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Method of levels (MOL) is an innovative transdiagnostic cognitive therapy with potential advantages over existing psychological treatments for psychosis.
The Next Level study is a feasibility randomised controlled trial (RCT) of MOL for people experiencing first-episode psychosis. It aims to determine the suitability of MOL for further testing in a definitive trial (trial registration ISRCTN13359355).
The study uses a parallel group non-masked feasibilityRCT design with two conditions: (a) treatment as usual (TAU) and (b) TAU plus MOL. Participants (n = 36) were recruited from early intervention in psychosis services. Outcome measures are completed at baseline, 10 and 14 months. The primary outcomes are recruitment and retention.
Participants’ demographic and clinical characteristics are presented along with baseline data.
Next Level has recruited to target, providing evidence that it is feasible to recruit to a RCT of MOL for first-episode psychosis.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
Although trophic position or level is one of the most basic aspects of a benthic marine species' ecology, its evolutionary significance remains obscure. Gastropods offer a suitable model for examining the relationship between trophic level and evolution since they exhibit a wide variety of trophic strategies and their mode of life is often reflected in their shell form. We examined 196 genera of Paleozoic gastropods (≈ 1/3 of known genera) for which first appearance and last appearance could be specified to stage level and for which trophic strategy could be inferred with a reasonable degree of confidence. We classified these genera into four trophic categories on the basis of shell characters relating to locomotion and clamping. These trophic categories are: Suspension feeders, Grazers on firm substrata, Soft substrate Grazers/Detritivores, and Carnivores. Suspension feeders are the most unambiguously recognizable category, marked by clear indicators of a sessile mode of life such as a radial apertures and planispiral shell forms. Our central observation from these data is that suspension feeders have shorter generic longevities than the other three trophic groups. This pattern is robust to a variety of methods of analysis. The mean generic longevity of the suspension feeders is 15 MY less than the other trophic categories. Cumulative frequency of genera within trophic categories versus log duration shows suspension feeders to be statisticaly significantly shorter lived than the other three trophic categories. The other three categories are not distinguishable. This pattern is unchanged by the removal of taxa dying out at mass extinctions. Suspension feeders have lower origination rates and higher extinction rates than the other trophic classes. This is not a taxonomic artifact produced by ornamentation and the number of characters available. This background pattern is also present in the end Ordovician and Late Devonian mass extinctions. Suspension feeders loose about half their genera in these extinctions, the two classes of grazers loose about 1/3 of their genera, and the carnivores suffer almost no extinctions. Suspension feeding appears to carry a significant evolutionary detriment in both mass extinctions and background times. This may be reflected in the change in trophic distribution of gastropods from the Ordovician to the Recent. The end Permian extinction shows a different pattern of selectivity; detritivores suffer the least.
In a time of major medical education transformation, emergency medicine (EM) needs to nurture education scholars who will influence EM education practice. However, the essential ingredients to ensure a career with impact in EM education are not clear.
To describe how to prepare EM educators for a high-impact career.
The Canadian Association of Emergency Physicians (CAEP) Academic Section commissioned an “Education Impact” working group (IWG) to guide the creation of consensus recommendations from the EM community. EM educators from across Canada were initially recruited from the networks of the IWG members, and additional educators were recruited via snowball sampling. “High impact educators” were nominated by this network. The high impact educators were then interviewed using a structured question guide. These interviews were transcribed and coded for themes using qualitative methods. The process continued until no new themes were identified. Proposed themes and recommendations were presented to the EM community at the CAEP 2016 Academic Symposium. Feedback was then incorporated into a final set of recommendations.
Fifty-five (71%) of 77 of identified Canadian EM educators participated, and 170 names of high impact educators were submitted and ranked by frequency. The IWG achieved sufficiency of themes after nine interviews. Five recommendations were made: 1) EM educators can pursue a high impact career by leveraging either traditional or innovative career pathways; 2) EM educators starting their education careers should have multiple senior mentors; 3) Early-career EM educators should immerse themselves in their area of interest and cultivate a community of practice, not limited to EM; 4) Every academic EM department and EM teaching site should have access to an EM educator with protected time and recognition for their EM education scholarship; and 5) Educators at all stages should continuously compile an impact portfolio.
