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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
Multi-decade observing campaigns of the globular clusters 47 Tucanae and M15 have led to an outstanding number of discoveries. Here, we report on the latest results of the long-term observations of the pulsars in these two clusters. For most of the pulsars in 47 Tucanae we have measured, among other things, their higher-order spin period derivatives, which have in turn provided stringent constraints on the physical parameters of the cluster, such as its distance and gravitational potential. For M15, we have studied the relativistic spin precession effect in PSR B2127+11C. We have used full-Stokes observations to model the precession effect, and to constrain the system geometry. We find that the visible beam of the pulsar is swiftly moving away from our line of sight and may very soon become undetectable. On the other hand, we expect to see the opposite emission beam sometime between 2041 and 2053.
PSR B1828–11 is a young pulsar once thought to be undergoing free precession and recently found instead to be switching magnetospheric states in tandem with spin-down changes. Here we show the two extreme states of the mode-changing found for this pulsar and comment briefly on its interpretation.
An evolution of the low-frequency pulse profile of PSR B2217+47 is observed during a six-year observing campaign with the LOFAR telescope at 150 MHz. The evolution is manifested as a new component in the profile trailing the main peak. The leading part of the profile, including a newly-observed weak component, is steady during the campaign. The transient component is not visible in simultaneous observations at 1500 MHz using the Lovell telescope, implying a chromatic effect. A variation in the dispersion measure of the source is detected in the same timespan. Precession of the pulsar and changes in the magnetosphere are investigated to explain the profile evolution. However, the listed properties favour a model based on turbulence in the interstellar medium (ISM). This interpretation is confirmed by a strong correlation between the intensity of the transient component and main peak in single pulses. Since PSR B2217+47 is the fourth brightest pulsar visible to LOFAR, we speculate that ISM-induced pulse profile evolution might be relatively common but subtle and that SKA-Low will detect many similar examples. In this scenario, similar studies of pulse profile evolution could be used in parallel with scintillation arcs to characterize the properties of the ISM.
During 2016 February, CSIRO Astronomy and Space Science and the Max-Planck-Institute for Radio Astronomy installed, commissioned, and carried out science observations with a phased array feed receiver system on the 64-m diameter Parkes radio telescope. Here, we demonstrate that the phased array feed can be used for pulsar observations and we highlight some unique capabilities. We demonstrate that the pulse profiles obtained using the phased array feed can be calibrated and that multiple pulsars can be simultaneously observed. Significantly, we find that an intrinsic polarisation leakage of −31 dB can be achieved with a phased array feed beam offset from the centre of the field of view. We discuss the possibilities for using a phased array feed for future pulsar observations and for searching for fast radio bursts with the Parkes and Effelsberg telescopes.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
While trauma-focused cognitive–behavioral therapy (TF-CBT) is the ‘gold standard’ treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.
Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala–insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.
We have obtained simultaneous observations of single pulses from the bright pulsars B0329+54 and B1133+16 at two frequencies in full polarization and a total of four frequencies in total power only. Here is a summary of our fantastic results!
In this paper it is shown that the ability to directly detect a daughter atom, using resonance ionization spectroscopy, in delayed time coincidence with the decay of a parent species promises to drastically reduce the background in low-level counting experiments. In addition, resonance ionization can also be used as an ion source for a mass spectrometer system that is capable of discriminating between isobars.
The need for increased quality assurance for radiocarbon measurements performed by the monitoring laboratories at nuclear stations has spurred the introduction of a number of interlaboratory comparisons. We organized two such intercomparisons: the first set, circulated in 1994, consisted of two milk samples, one containing current global levels of 14C, the other containing an added spike of 14C-methylated casein. The second set, circulated in 1995, consisted of two samples of natural vegetation growing on the site of the Chalk River Laboratories (CRL), containing two different levels of 14C, both well above global background. The response to our invitation to participate in these studies was very encouraging; six laboratories took part in the first intercomparison, eleven in the second. The list included both monitoring laboratories and those whose main function is 14C dating. Understandably, some of the latter preferred not to analyze the higher-activity samples. The results in 3 of the 4 data sets were consistent with a statistical distribution based on the reported errors. This report provides details of two intercomparisons, including the preparation of the samples, which may now be considered potential secondary reference materials, the range of analytical techniques in use at the participating laboratories, and a statistical analysis of the results returned to us.
The aims of this study were to develop and validate a prediction equation of fat-free mass (FFM) based on bioelectrical impedance analysis (BIA) and anthropometry using air-displacement plethysmography (ADP) as a reference in Asian neonates and to test the applicability of the prediction equations in an independent Western cohort. A total of 173 neonates at birth and 140 at two weeks of age were included. Multiple linear regression analysis was performed to develop the prediction equations in a two-third randomly selected subset and validated on the remaining one-third subset at each time point and in an independent Queensland cohort. FFM measured by ADP was the dependent variable, and anthropometric measures, sex and impedance quotient (L2/R50) were independent variables in the model. Accuracy of prediction equations was assessed using intra-class correlation and Bland–Altman analyses. L2/R50 was the significant predictor of FFM at week two but not at birth. Compared with the model using weight, sex and length, including L2/R50 slightly improved the prediction with a bias of 0·01 kg with 2 sd limits of agreement (LOA) (0·18, −0·20). Prediction explained 88·9 % of variation but not beyond that of anthropometry. Applying these equations to the Queensland cohort provided similar performance at the appropriate age. However, when the Queensland equations were applied to our cohort, the bias increased slightly but with similar LOA. BIA appears to have limited use in predicting FFM in the first few weeks of life compared with simple anthropometry in Asian populations. There is a need for population- and age-appropriate FFM prediction equations.
