show that genera with greater dispersion have greater extinction resistance, but that within- and among-species dispersion are not demonstrable predictors of survival once the dispersion of the genus is accounted for. Thus it is the range of the genus, rather than how it is attained, that is most relevant to its fate. Species richness is also a clear predictor of survival, beyond its effects on geographic range.
This paper applies cointegration techniques, developed in econometrics to model long-run relationships, to cause-of-death data. We analyze the five main causes of death across five major countries, including USA, Japan, France, England & Wales and Australia. Our analysis provides a better understanding of the long-run equilibrium relationships between the five main causes of death, providing new insights into similarities and differences in trends. The results identify for the first time similarities between countries and genders that are consistent with past studies on the aging processes by biologists and demographers. The insights from biological theory on aging are found to be reflected in the cointegrating relations in all of the countries included in the study.
To determine whether use of contact precautions on hospital ward patients is associated with patient adverse events
Individually matched prospective cohort study
The University of Maryland Medical Center, a tertiary care hospital in Baltimore, Maryland
A total of 296 medical or surgical inpatients admitted to non–intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient’s stay using the standardized Institute for Healthcare Improvement’s Global Trigger Tool.
The cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51–0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46–1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59–1.24; P=.41).
Hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.
Infect. Control Hosp. Epidemiol. 2015;36(11):1268–1274
Kalahari Group sediments accumulated in the Kalahari basin, which started forming during the breakup of Gondwana in the early Cretaceous. These sediments cover an extensive part of southern Africa and form a low-relief landscape. Current models assume that the Kalahari Group accumulated throughout the entire Cenozoic. However, chronology has been restricted to early–middle Cenozoic biostratigraphic correlations and to OSL dating of only the past ~ 300 ka. We present a new chronological framework that reveals a dynamic nature of sedimentation in the southern Kalahari. Cosmogenic burial ages obtained from a 55 m section of Kalahari Group sediments from the Mamatwan Mine, southern Kalahari, indicate that the majority of deposition at this location occurred rapidly at 1–1.2 Ma. This Pleistocene sequence overlies the Archaean basement, forming a significant hiatus that permits the possibility of many Phanerozoic cycles of deposition and erosion no longer preserved in the sedimentary record. Our data also establish the existence of a shallow early–middle Pleistocene water body that persisted for > 450 ka prior to this rapid period of deposition. Evidence from neighboring archeological excavations in southern Africa suggests an association of high-density hominin occupation with this water body.
The analysis of causal mortality provides rich insight into changes in mortality trends that are hidden in population-level data. Therefore, we develop and apply a multinomial logistic framework to model causal mortality. We use internationally classified cause-of-death categories and data obtained from the World Health Organization. Inherent dependence amongst the competing causes is accounted for in the framework, which also allows us to investigate the effects of improvements in, or the elimination of, cause-specific mortality. This has applications to scenario-based forecasting often used to assess the impact of changes in mortality. The multinomial model is shown to be more conservative than commonly used approaches based on the force of mortality. We use the model to demonstrate the impact of cause-elimination on aggregate mortality using residual life expectancy and apply the model to a French case study.
The government's cocoa spraying gangs in Ghana treat about two million hectares of the crop against black pod disease and mirids, the key insect pests of cocoa in West Africa, each August through to December, based on recommendations issued in the 1950s. A few cocoa farmers use additional pesticides. We studied the temporal distribution of two important mirid species, Distantiella theobroma (Dist.) and Sahlbergella singularis Hagl., in 1991, 1999, 2003 and 2012 to determine the appropriate timing for the application of control measures in current farming systems. There was a significant correlation between mirid abundance and pod availability on trees, as well as the number of basal shoots and the cocoa variety grown. Mirid populations peaked between January and April and from September to October. Surveys (interviews and focus group discussions involving over 300 farmers in 33 cocoa-growing districts) on pesticide use, sources of recommendations, and perceived successes and failures of current cocoa pest treatments suggested that the 1950 recommendations on the timing of insecticide application need revising.
Much has been reported on the excellent performance of the Eu2+ activated SrI2-scintillator in spectroscopic applications, like the high light yield (97 660 ph/MeV) and good energy resolution (2.7% FWHM at 662 keV). The exploitation of these properties for other application fields is limited by the hygroscopic nature of the SrI2. Single crystal scintillating screens exhibit high spatial resolution, this combined with the high density, high effective atomic number, and the high light yield of the SrI2 could be used for high resolution X-ray imaging.
Some of the questions we tried to answer in this work are the following: owing to the excellent performance of the SrI2-scintillator in spectroscopic applications, how would it perform in X-ray imaging applications. X-ray images are described based on their (spatial) resolution and contrast, how would they look like when recorded using the SrI2-scintillator detector.
First a packaging technique was developed that protected the hygroscopic screens during the measurements. Our results show a high resolution of the images obtained with thin SrI2-scintillator screens both in 2D radiography and 3D tomography measurements. With these results, we think that the SrI2-scinitillator is not only a candidate for spectroscopic applications, but also for high resolution X-ray imaging purposes.
Semiconductor materials have shown promise as ionizing radiation detection devices; however, to be used as a neutron detector, these materials require the addition of a nucleus with a large neutron absorption cross section (such as 10B or 6Li) to capture thermal neutrons and convert them into directly detectable particles. A semiconducting material that contains the neutron absorber within its regular stoichiometry has the potential to be more efficient than a layered or heterogeneous device at transferring the kinetic energy of the charged particle into the semiconducting material. One class of materials that has shown promise is Li-containing AIBIIIXVI2 compounds such as LiGaTe2, LiGaSe2, and LiInSe2. These materials have band gaps (2-3.5 eV) appropriate for room-temperature detection of thermal neutrons and would be the first detection material that is simultaneously, exquisitely sensitive to thermal neutrons; is insensitive to gammas; and acts as a direct conversion device. A vacuum distillation process provided high-purity lithium metal for AIBIIIXVI2 synthesis. Single crystals of sufficient bulk resistivity (grown for LiGaSe2 and LiInSe2LiInSe2) showed a distinct photo response as well as a clear response to alpha particles. Additional radiation measurements indicated that a 6 mm x 7 mm x 1.33 mm crystal of LiInSe2 detected gamma rays, and despite being composed of natural abundance lithium, responded to thermal neutrons as well.