We describe a unique set of recommendations to develop educators who will influence EM, derived from a consensus from the EM community. EM leaders, educators, and aspiring educational scholars should consider how to implement this guide towards enhancing our specialty’s educational mission.
Urban riparian plant communities exist at the interface between terrestrial and aquatic habitats, and they are rich sources of species biodiversity and ecosystem services. The periodic floods that promote species diversity in riparian plant communities also increase their vulnerability to nonnative plant invasions. Plant invasions are constrained by seed and suitable habitat availability. However, how seed dispersal and establishment limitations interact to shape nonnative plant invasions in riparian communities is poorly understood. We use Stream Visual Assessment Protocol data to evaluate the hydrological and geomorphological parameters that influence the seeding and establishment of six common nonnative species in urban riparian habitats: garlic mustard, purple loosestrife, reed canarygrass, common reed, Japanese knotweed, and multiflora rose. To address this objective, we analyzed stream reach data collected during a basin-wide environmental assessment of the extensively urbanized upper Niagara River watershed. We found limited support for our prediction that propagule limitation constrains the distribution of nonnative riparian species, likely because these species are well established in the study area. Instead, we found that opportune stream reach characteristics better predict the distribution of the common invasive riparian species—most notably open tree canopy. Given that there is widespread investment in urban riparian forest restoration to improve water quality, increase stream-bank stability, enhance wildlife habitat and promote recreation, our data suggest that riparian forests may provide the additional benefit of reducing the abundance of some, but not all, invasive plants.
The Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project will test the overarching hypothesis that an active hydrological system exists beneath a West Antarctic ice stream that exerts a major control on ice dynamics, and the metabolic and phylogenetic diversity of the microbial community in subglacial water and sediment. WISSARD will explore Subglacial Lake Whillans (SLW, unofficial name) and its outflow toward the grounding line where it is thought to enter the Ross Ice Shelf seawater cavity. Introducing microbial contamination to the subglacial environment during drilling operations could compromise environmental stewardship and the science objectives of the project, consequently we developed a set of tools and procedures to directly address these issues. WISSARD hot water drilling efforts will include a custom water treatment system designed to remove micron and sub-micron sized particles (biotic and abiotic), irradiate the drilling water with germicidal ultraviolet (UV) radiation, and pasteurize the water to reduce the viability of persisting microbial contamination. Our clean access protocols also include methods to reduce microbial contamination on the surfaces of cables/hoses and down-borehole equipment using germicidal UV exposure and chemical disinfection. This paper presents experimental data showing that our protocols will meet expectations established by international agreement between participating Antarctic nations.
To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.
Nested case-control study.
Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.
Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.
PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.
The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17]; P = .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19]; P = .004), Clostidium difficile infection (OR, 2.25 [95% CI, 1.17–4.33]; P = .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78]; P = .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55]; P < .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10]; P = .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92]; P = .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78]; P = .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79]; P = .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99]; P = .05) services were less likely to be associated with having a PICC BSI.
We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.
The regularity of solutions to optimal transportation problems has become a hot topic in current research. It is well known by now that the optimal measure may not be concentrated on the graph of a continuous mapping unless both the transportation cost and the masses transported satisfy very restrictive hypotheses (including sign conditions on the mixed fourth-order derivatives of the cost function). The purpose of this note is to show that in spite of this, the optimal measure is supported on a Lipschitz manifold, provided only that the cost is
with non-singular mixed second derivative. We use this result to provide a simple proof that solutions to Monge's optimal transportation problem satisfy a change of variables equation almost everywhere.
