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Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.
Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)
Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).
OBJECTIVES/SPECIFIC AIMS: Background: Children with autism spectrum disorder (ASD) show a broad range of unusual responses to sensory stimuli and experiences. It has been hypothesized that early differences in sensory responsiveness arise from atypical neural function and produce “cascading effects” on development across a number of domains, impacting social and communication skill, as well as broader development in children affected by ASD. A primary challenge to confirming these hypotheses is that ASD cannot be definitely diagnosed in the earliest stages of development (i.e., infancy). A potential solution is to prospectively follow infants at heightened risk for ASD based on their status as infant siblings of children who are diagnosed. We examined the developmental sequelae and possible neurophysiological substrates of three different patterns of sensory responsiveness—hyporesponsiveness (reduced or absent responding to sensory stimuli) and hyperresponsiveness (exaggerated responding to sensory stimuli), as well as sensory seeking (craving of or fascination with certain sensory experiences). Infants at high risk (HR) for ASD were compared with a control group of infants at relatively lower risk for ASD (LR; siblings of children with typical developmental histories). Objectives: Research questions included: (a) Do HR infants differ from LR infants in early sensory responsiveness?, (b) Does sensory responsiveness predict future ASD and related symptomatology? and (c) Is sensory responsiveness predicted by resting brain states? METHODS/STUDY POPULATION: Methods: To answer these questions, we carried out a longitudinal correlational investigation in which 20 HR infants and 20 LR controls matched on sex and chronological age were followed over 18 months. At entry to the study, when infants were 18 months old, sensory responsiveness was measured using the Sensory Processing Assessment and the Sensory Experiences Questionnaire, and a number of putative neural signatures of early sensory differences were measured via resting state EEG. When infants were 24 and 36 months of age, ASD and related symptomatology was evaluated in a comprehensive diagnostic evaluation. RESULTS/ANTICIPATED RESULTS: Results: HR infants trended towards increased hyporesponsiveness and hyperresponsiveness and showed significantly elevated levels of sensory seeking relative to LR controls at 18 months of age. Both groups, furthermore, displayed a high degree of heterogeneity in sensory responsiveness. Atypical sensory responsiveness (increased hyperresponsiveness and/or hyporesponsiveness, as well as sensory seeking behavior) predicted several aspects of ASD and related symptomatology, including social, communication, and play skill, and was associated with differences in resting brain state, including metrics of oscillatory power, complexity, and connectivity, as well as hemispheric asymmetry. Moderation analyses revealed that several relations varied according to risk group, such that associations were stronger in magnitude in the HR Versus LR group. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusion: Findings provide empirical support for the notion that early sensory responsiveness may produce cascading effects on development in infants at heightened risk for ASD. Differences in resting brain states may underlie atypical behavioral patterns of sensory responsiveness. From a clinical standpoint, results suggest that early sensory differences may be useful for predicting developmental trajectories, and be potentially important targets for early preventive intervention, in infants at risk for autism.
Consider the dynamics of a healing film driven by surface tension, that is, the inward spreading process of a liquid film to fill a hole. The film is modelled using the lubrication (or thin-film) approximation, which results in a fourth-order nonlinear partial differential equation. We obtain a self-similar solution describing the early-time relaxation of an initial step-function condition and a family of self-similar solutions governing the finite-time healing. The similarity exponent of this family of solutions is not determined purely from scaling arguments; instead, the scaling exponent is a function of the finite thickness of the prewetting film, which we determine numerically. Thus, the solutions that govern the finite-time healing are self-similar solutions of the second kind. Laboratory experiments and time-dependent computations of the partial differential equation are also performed. We compare the self-similar profiles and exponents, obtained by matching the estimated prewetting film thickness, with both measurements in experiments and time-dependent computations near the healing time, and we observe good agreement in each case.
Increased temporal and frontal slow-wave delta (1–4 Hz) and theta (4–7
Hz) activities are the most consistent resting-state neural abnormalities
reported in schizophrenia. The frontal lobe is associated with negative
symptoms and cognitive abilities such as attention, with negative
symptoms and impaired attention associated with poor functional
To establish whether frontal dysfunction, as indexed by slowing, would be
associated with functional impairments.
Eyes-closed magnetoencephalography data were collected in 41 participants
with schizophrenia and 37 healthy controls, and frequency-domain source
imaging localised delta and theta activity.
Elevated delta and theta activity in right frontal and right
temporoparietal regions was observed in the schizophrenia
v. control group. In schizophrenia, right-frontal
delta activity was uniquely associated with negative but not positive
symptoms. In the full sample, increased right-frontal delta activity
predicted poorer attention and functional capacity.
Our findings suggest that treatment-associated decreases in slow-wave
activity could be accompanied by improved functional outcome and thus
Small bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation. The application of POCUS for SBO is easily learned and applied in the ED. POCUS for SBO may obviate the need for plain radiography and expedite patient care.
