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To evaluate the Orange County Clostridium difficile infection (CDI) prevention collaborative’s effect on rates of CDI in acute-care hospitals (ACHs) in Orange County, California.
Controlled interrupted time series.
We convened a CDI prevention collaborative with healthcare facilities in Orange County to reduce CDI incidence in the region. Collaborative participants received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions, and an interfacility transfer communication improvement initiative during June 2015–June 2016. We used segmented regression to evaluate changes in monthly hospital-onset (HO) and community-onset (CO) CDI rates for ACHs. The baseline period comprised 17 months (January 2014–June 2015) and the follow-up period comprised 28 months (September 2015–December 2017). All 25 Orange County ACHs were included in the CO-CDI model to account for direct and indirect effects of the collaborative. For comparison, we assessed HO-CDI and CO-CDI rates among 27 ACHs in 3 San Francisco Bay Area counties.
HO-CDI rates in the 15 participating Orange County ACHs decreased 4% per month (incidence rate ratio [IRR], 0.96; 95% CI, 0.95–0.97; P < .0001) during the follow-up period compared with the baseline period and 3% (IRR, 0.97; 95% CI, 0.95–0.99; P = .002) per month compared to the San Francisco Bay Area nonparticipant ACHs. Orange County CO-CDI rates declined 2% per month (IRR, 0.98; 95% CI, 0.96–1.00; P = .03) between the baseline and follow-up periods. This decline was not statistically different from the San Francisco Bay Area ACHs (IRR, 0.97; 95% CI, 0.95–1.00; P = .09).
Our analysis of ACHs in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.
There is contradictory evidence regarding negative memory biases in major depressive disorder (MDD) and whether these persist into remission, which would suggest their role as vulnerability traits rather than correlates of mood state. Early life stress (ELS), common in patients with psychiatric disorders, has independently been associated with memory biases, and confounds MDD versus control group comparisons. Furthermore, in most studies negative biases could have resulted from executive impairments rather than memory difficulties per se.
To investigate whether memory biases are relevant to MDD vulnerability and how they are influenced by ELS, we developed an associative recognition memory task for temporo-spatial contexts of social actions with low executive demands, which were matched across conditions (self-blame, other-blame, self-praise, other-praise). We included fifty-three medication-free remitted MDD (25 with ELS, 28 without) and 24 healthy control (HC) participants without ELS.
Only MDD patients with ELS showed a reduced bias (accuracy/speed ratio) towards memory for positive vs. negative materials when compared with MDD without ELS and with HC participants; attenuated positive biases correlated with number of past major depressive episodes, but not current symptoms. There were no biases towards self-blaming or self-praising memories.
This demonstrates that reduced positive biases in associative memory were specific to MDD patients with ELS rather than a general feature of MDD, and were associated with lifetime recurrence risk which may reflect a scarring effect. If replicated, our results would call for stratifying MDD patients by history of ELS when assessing and treating emotional memories.
A high proportion of patients with remitted major depressive disorder (MDD) will experience recurring episodes, whilst some develop resilience and remain in recovery. The neural basis of resilience to recurrence is elusive. Abnormal resting-state connectivity of the subgenual cingulate cortex (sgACC) was previously found in cross-sectional studies of MDD, suggesting its potential pathophysiological importance. The current study aimed to investigate whether resting-state connectivity to a left sgACC seed region distinguishes resilient patients from those developing recurring episodes.
A total of 47 medication-free remitted MDD patients and 38 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. Over 14 months, 30 patients remained resilient whilst 17 experienced a recurring episode.
Attenuated interhemispheric left-to-right sgACC connectivity distinguished the resilient from the recurring-episode and control groups and was not correlated with residual depressive symptoms.
The current study revealed a neural signature of resilience to recurrence in MDD and thereby elucidates the role of compensatory adaptation in sgACC networks.
