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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.
The Coronal Solar Magnetism Observatory (CoSMO) is a proposed new facility led by the High Altitude Observatory and a consortium of partners to measure magnetic field and plasma properties in a large (one degree) field of view extending down to the inner parts of the solar corona. CoSMO is intended as a research facility that will advance the understanding and prediction of space weather. The instrumentation elements of CoSMO are: a white-light coronagraph (KCor), already operational at the Mauna Loa Solar Observatory (MLSO); the Chromosphere and Prominence Magnetometer (ChroMag), due for deployment to MLSO next year; and the CoSMO Large Coronagraph (LC) which has completed Preliminary Design Review.
Irregularities plague elections in developing democracies. The international community spends hundreds of millions of dollars on election observation, with little robust evidence that it consistently improves electoral integrity. We conducted a randomized control trial to measure the effect of an intervention to detect and deter electoral irregularities employing a nation-wide sample of polling stations in Uganda using scalable information and communications technology (ICT). In treatment stations, researchers delivered letters to polling officials stating that tallies would be photographed using smartphones and compared against official results. Compared to stations with no letters, the letters increased the frequency of posted tallies by polling center managers in compliance with the law; decreased the number of sequential digits found on tallies – a fraud indicator; and decreased the vote share for the incumbent president in some specifications. Our results demonstrate that a cost-effective citizen and ICT intervention can improve electoral integrity in emerging democracies.
The expansion of populations of invasive species continues to compromise the ecological and economic integrity of our natural resources. The negative effects of invasive species on native biota are widely reported. However, less is known about how the duration (i.e., age of oldest invaders) and intensity (i.e., density and percent cover) of an invasion influences native plant diversity and abundance at the microsite scale. We examined the influence of density, percent cover, and age of Amur honeysuckle (a nonnative invasive shrub), and several environmental factors on native plant taxa at 12 mixed hardwood forests in Indiana, USA. Overall, study sites with the greatest taxonomic diversity (Shannon's Diversity; H′), richness (S), percent cover, and density of native vegetation also had the lowest percent cover of Amur honeysuckle in the upper vertical stratum (1.01 to 5 m). Based on linear mixed model analyses, percent cover of Amur honeysuckle in the upper vertical stratum was consistently and negatively correlated with H′, S, total percent cover, and woody seedling density of native taxa at the microsite scale (P < 0.05). Duration of Amur honeysuckle at the microsite scale was not significant when percent cover of Amur honeysuckle in the upper vertical stratum was included in models. However, duration of Amur honeysuckle invasion was significantly correlated with dependent variables and with upper-stratum honeysuckle cover, suggesting that older Amur honeysuckle in a microsite resulted in greater light competition from above for native understory plant species. Beyond increased cover and shading, our results do not provide evidence of duration-related effects from long-term dominance of honeysuckle in our sampled mixed hardwood forest sites.
In her groundbreaking bookMasks of Conquest: Literary Study and British Rule in India (1989), Guari Viswanathan established that “the discipline of English came into its own” not in England but in India, as an instrument of cultural colonization: “As early as the 1820s, when the classical curriculum reigned supreme in England despite the strenuous efforts of some concerned critics to loosen its hold, English as the study of culture and not simply the study of language had already found a secure place in the British Indian curriculum” (2, 3). Pausing to summarize the English literary curriculum fostered by “government schools in midcentury India,” she lists the following poetical works, gleaned from a report reprinted for the House of Lords in 1853: “Richardson's Poetical Selections (Goldsmith, Gray, Addison, Pope, and Shakespeare), Otway's Venice Preserved, Shakespeare's Hamlet, Othello, and Macbeth, Pope's Iliad by Homer, [and] Milton's Paradise Lost (the first four books)” (54). Although Viswanathan does not identify Richardson or his Poetical Selections, she is right to head the list with that textbook, which is mentioned in many other government reports of the period, and which was instrumental in establishing a classroom canon of British poetry in India before any such curriculum had been determined in Great Britain.
