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To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
Internal gravity wave energy contributes significantly to the energy budget of the oceans, affecting mixing and the thermohaline circulation. Hence it is important to determine the internal wave energy flux
is the pressure perturbation field and
is the velocity perturbation field. However, the pressure perturbation field is not directly accessible in laboratory or field observations. Previously, a Green’s function based method was developed to calculate the instantaneous energy flux field from a measured density perturbation field
, given a constant buoyancy frequency
. Here we present methods for computing the instantaneous energy flux
for an internal wave field with vertically varying background
, as in the oceans where
typically decreases by two orders of magnitude from the pycnocline to the deep ocean. Analytic methods are presented for computing
from a density perturbation field for
varying linearly with
. To generalize this approach to arbitrary
, we present a computational method for obtaining
. The results for
for the different cases agree well with results from direct numerical simulations of the Navier–Stokes equations. Our computational method can be applied to any density perturbation data using the MATLAB graphical user interface ‘EnergyFlux’.
Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.
Over the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.
Mapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.
Insomnia treatment using an internet-based cognitive–behavioural therapy
for insomnia (CBT-I) program reduces depression symptoms, anxiety
symptoms and suicidal ideation. However, the speed, longevity and
consistency of these effects are unknown.
To test the following: whether the efficacy of online CBT-I was sustained
over 18 months; how rapidly the effects of CBT-I emerged; evidence for
distinct trajectories of change in depressive symptoms; and predictors of
A randomised controlled trial compared the 6-week Sleep Healthy Using the
Internet (SHUTi) CBT-I program to an attention control program. Adults
(N=1149) with clinical insomnia and subclinical
depression symptoms were recruited online from the Australian
Depression, anxiety and insomnia decreased significantly by week 4 of the
intervention period and remained significantly lower relative to control
for >18 months (between-group Cohen's d=0.63, 0.47,
0.55, respectively, at 18 months). Effects on suicidal ideation were only
short term. Two depression trajectories were identified using growth
mixture models: improving (95%) and stable/deteriorating (5%) symptoms.
More severe baseline depression, younger age and limited comfort with the
internet were associated with reduced odds of improvement.
Online CBT-I produced rapid and long-term symptom reduction in people
with subclinical depressive symptoms, although the initial effect on
suicidal ideation was not sustained.
The Anfang movement, centered in Vienna and Berlin from 1912 to 1914, was the twentieth century's first left-wing political youth movement whose main concern was youthful independence from adult authority. The movement took its name from its journal Der Anfang (“The Beginning”). The 3000 members were Austrians and Germans born between 1890 and 1899. Most were urban state secondary school pupils and university students from middle-class families, many of which were artistic, academic and intellectual. A third of the members were Jewish; in Vienna 90% were Jewish. In June 1914 the journal reached a high point of 1000 subscribers.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
This research employs an agricultural sector model that links seasonal crop production with disaggregated livestock production sectors, in tandem with observed quarterly data on U.S. drought conditions to assess the long term economic implications of drought for U.S beef cattle producers. Short term impacts show increases in feed costs as well as increases in cattle slaughter resulting from drought-induced culling. The price of live cattle decreases in the short run; however, feed prices remain above baseline levels, and beef cattle breeding inventories decline in the long run, leading to fewer calves moving through the supply chain.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
To clarify and record their role in the care of patients, hospital chaplains are increasingly called on to document their work in the medical record. Chaplains' documentation, however, varies widely, even within single institutions. Little has been known, however, about the forms that documentation takes in different settings or about how clinicians interpret chaplain documentation. This study aims to examine how chaplains record their encounters in an intensive care unit (ICU).
We performed a retrospective chart review of the chaplain notes filed on patients in the adult ICUs at a major academic medical center over a six-month period. We used an iterative process of qualitative textual analysis to code and analyze chaplains' free-text entries for emergent themes.
Four primary themes emerged from chaplain documentation. First, chaplains frequently used “code language,” such as “compassionate presence,” to recapitulate interventions already documented elsewhere in a checklist of ministry interventions. Second, chaplains typically described what they observed rather than interpreting its clinical significance. Third, chaplains indicated passive follow-up plans, waiting for patients or family members to request further interaction. Fourth, chaplains sometimes provided insights into particular relationship dynamics.
Significance of results:
As members of the patient care team, chaplains access the medical record to communicate clinically relevant information. The present study suggests that recent emphasis on evidence-based practice may be leading chaplains, at least in the medical center we studied, to use a reduced, mechanical language insufficient for illuminating patients' individual stories. We hope that our study will promote further consideration of how chaplain documentation can enhance patient care and convey the unique value that chaplains add to the clinical team.
In our target article, we made four claims: (1) Social psychology is now politically homogeneous; (2) this homogeneity sometimes harms the science; (3) increasing political diversity would reduce this damage; and (4) some portion of the homogeneity is due to a hostile climate and outright discrimination against non-liberals. In this response, we review these claims in light of the arguments made by a diverse group of commentators. We were surprised to find near-universal agreement with our first two claims, and we note that few challenged our fourth claim. Most of the disagreements came in response to our claim that increasing political diversity would be beneficial. We agree with our critics that increasing political diversity may be harder than we had thought, but we explain why we still believe that it is possible and desirable to do so. We conclude with a revised list of 12 recommendations for improving political diversity in social psychology, as well as in other areas of the academy.