The purpose of this study was to apply a novel statistical method for variable selection and a model-based approach for filling data gaps in mortality rates associated with foodborne diseases using the WHO Vital Registration mortality dataset. Correlation analysis and elastic net regularization methods were applied to drop redundant variables and to select the most meaningful subset of predictors. Whenever predictor data were missing, multiple imputation was used to fill in plausible values. Cluster analysis was applied to identify similar groups of countries based on the values of the predictors. Finally, a Bayesian hierarchical regression model was fit to the final dataset for predicting mortality rates. From 113 potential predictors, 32 were retained after correlation analysis. Out of these 32 predictors, eight with non-zero coefficients were selected using the elastic net regularization method. Based on the values of these variables, four clusters of countries were identified. The uncertainty of predictions was large for countries within clusters lacking mortality rates, and it was low for a cluster that had mortality rate information. Our results demonstrated that, using Bayesian hierarchical regression models, a data-driven clustering of countries and a meaningful subset of predictors can be used to fill data gaps in foodborne disease mortality.
Prosocial emotions related to self-blame are important in guiding human altruistic decisions. These emotions are elevated in major depressive disorder (MDD), such that MDD has been associated with guilt-driven pathological hyper-altruism. However, the impact of such emotional impairments in MDD on different types of social decision-making is unknown.
In order to address this issue, we investigated different kinds of altruistic behaviour (interpersonal cooperation and fund allocation, altruistic punishment and charitable donation) in 33 healthy subjects, 35 patients in full remission (unmedicated) and 24 currently depressed patients (11 on medication) using behavioural-economical paradigms.
We show a significant main effect of clinical status on altruistic decisions (p = 0.04) and a significant interaction between clinical status and type of altruistic decisions (p = 0.03). More specifically, symptomatic patients defected significantly more in the Prisoner's Dilemma game (p < 0.05) and made significantly lower charitable donations, whether or not these incurred a personal cost (p < 0.05 and p < 0.01, respectively). Currently depressed patients also reported significantly higher guilt elicited by receiving unfair financial offers in the Ultimatum Game (p < 0.05).
Currently depressed individuals were less altruistic in both a charitable donation and an interpersonal cooperation task. Taken together, our results challenge the guilt-driven pathological hyper-altruism hypothesis in depression. There were also differences in both current and remitted patients in the relationship between altruistic behaviour and pathological self-blaming, suggesting an important role for these emotions in moral and social decision-making abnormalities in depression.
Major depressive disorder (MDD) is associated with abnormalities in financial reward processing. Previous research suggests that patients with MDD show reduced sensitivity to frequency of financial rewards. However, there is a lack of conclusive evidence from studies investigating the evaluation of financial rewards over time, an important aspect of reward processing that influences the way people plan long-term investments. Beck's cognitive model posits that patients with MDD hold a negative view of the future that may influence the amount of resources patients are willing to invest into their future selves.
We administered a delay discounting task to 82 participants: 29 healthy controls, 29 unmedicated participants with fully remitted MDD (rMDD) and 24 participants with current MDD (11 on medication).
Patients with current MDD, relative to remitted patients and healthy subjects, discounted large-sized future rewards at a significantly higher rate and were insensitive to changes in reward size from medium to large. There was a main effect of clinical group on discounting rates for large-sized rewards, and discounting rates for large-sized rewards correlated with severity of depressive symptoms, particularly hopelessness.
Higher discounting of delayed rewards in MDD seems to be state dependent and may be a reflection of depressive symptoms, specifically hopelessness. Discounting distant rewards at a higher rate means that patients are more likely to choose immediate financial options. Such impairments related to long-term investment planning may be important for understanding value-based decision making in MDD, and contribute to ongoing functional impairment.
We summarize the use of radiocarbon produced by spallation in meteorites in space to determine their terrestrial age or residence time. This “age” gives us important information as it can be compared to the rates of weathering and infall of meteorites. The processes that affect the collection of meteorites in a given area can be related to the rates of infall of new meteorites, and the rate of removal by chemical weathering and physical erosion.