We report theoretical and numerical studies of the flow behaviour when a fluid is injected into a confined porous medium saturated with another fluid of different density and viscosity. For a two-dimensional configuration with point source injection, a nonlinear convection–diffusion equation is derived to describe the time evolution of the fluid–fluid interface. In the early time period, the fluid motion is mainly driven by the buoyancy force and the governing equation is reduced to a nonlinear diffusion equation with a well-known self-similar solution. In the late time period, the fluid flow is mainly driven by the injection, and the governing equation is approximated by a nonlinear hyperbolic equation that determines the global spreading rate; a shock solution is obtained when the injected fluid is more viscous than the displaced fluid, whereas a rarefaction wave solution is found when the injected fluid is less viscous. In the late time period, we also obtain analytical solutions including the diffusive term associated with the buoyancy effects (for an injected fluid with a viscosity higher than or equal to that of the displaced fluid), which provide the structure of the moving front. Numerical simulations of the convection–diffusion equation are performed; the various analytical solutions are verified as appropriate asymptotic limits, and the transition processes between the individual limits are demonstrated. The flow behaviour is summarized in a diagram with five distinct dynamical regimes: a nonlinear diffusion regime, a transition regime, a travelling wave regime, an equal-viscosity regime, and a rarefaction regime.
Course viability requires dealing with issues of adequate class size, diversity of academic background and goals, English fluency, heavy content and more. To this end, for thirteen years a consortium of five Virginia universities, including an HBCU, has shared a first-year graduate course on materials characterization. The journey began with just classroom co-presence. The present state includes common-server availability of materials (presentation slides, background articles, e-books), of content-delivery lectures (“full flip”) and of recorded class sessions (all). The most significant current issue is making effective use of the extensive in-class discussion time now made available by flipping.
We report a study on the wetting and spreading of hydrazine-CZTS solution on a series of solid surfaces. The work of adhesion between a hydrazine solution and soda-lime glass, Si, graphite, ITO, SnO2, ZnO, CdS, In2S3, Cu, Au, Ag, Al, Ni, Mo, and carbon single-walled nanotubes was calculated using observed contact angles and the areas of the interface. The surface roughness of drop-casted CZTS precursor films was lower on surfaces with better hydrazine wettability. This suggests that the surface roughness of solution-processed films can be controlled by altering the wetting behavior of the solution on the substrate.
A novel approach to fabricate CuIn(S,Se)2 (CIS) thin films through ultrasonically spraying a hydrazine-based precursor solution onto a heated substrate is reported. The effects of the composition of the precursor solutions and the deposition temperature on the CIS film properties were investigated by comparing thin films fabricated using aqueous metal salt solution, anhydrous hydrazine solution, and hydrazine hydrate solution at various deposition temperatures. Crystallite size and texture coefficient in the preferred (112) orientation in the sprayed films increased when the aqueous solution was replaced by hydrazine-based solutions. Additionally, the hydrazine-based precursor solutions resulted in films with better surface smoothness and compositional uniformity than those fabricated using water-based solutions and the hydrazine hydrate solution resulting in the smoothest, most uniform films. The sprayed films were used to fabricate preliminary solar cells that demonstrated a modest photovoltaic response. With optimization, the synthesis of high-quality CIS films by spray pyrolysis from a hydrazine hydrate solution could demonstrate the potential for a low-cost, high-throughput manufacturing process.
We study theoretically the dynamics of porous ellipsoids rotating in simple shear flows. We use the Brinkman–Debye–Bueche (BDB) model to simulate flow within and through particles and solve the coupled Stokes–BDB equations to calculate the overall flow field and the rotation rate of porous ellipsoids. Our results show that the permeability has little effect on the rotational behaviour of particles, and that Jeffery’s prediction of the angular velocity of impermeable ellipsoids in simple shear flows (Proc. R. Soc. Lond. A, vol. 102, 1922, pp. 161–179) remains an excellent approximation, if not an exact one, for porous ellipsoids. Employing an appropriate scaling, we also present approximate expressions for the torque exerted on ellipses and spheroids rotating in a quiescent fluid. Our findings can serve as the basis for developing a suspension theory for non-spherical porous particles, or for understanding the orientational diffusion of permeable ellipses and spheroids.
The complex relationship between masculinity and religion, as experienced in both the secular and ecclesiastical worlds, forms the focus for this volume, whose range encompasses the rabbis of the Babylonian and Palestinian Talmud, and moves via Carolingian and Norman France, Siena, Antioch, and high and late medieval England to the eve of the Reformation. Chapters investigate the creation and reconstitution of different expressions of masculine identity, from the clerical enthusiasts for marriage to the lay practitioners of chastity, from crusading bishops to holy kings. They also consider the extent to which lay and clerical understandings of masculinity existed in an unstable dialectical relationship, at times sharing similar features, at others pointedly different, co-opting and rejecting features of the other; the articles show this interplay to be more far more complicated than a simple linear narrative of either increasing divergence, or of clerical colonization of lay masculinity. They also challenge conventional historiographies of the adoption of clerical celibacy, of the decline of monasticism and the gendered nature of piety. Patricia Cullum is Head of History at the University of Huddersfield; Katherine J. Lewis is Senior Lecturer in History at the University of Huddersfield. Contributors: James G. Clark, P.H. Cullum, Kirsten A. Fenton, Joanna Huntington, Katherine J. Lewis, Matthew Mesley, Catherine Sanok, Michael L. Satlow, Rachel Stone, Jennifer D. Thibodeaux, Marita von Weissenberg