Prototype ferroelectric thin film, nonvolatile memory, nondestructive readout (NDRO), semiconductor devices have been fabricated. The “1” and “0” logic states of these prototype devices are in principle determined by the modulation of the conductivity of a semiconductor film channel by the polarization state of the underlying ferroelectric thin film layer. Programmed resistance ratios of the two logic states of 5:1 are demonstrated. While the best performance to date has been achieved for devices that have a 40 nm ln2O3 film covering a 300 nm thick PZT 20/80 layer, we also develop criteria for selecting semiconductor films that will improve performance for this NDRO device design. Among the other semiconductor films that are characterized with respect to this criteria are boron doped Ge, ZnO and aluminum doped ZnO. It is demonstrated that by appropriate donor doping of ZnO films the effects of intrinsic defects are masked and that process temperatures can be extended by 300×C.
A novel near-room temperature CVD process has been developed using H-atoms reaction with WF6 to produce tungsten and tungsten oxide films. The chemical, physical and electrical properties of these films were studied. Good adhesion and low resistivity of W films were measured. Conformal W03 films were obtained on columnar tungsten using a small amount of molecular oxygen in the gas stream. A reaction mechanism was evaluated on the basis of experimental results. The advantages of the method include deposition of adherent films in a plasma-free environment, near-room temperature, with a low level of impurity
Thin film properties of LPCVD TiN barriers deposited on Si(100), using TiCl4 and NH3 as reactants, were investigated as a function of deposition temperature between 400 °C and 700 °C. The TiN film chemistry and film composition were studied by AES and RBS techniques, while the microstructural properties (grain size, lattice parameter and texture) were evaluated by XRD. The TiN deposition rates and film resistivities were also determined. Finally the film properties of the TiN barriers as determined by surface analysis were related to the process parameters.
Chemical vapor deposition using tetra(allyl) tungsten and molybdenum precursors yielded amorphous tungsten and molybdenum carbide films on pyrex substrates. The films were characterized by Auger, ESCA, SEM, XRD and resistivity measurements. Volatile pyrolysis products consisted primarily of propene, C3H6.
Particle-enhanced chemical vapor deposition (PECVD) is capable of producing ceramic films at high deposition rates. A mathematical model of the particle-vapor codeposition process has been developed and has been applied to PECVD processes to predict deposition rate enhancements and deposit properties.
The stability of BN thin film coatings (2–5 nm thick) on MgO and TiO2 substrates was investigated using transmission electron microscopy (TEM). The samples were heated in air for at least 16 hours at temperatures ranging from 773 K - 1273 K. On MgO supports, the BN thin film coating was lost by 1073 K due to a solid state reaction with the substrate leading to formation of Mg2B2O5. No such reaction occurred with the TiO2 substrate and the BN was stable even at 1273 K. However, the coating appeared to ball up and phase segregate into islands of near-graphitic BN and clumps of TiO2 (rutile). The oxidizing treatment appears to promote the transformation from turbostratic BN to graphitic BN.
The emergence of III-nitride technology and fabrication of high quality GaN based devices is possible due to the advances in the heteroepitaxial growth of III-N thin-films on lattice-mismatched substrates. Typically, the substrate of choice is either SiC or sapphire. We have adopted 100mm Si as our substrate of choice; uniform substrates of high quality are inexpensive and plentiful due to decades of use in the microelectronics industry. Growth of device quality GaN on Si is challenged by the ∼17% lattice mismatch and an additional thermal expansion coefficient (TEC) mismatch of ∼56%. In order to accommodate this strain and TEC mismatch between Si and GaN, a novel transition layer was designed, grown and successfully optimized, ® obviating the need for either a PENDEO based overgrowth process or a SiC interlayer-based process. This growth technique (SIGANTIC®) does not require any wafer conditioning prior to growth and thus reduces the process complexity and maintains the cost effectiveness of the GaN on Si strategy. We will report on this manufacturable 100mm MOCVD heteroepitaxial process that consistently produces device quality AlGaN/GaN heterostructures with two dimensional electron gas (2DEG) mobilities typically around 1400 cm2/Vs at room temperature. Structural and electrical properties as determined by optical reflectance, atomic force microscopy, capacitance-voltage and van der Pauw Hall measurements, which are measured across the 100mm wafer, will be presented. Device results will be mentioned to show continuous wave (CW) RF operation at 2 GHz with competitive power output, gain and power added efficiency (PAE).