Thin films of perfluorinated vanadyl phthalocyanine F16PcVO were prepared by physical vapor deposition in high vacuum on KBr and fused silica substrates. The absorption spectra in the visible region show that the films on different substrates have different structure. The optical constants for F16PcVO films were obtained in the spectral range of 0.7–4.5 eV from the simulation of ellipsometry spectra with an anisotropic uniaxial model. From the difference between the in-plane and out-of-plane components of the extinction coefficient the average tilt angle of the F16PcVO molecular planes with respect to the substrate plane was found to be 56° for fused silica substrates and between 0° and 3° for KBr substrates.
In recent years, the role of gender in the development of psychopathology has increasingly attracted the attention of researchers, theoreticians, and other professionals interested in the well-being of children and adolescents. This interest has taken diverse forms, ranging from the examination of sex differences in the prevalence of adjustment difficulties to the exploration of unique etiologies and trajectories in the development of psychopathology for boys versus girls. In this paper we (a) critically examine the current status of available theories, research, and methods related to the study of gender and psychopathology and provide recommendations for future work; (b) identify promising new trends that appear to have utility for enhancing our understanding of the role of gender in the development of adjustment difficulties; and (c) generate conclusions regarding gender and psychopathology by integrating information from past and present work with new ideas about fruitful directions for future inquiry.
Vibrational properties of self-assembled InAs quantum dots (QD’s) embedded in AlAs and aluminium oxide were studied by Raman spectroscopy. The InAs/AlAs QD structures were grown by molecular beam epitaxy on GaAs (001) substrates. The following main features of the phonon spectra of InAs/AlAs QD nanostructures were observed: 1) asymmetric lines of QD LO phonons affected by strain, confinement and size inhomogeneity of QD’s; 2) confined phonons of InAs wetting layer (WL); 3) two bands of interface phonons in the AlAs frequency region, attributed to modes associated with the planar interface WL/AlAs matrix and the three-dimensional QD/matrix interface; 4) doublets of folded acoustic phonons caused by periodicity in the multilayer QD structures. The influence of growth temperature, varied from 420 to 550°C, on the morphology of QD’s was investigated. QD’s grown at 420°C are found to have the smallest size. Increasing the temperature up to 480°C leads to the formation of larger InAs islands and improved size homogeneity. Further temperature elevation (above 500°C) causes partial re-evaporation of InAs leading to a decrease of QD size and density, and, finally, their complete disappearance. InAs QD’s embedded in aluminium oxide were fabricated by selective oxidation of the AlAs matrix in self-assembled InAs/AlAs QD’s. Micro-Raman spectroscopy data show that depending on oxidation conditions (humidity, temperature) InAs QD’s in an oxide matrix can be even more strained than before oxidation, or become fully relaxed. At the boundaries of oxidized/non-oxidized areas the presence of amorphous and crystalline As clusters is evident.
Our Commission decided to proceed as before, with a rather comprehensive report, while focusing on the subjects where most progress has been achieved during the past three years. The colleagues who kindly contributed to it are W. Dziembowski (helio- and aster-oseismology), J. Guzik (intermediate-mass stars), G. Meynet (massive stars), G. Michaud (atomic diffusion), D. VandenBerg (low mass stars), G. Vauclair (white dwarfs), J.-P. Zahn (convection, rotational mixing).
Starting from a tight binding formulation of the KKR (Korringa-Kohn-Rostocker) Green function method we developed a self consistent band structure code. By using a reference system containing repulsive muffin tin potentials we obtain structure constants which decay exponentially with distance. In the case of multilayered systems the numerical effort scales linearly with the number of monolayers in a unit cell. We report about calculations of CoCu(001) systems. With our method we are able to consider the electronic structure, the interlayer exchange coupling, and the transport properties (conductivity, giant magnetoresistance = GMR) on an equal footing.
Siliconoxynitride layers with thicknesses between 5 and 10 nm were grown on (100) oriented silicon by rapid thermal processing (RTP) using either N2O or NH3 as nitridant. In order to study the trapping behaviour at the interface and in the insulator bulk, capacitance-voltage (CV) and current-voltage (IV) measurements have been performed combined with different magnitudes of Fowler-Nordheim stress. In addition, Deep Level Transient Spectroscopy (DLTS) has been applied for interface state detection. Auger Electron Spectroscopy (AES) has been used to obtain depth profiles for Si, N, O and C. The deconvolution of the AES signal displays significant peak contributions related to intermedium oxidation states. Nuclear Reaction Analysis (NRA) was successfully applied for hydrogen detection in buried SiOxNy thin films.