The development of effective new tools for structural characterization of disordered materials and systems is becoming increasingly important as such tools provide the key to understanding, and ultimately controlling, their properties. The relatively novel technique of correlograph analysis (i.e., the approach of calculating angular autocorrelations within diffraction patterns) promises unique advantages for probing the local symmetries of disordered structures. Because correlograph analysis examines a component of the high-order four-body correlation function, it is more sensitive to medium-range ordering than conventional diffraction methods. As a follow-up of our previous publication, where we studied thin samples of sputtered amorphous silicon, we describe here the practical experimental method and common systematic errors of electron correlograph analysis. Using both experimental data and numerical simulations, we demonstrate that reliable structural information about the sample can only be extracted from the mean correlograph averaged over a sufficient number of individual results.
Developer-funded archaeology on the Isle of Sheppey resulted in the discovery of not one but two Neolithic causewayed enclosures on the same hilltop in very close (c. 300 m) proximity. In the later Bronze Age enclosures and cremation cemeteries were constructed immediately to the east, followed by Iron Age enclosures and, ultimately, field systems dating to the later Iron Age onwards.
A radiocarbon programme enabled the chronological sequence and hiatus between all of these events to be discerned, but the majority of this paper explores the physical, chronological, and social relationship between the two Neolithic causewayed enclosures. These were of different forms and, although on the same hilltop, they each seem to have had distinctly different viewsheds over the Thames and the Swale respectively. There are subtle, but potentially significant, differences in the material culture and deposition which allow exploration of the possible functions and role(s) of the two largely contemporaneous sites. Questions may be addressed such as whether they performed the same functions for two communities or had separate and distinct roles for a single community. Beyond the Neolithic, the paper also explores the nature of the later use of the hilltop. The Bronze Age enclosures, though agricultural in function, clearly seem to respect their Neolithic predecessors invoking a remembrance of space, which is lost by the Iron Age. The shift away from the special function of this landscape in the Neolithic to a subsequent agricultural use is explored, as is the hiatus in use and subsequent re-use of the area.
AAT/WFI optical images of a candidate extragalactic HI cloud, HIPASS J1712–64, are presented. The g and r band CCD mosaic camera frames were processed using a new data pipeline recently installed at the AAO. The resultant stacked images reach significantly deeper levels than those of previous published optical imaging of this candidate, providing a detection limit Mg ˜ −7 at a distance of 3 Mpc, the inferred distance to HIPASS J1712–64. However, detailed analysis of the images fails to uncover any stellar population associated with the HI emission. If this system is a member of the Local Group then it is pathologically different to other members. Hence, our observations reinforce earlier suggestions that this HI cloud is most likely Galactic in origin and not a Local Volume dwarf galaxy.
We present the proceedings from a two-day workshop held at Swinburne University on 2005 May 24–25. The workshop participants highlighted current Australian research on both theoretical and observational aspects of galaxy groups. These proceedings include short one-page summaries of a number of the talks presented at the workshop. The talks presented ranged from reconciling N-body simulations with observations, to the Hı content of galaxies in groups and the existence of ‘dark galaxies’. The formation and existence of ultra-compact dwarfs in groups, and a new supergroup in Eridanus were also discussed.
Hardwood forests in eastern North America are being colonized by multiple nonnative plant and animal species. Colonization rates can be affected by stand structure and distance from edge. We sampled earthworm densities and understory plant species cover in transects located in paired old- and second-growth forests in Indiana. Two 100-m transects were established within each forest stand during late April to early May in each year. One transect was placed parallel to and within 5 m of a south- or west-facing edge. The second transect was placed parallel to the first. but at no less than 100 m from any edge. Nonnative earthworms and plants were found in forest edge and interior regardless of structural stage (second-growth vs. old-growth). The number of native plant species decreased linearly as the densities of adult Lumbricus and Aporrectodea earthworms and the percent cover of multiflora rose (an invasive plant species) increased. Densities of L. terrestris and Aporrectodea earthworms and percent cover of multiflora rose cumulatively explained 39% of the variation in the number of native plant species found in transects across the state. However, multivariate analyses suggested that the species composition of Indiana understory plant communities was affected more by geography than by earthworm densities. Our results suggest that nonnative earthworms and plants are ubiquitous in Indiana hardwood forests and that they may reduce the number of native plant species.
In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children – age less than or equal to 21 years – with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.
