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An estimated 293,300 healthcare-associated cases of Clostridium difficile infection (CDI) occur annually in the United States. To date, research has focused on developing risk prediction models for CDI that work well across institutions. However, this one-size-fits-all approach ignores important hospital-specific factors. We focus on a generalizable method for building facility-specific models. We demonstrate the applicability of the approach using electronic health records (EHR) from the University of Michigan Hospitals (UM) and the Massachusetts General Hospital (MGH).
We utilized EHR data from 191,014 adult admissions to UM and 65,718 adult admissions to MGH. We extracted patient demographics, admission details, patient history, and daily hospitalization details, resulting in 4,836 features from patients at UM and 1,837 from patients at MGH. We used L2 regularized logistic regression to learn the models, and we measured the discriminative performance of the models on held-out data from each hospital.
Using the UM and MGH test data, the models achieved area under the receiver operating characteristic curve (AUROC) values of 0.82 (95% confidence interval [CI], 0.80–0.84) and 0.75 ( 95% CI, 0.73–0.78), respectively. Some predictive factors were shared between the 2 models, but many of the top predictive factors differed between facilities.
A data-driven approach to building models for estimating daily patient risk for CDI was used to build institution-specific models at 2 large hospitals with different patient populations and EHR systems. In contrast to traditional approaches that focus on developing models that apply across hospitals, our generalizable approach yields risk-stratification models tailored to an institution. These hospital-specific models allow for earlier and more accurate identification of high-risk patients and better targeting of infection prevention strategies.
Ten ice-sheet models are used to study sensitivity of the Greenland and Antarctic ice sheets to prescribed changes of surface mass balance, sub-ice-shelf melting and basal sliding. Results exhibit a large range in projected contributions to sea-level change. In most cases, the ice volume above flotation lost is linearly dependent on the strength of the forcing. Combinations of forcings can be closely approximated by linearly summing the contributions from single forcing experiments, suggesting that nonlinear feedbacks are modest. Our models indicate that Greenland is more sensitive than Antarctica to likely atmospheric changes in temperature and precipitation, while Antarctica is more sensitive to increased ice-shelf basal melting. An experiment approximating the Intergovernmental Panel on Climate Change’s RCP8.5 scenario produces additional first-century contributions to sea level of 22.3 and 8.1 cm from Greenland and Antarctica, respectively, with a range among models of 62 and 14 cm, respectively. By 200 years, projections increase to 53.2 and 26.7 cm, respectively, with ranges of 79 and 43 cm. Linear interpolation of the sensitivity results closely approximates these projections, revealing the relative contributions of the individual forcings on the combined volume change and suggesting that total ice-sheet response to complicated forcings over 200 years can be linearized.
A microchannel plate was used as an ion sensitive detector in a commercial helium ion microscope (HIM) for dark-field transmission imaging of nanomaterials, i.e. scanning transmission ion microscopy (STIM). In contrast to previous transmission HIM approaches that used secondary electron conversion holders, our new approach detects forward-scattered helium ions on a dedicated annular shaped ion sensitive detector. Minimum collection angles between 125 mrad and 325 mrad were obtained by varying the distance of the sample from the microchannel plate detector during imaging. Monte Carlo simulations were used to predict detector angular ranges at which dark-field images with atomic number contrast could be obtained. We demonstrate atomic number contrast imaging via scanning transmission ion imaging of silica-coated gold nanoparticles and magnetite nanoparticles. Although the resolution of STIM is known to be degraded by beam broadening in the substrate, we imaged magnetite nanoparticles with high contrast on a relatively thick silicon nitride substrate. We expect this new approach to annular dark-field STIM will open avenues for more quantitative ion imaging techniques and advance fundamental understanding of underlying ion scattering mechanisms leading to image formation.
We present the characteristics of a high temperature CMOS integrated circuit process based on 4H silicon carbide designed to operate at temperatures beyond 300°C. N-channel and P-channel transistor characteristics at room and elevated temperatures are presented. Both channel types show the expected low values of field effect mobility well known in SiC MOSFETS. However the performance achieved is easily capable of exploitation in CMOS digital logic circuits and certain analogue circuits, over a wide temperature range.
Data is also presented for the performance of digital logic demonstrator circuits, in particular a 4 to 1 analogue multiplexer and a configurable timer operating over a wide temperature range. Devices are packaged in high temperature ceramic dual in line (DIL) packages, which are capable of greater than 300°C operation. A high temperature “micro-oven” system has been designed and built to enable testing and stressing of units assembled in these package types. This system heats a group of devices together to temperatures of up to 300°C while keeping the electrical connections at much lower temperatures. In addition, long term reliability data for some structures such as contact chains to n-type and p-type SiC and simple logic circuits is summarized.