6H silicon carbide (SiC) substrates were implanted with nitrogen and aluminum at different doses and annealed in the temperature range from 1300°C-1700°C. Micro-Raman Spectroscopy (μ-RS) measurements were performed in two sample geometries (conventional plane-view and cross-sectional). Changes of the polytype from 6H- to a cubic (SiC)1-xAIN)x, and influences in the 6H-SiC wafer up to depths of 2μm were detected. The results obtained by crosssectional μ-RS are discussed in comparison to other results from Reflection High Electron Energy Diffraction (RHEED), Rutherford Backscattering (RBS), Auger Electron Spectroscopy (AES), Transmission Electron Microscopy (TEM), and Positron Annihilation Spectroscopy (PAS) measurements.
We report studies of the interface formed when InSb is deposited onto a CdTe substrate in a molecular beam epitaxy chamber and elucidate conditions under which epitaxial growth is possible. We find that a necessary condition for epitaxy at a substrate temperature Ts is that the growth rate exceed a minimum value Ωmin(Ts). Reflection high energy electron diffraction patterns taken in situ and transmission electron micrographs taken ex situ show that interfaces formed when Ω > Ωmin have a short period roughness which is independent of the Sb/In flux ratio and which diminishes with increasing Ω. Raman spectra show no evidence of interfacial compounds. An analysis of Auger spectra of thin layers of InSb grown on CdTe indicates the existence of Te at the surface of the InSb but not in the layer itself. The Te concentration is found to decrease with InSb layer thickness. We propose a model based on a competition between the reaction of free In and Sb with the CdTe surface and the nucleation and growth of InSb. We use this model to account for the existence of Omin, interface roughness, and the presence of Te at the surface of the InSb epilayer.
Crystal damage of GaAs(100) caused by Reactive Ion Etching (RIE) using a mixture of Cl2 and Ar gas has been assessed using Surface Roughness (Ra), Resonant Raman Spectroscopy (RRS), Schottky diodes, and Spectroscopic Ellipsometry (SE). Plasma conditions for minimum induced damage have been determined and compared to optimised RIE processes using plasma gases SiCl4, CH4-H2, CCl2F2 and Ar. The SiCl4 plasma was found to produce the least crystal damage.
This report of Commission 35, as in past reports, consists of some details of only a few selected topics. This is necessary because a survey of the entire field of stellar formation, structure, stability, evolution, pulsation, and explosions for the three year period from mid-1981 to mid-1984 would be excessively long. Our topics here, in order from the most massive stellar classes to the least are: Massive Stars (R.M. Humphreys), Rotation in Late Type Stars (W. Benz), Helioseismology (J. Christensen-Dalsgaard), Planetary Nebula Central Stars (E.M. Sion), Pulsations in Hot Degenerate Dwarf Stars (A.N. Cox and S.D. Kawaler), and White Dwarfs (V. Weidemann). There is some overlap in the reviewing of these last three reports because the topics are very closely related. Concentration in this dying stage of stellar evolution seems appropriate because of the great current interest in these matters.
Twelve patients with obsessive compulsive disorder were studied with psychophysiological measures during a randomised, double-blind placebo-controlled drug trial. Significant clinical improvement followed six weeks of treatment with the tricyclic antidepressant clomipramine, but was not evident after an equal period of treatment with the monoamine oxidase inhibitor (MAOI) clorgyline. Compared to placebo, both drugs reduced skin conductance indices of baseline arousal, but only clomipramine reduced skin conductance and heart rate responses to loud tones and tonic and phasic skin conductance responses in a two-flash discrimination task. This suggests that reductions in autonomic responses to important and/or aversive stimuli may be critical to clinical improvement in obsessive compulsive disorder.