Three important oxidation regimes have been identified in the temporal evolution of the wet thermal oxidation of AlxGa1-xAs (1 ≥ x ≥ 0.90) on GaAs: 1) oxidation of Al and Ga in the AlxGa1-xAs alloy to form an amorphous oxide layer, 2) oxidative formation and elimination of elemental As (both crystalline and amorphous) and of amorphous As2O3, and 3) crystallization of the oxide film. Residual As can result in up to a 100-fold increase in leakage current and a 30% increase in the dielectric constant and produce strong Fermi-level pinning and high leakage currents at the oxidized AlxGa1-xAs/GaAs interface. The presence of thermodynamically-favored interfacial As may impose a fundamental limitation on the application of AlGaAs wet oxidation for achieving MIS devices in the GaAs material system.
The adsorption and decomposition of diethylgermane, triethylgermane, and digermane on the Ge(100) surface are investigated with the intent of elucidating the surface processes leading to the deposition of epitaxial Ge films. Room temperature adsorption of diethylgermane or triethylgermane leads to the formation of surface germanium hydrides and ethyl groups. The ethyl groups decompose at higher temperatures and form ethylene via a β-hydride elimination reaction. Isotopic labeling experiments are used to confirm this reaction step. This is in contrast to the Si(100) surface where both α- and β-hydride elimination is observed for the decomposition of surface ethyl groups. The adsorption and reaction of digermane with the Ge surface is also determined to help provide a comparison with the ethylgermanes. Low energy electron diffraction is used to evaluate the quality of the deposited germanium films.
Temperate and boreal forests in Canada and the northeastern United States have been invaded by several exotic species, including European earthworms (family Lumbricidae) and garlic mustard. Earthworms and garlic mustard co-occur and are both known to adversely impact some native plant species. However, relatively little is known about potential interactions between these two invaders. In a series of growth chamber experiments, we determined the palatability of garlic mustard and six native herbaceous forest species (shooting star, columbine, wild geranium, sweet cicely, butterfly milkweed, and yellow jewelweed) to the common nightcrawler. We also assessed the ability of the common nightcrawler to bury and digest garlic mustard and wild geranium. When offered seeds from garlic mustard and a native plant species, the earthworms ingested more garlic mustard seeds than seeds from four of the six native species. In a mesocosm experiment, the common nightcrawlers apparently digested 72 and 27% of garlic mustard and wild geranium seeds, respectively, that were placed on the soil surface. No seeds were observed on the soil surface at the end of the experiment but the majority of recovered seeds for both species were found within the top 10 cm (3.94 in). More seeds were recovered in 0- to 10-cm and 31- to 40-cm sections for wild geranium than for garlic mustard. No difference in seed recovery was detected at the other depths. Garlic mustard seed is readily consumed by common nightcrawlers and appears to be preferred over some native plant species suggesting that common nightcrawlers may reduce the size of the garlic mustard seed bank.
Systemic right ventricular systolic dysfunction is common late after atrial switch surgery for transposition of the great arteries. Total isovolumic time is the time that the ventricle is neither ejecting nor filling and is calculated without relying on geometric assumptions. We assessed resting total isovolumic time in this population and its relationship to exercise capacity.
A total of 40 adult patients with transposition of the great arteries after atrial switch – and 10 healthy controls – underwent transthoracic echocardiography and cardiopulmonary exercise testing from January, 2006 to January, 2009. Resting total isovolumic time was measured in seconds per minute: 60 minus total ejection time plus total filling time.
The mean age was 31.6 plus or minus 7.6 years, and 38.0% were men. There were 16 patients (40%) who had more than or equal to moderate systolic dysfunction of the right ventricle. Intra- and inter-observer agreement was good for total isovolumic time, which was significantly prolonged in patients compared with controls (12.0 plus or minus 3.9 seconds per minute versus 6.0 plus or minus 1.8 seconds per minute, p-value less than 0.001) and correlated significantly with peak oxygen consumption (r equals minus 0.63, p-value less than 0.001). The correlation strengthened (r equals minus 0.73, p-value less than 0.001) after excluding seven patients with exercise-induced cyanosis. No relationship was found between exercise capacity and right ventricular ejection fraction or long-axis amplitude.
Resting isovolumic time is prolonged after atrial switch for patients with transposition of the great arteries. It is highly reproducible and relates well to exercise capacity.