We describe the La Silla-QUEST (LSQ) Variability Survey. LSQ is a dedicated wide-field synoptic survey in the Southern Hemisphere, focussing on the discovery and study of transients ranging from low redshift (z < 0.1) SN Ia, Tidal Disruption events, RR Lyræ variables, CVs, Quasars, TNOs and others. The survey utilizes the 1.0-m Schmidt Telescope of the European Southern Observatory at La Silla, Chile, with the large-area QUEST camera, a mosaic of 112 CCDs with field of view of 9.6 square degrees. The LSQ Survey was commissioned in 2009, and is now regularly covering ~1000 square deg per night with a repeat cadence of hours to days. The data are currently processed on a daily basis. We present here a first look at the photometric capabilities of LSQ and we discuss some of the most interesting recent transient detections.
We have demonstrated that the microstructure of thick pentaerythritol tetranitrate (PETN) films can be controlled using physical vapor deposition by varying the film/substrate interface. PETN films were deposited on silicon and fused silica with and without a thin layer of sputtered aluminum to demonstrate the effects of the interface on subsequent film growth. Evolution of surface morphology, average density, and surface roughness as a function of film thickness were characterized using surface profilometry, scanning electron microscopy, and atomic force microscopy. Significant variations in density, pore size, and surface morphology were observed in films deposited on the different substrates. In addition, x-ray diffraction experiments showed that while films deposited on bare fused silica or silicon had only weak texturing, films deposited on a sputtered aluminum layer were highly oriented, with a strong (110) out-of-plane texture.
The effect of the dietary n-3 long-chain PUFA, DHA (22 : 6n-3), on the growth of pre-term infants is controversial. We tested the effect of higher-dose DHA (approximately 1 % dietary fatty acids) on the growth of pre-term infants to 18 months corrected age compared with standard feeding practice (0·2–0·3 % DHA) in a randomised controlled trial. Infants born < 33 weeks gestation (n 657) were randomly allocated to receive breast milk and/or formula with higher DHA or standard DHA according to a concealed schedule stratified for sex and birth-weight ( < 1250 and ≥ 1250 g). The dietary arachidonic acid content of both diets was constant at approximately 0·4 % total fatty acids. The intervention was from day 2 to 5 of life until the infant's expected date of delivery (EDD). Growth was assessed at EDD, and at 4, 12 and 18 months corrected age. There was no effect of higher DHA on weight or head circumference at any age, but infants fed higher DHA were 0·7 cm (95 % CI 0·1, 1·4 cm; P = 0·02) longer at 18 months corrected age. There was an interaction effect between treatment and birth weight strata for weight (P = 0·01) and length (P = 0·04). Higher DHA resulted in increased length in infants born weighing ≥ 1250 g at 4 months corrected age and in both weight and length at 12 and 18 months corrected age. Our data show that DHA up to 1 % total dietary fatty acids does not adversely affect growth.
Attempts to identify intermediates in an alkoxide-based solution route to films of the high temperature superconductor YBa2Cu3O7 reported by Fahrenholtz et al. have led to the isolation of the first molecular barium-copper cluster, Ba2Cu2(OR)4(acac)4·2 HOR, R = CH2CH2OCH3. The extension of this route to the preparation of the bismuth superconductors has necessitated the investigation of bismuth alkoxide chemistry. Two separate routes to bismuth alkoxides have been examined: the metathesis of the metal halides with NaOR, (R = t-butyl, and diisopropylphenoxide) and the alcoholysis of bismuth amides, Bi(NR2)3, [R = N(SiMe3)2] The alcoholysis preparation gives high yields of several alkoxides suitable as precursors to the high Tc materials. A monomeric bismuth phenoxide, which is targeted as a volatile precursor, and a bismuth t-butoxide cluster have been isolated and stucturally characterized. Solubility and volatility studies have also been undertaken.
Arrays of Ni nanorods were electrodeposited into alumina oxide templates with various lengths (11-50 micro meter) and fixed pore diameter (150 nm). The magnetization behavior of these rods were investigated with ferromagnetic resonance (FMR) techniques; fixed frequency (conventional FMR) and swept frequency (Network Analyzer FMR). Both resonance spectra indicate the presence of strong dipolar interaction between the nanorods. The fundamental magnetic parameters like spontaneous magnetization, gyromagnetic ratio, and magnetic anisotropies of the nanorods were derived from the angular variation of resonance field data. Further, the use of nanorods as a tunable stop-band notch-filter in a coplanar waveguide geometry has been assessed. The stop-band frequency (fr) is observed to be tunable up to 24 GHz with an applied field (H) of up to 6 kOe. The theoretical fitting of fr(H)data to resonance relation yield values of effective field (Heff) and gyromagnetic ratio, which are a little higher than the conventional FMR results.