This study investigates the long-term adjustments to drought by crop and livestock sectors using a dynamic partial equilibrium quarterly model of the U.S. agricultural economy. Results show that short-term drought effects including increases in crop and forage prices are in tandem with decreased live cattle prices resulting from drought-induced beef cattle herd liquidation. Crop price increases in the long run cause livestock inventory reductions, leading to fewer animals moving through the U.S. meat supply chain and increased livestock prices. Longer-term market adjustments cause a significant decrease in consumer surplus, and prolonged drought amplifies and extends the model-predicted results.
Psychologists have demonstrated the value of diversity – particularly diversity of viewpoints – for enhancing creativity, discovery, and problem solving. But one key type of viewpoint diversity is lacking in academic psychology in general and social psychology in particular: political diversity. This article reviews the available evidence and finds support for four claims: (1) Academic psychology once had considerable political diversity, but has lost nearly all of it in the last 50 years. (2) This lack of political diversity can undermine the validity of social psychological science via mechanisms such as the embedding of liberal values into research questions and methods, steering researchers away from important but politically unpalatable research topics, and producing conclusions that mischaracterize liberals and conservatives alike. (3) Increased political diversity would improve social psychological science by reducing the impact of bias mechanisms such as confirmation bias, and by empowering dissenting minorities to improve the quality of the majority's thinking. (4) The underrepresentation of non-liberals in social psychology is most likely due to a combination of self-selection, hostile climate, and discrimination. We close with recommendations for increasing political diversity in social psychology.
Sustaining performance is a difficult and often overlooked aspect of quality improvement and implementation science. Over a 4-year period, we observed that monthly feedback of performance data in face-to-face meetings with frontline personnel was crucial in maintaining environmental-cleaning effectiveness in adult critical care units.
We demonstrate one-dimensional (1D) and two-dimensional (2D) resonant nanoelectromechanical systems (NEMS) derived from nano carbon materials, where the resonance frequency and the quality (Q) factor of the devices are measured experimentally using ultrasensitive optical interferometry. The 1D nano carbon resonators are formed using carbon nanofibers (CNFs) which are synthesized using a plasma-enhanced chemical vapor deposition (PECVD) process, while the 2D nanocarbon resonators are based on CVD grown graphene. The CNFs are prototyped into few-μm-long cantilever-shaped 1D resonators, where the resonance frequency and Qs are extracted from measurements of the undriven thermomechanical noise spectrum. The thermomechanical noise measurements yield resonances in the ∼3–15 MHz range, with Q of ∼200–800. Significant changes in resonance characteristics are observed due to electron beam induced amorphous carbon deposition on the CNFs, which suggests that 1D CNF resonators have strong prospects for ultrasensitive mass detection. We also present NEMS resonators based on 2D graphene nanomembranes, which exhibit robust undriven thermomechanical resonances for the extraction of ultrasmall strain levels.
The Ciuntu rockshelter is situated in the north-western part of the Republic of Moldova, on the left bank of the river Pruth. It has a single Upper Palaeolithic layer of occupation, which was originally regarded as Early Upper Palaeolithic and was assigned to the Brinzeni archaeological culture. More recent investigations, including radiocarbon dating, have led to a revision of this suggested age and classification. The site is now regarded as belonging to the Middle Gravettian and is dated to the beginning of the last glacial maximum.
In 2009, the European Commission set restricted fishing areas northwest of the British Isles to protect deep-sea vulnerable marine ecosystems and fish stocks. Two protection areas which, historically, have been targeted by fisheries directed at blue ling (Molva dypterygia), were defined. The study aims to assess the effectiveness of restricting fishing activity within the protection areas during the blue ling spawning period (March–May) and to determine whether the existing boundaries are fit for purpose. Estimations of the spatial apportionment of blue ling landings within and outside the protection areas are achieved by combining low-resolution data from fishing vessel logbook entries with higher-resolution vessel monitoring system (VMS) data. High-resolution spatial apportionment of blue ling landings is limited by a lack of high-resolution logbook data, and certain assumptions need to be made on whether vessels are engaging in fishing activity at any individual VMS data point, based on vessel speed and types of fishing gear available. Although current measures appear to have influenced fishing activity in the vicinity of the protection areas, more evidence is needed for a robust evaluation of their effectiveness in protecting blue ling. Recommendations are made for improvements in data collection methods and data availability for research in support of monitoring, assessment and delineation of marine protection boundaries.
Environmental surfaces in hospital rooms often become contaminated with microbes, and evidence has linked the patient care environment to transmission of potential pathogens. Despite attempts at standardization of training and cleaning techniques, there is great variation between housekeepers with regard to room cleaning practices. Environmental cleanliness can be assessed by direct observation, surface cultures, detection of adenosine triphosphate, or use of a fluorescent marking solution. Each monitoring technique has limitations.
We participated in a multicenter study that demonstrated improved cleaning of high-touch surfaces through the use of a fluorescent marking solution and rapid-cycle performance feedback. As part of an earlier study, housekeepers were instructed about the importance of environmental cleanliness and appropriate cleaning of high-touch surfaces, and a room cleaning checklist was introduced. In this study, we sought to examine the relationship between the amount of time that a housekeeper spent cleaning a hospital room and the thoroughness of surface cleaning.