Geothermal low enthalpy heat in non-magmatic areas can be produced by pumping hot water from aquifers at large depth (>1 km). Key parameters for aquifer performance are temperature, depth, thickness and permeability. Geothermal exploration in the Netherlands can benefit considerably from the wealth of oil and gas data; in many cases hydrocarbon reservoirs form the lateral equivalent of geothermal aquifers. In the past decades subsurface oil and gas data have been used to develop 3D models of the subsurface structure. These models have been used as a starting point for the mapping of geothermal reservoir geometries and its properties. A workflow was developed to map aquifer properties on a regional scale. Transmissivity maps and underlying uncertainty have been obtained for 20 geothermal aquifers. Of particular importance is to take into account corrections for maximum burial depth and the assessment of uncertainties. The mapping of transmissivity and temperature shows favorable aquifer conditions in the northern part of the Netherlands (Rotliegend aquifers), while in the western and southern parts of the Netherlands aquifers of the Triassic and Upper Cretaceous / Jurassic have high prospectivity. Despite the high transmissivity of the Cenozoic aquifers, the limited depth and temperature reduce the prospective geothermal area significantly.
The results show a considerable remaining uncertainty of transmissivity values, due to lack of data and heterogeneous spatial data distribution. In part these uncertainties may be significantly reduced by adding well test results and facies parameters for the map interpolation in future work. For underexplored areas this bears a significant risk, but it can also result in much higher flowrates than originally expected, representing an upside in project performance.
We present an overview of the latest results from the PdBI Arcsecond Whirlpool Survey (PAWS, PI: E. Schinnerer), which has mapped CO(1-0) emission in the nearby grand-design spiral galaxy M51 at 40pc resolution. Our data are sensitive to GMCs above 105 M⊙, allowing the construction of the largest GMC catalog to date – containing over 1500 objects – using the CPROPS algorithm (Rosolowsky & Leroy 2006). In the inner disk of M51, the properties of the CO emission show significant variation that can be linked to the dynamical environment in which the molecular gas is located. We find that dynamically distinct regions host clouds with different properties and exhibit different GMC mass spectra, as well as distinct patterns of star formation. To understand how this sensitivity to environment emerges, we consider the role of pressure on GMC stabilization (including shear and star formation feedback-driven turbulence). We suggest that, in the presence of significant external pressure, streaming motions driven by the spiral arm can act to reduce the surface pressure on clouds. The resulting stabilization impacts the global pattern of star formation and can account for the observed non-monotonic radial dependence of the gas depletion time. Our findings have implications for the observed scatter in the standard GMC relations and extragalactic star formation laws.
Antenatal exposure of the fetus to inflammation may alter postnatal organ development. In our previous work, we demonstrated that the fetal liver is involved in the systemic inflammation associated with chorioamnionitis, leading to metabolic changes. On the basis of these findings, we hypothesized that chorioamnionitis can lead to postnatal inflammation-related liver injury and disturbed lipid metabolism. Chorioamnionitis was induced in sheep by intra-amniotic injection of lipopolysaccharide (LPS) or saline at 90, 100 and 110 days of gestation. Liver homeostasis and lipid metabolism were analyzed at term and at 7 weeks of age. At term, hepatic T-lymphocytes and apoptotic hepatocytes were increased. In addition, hepatic cholesterol and triglyceride levels were decreased in LPS-exposed animals compared with controls. At 7 weeks of age, no hepatic inflammation could be detected. However, liver triglycerides and plasma cholesterol levels were increased in LPS-exposed animals relative to controls. The changes in lipid levels at 7 weeks of age were associated with increased leptin receptor mRNA levels, increased lipid peroxidation, increased expression of cytochrome c oxidase subunit 4 as a marker for mitochondrial function and increased circulating ceramide levels. These findings demonstrate that chorioamnionitis-mediated antenatal inflammation-related liver disturbances have long-lasting postnatal effects on lipid metabolism.
Within the Herschel key project “The Warm And Dense ISM” (WADI) we systematically observe
a number of prominent photon-dominated regions (PDRs) to measure the impact of varying UV
fields on the energy balance, the chemical and dynamical structure of heated molecular
Within the key project “Herschel M 33 extended survey” (HerM33es), we are studying the physical and chemical processes driving star formation and galactic evolution in the nearby galaxy M 33, combining the study of local conditions affecting individual star formation with properties only becoming apparent on global scales. Here, we present recent results obtained by the HerM33es team. Combining Spitzer and Herschel data ranging from 3.6 μm to 500μm, along with H i, Hα, and GALEX UV data, we have studied the dust at high spatial resolutions of 150 pc, providing estimators of the total infrared (TIR) brightness and of the star formation rate. While the temperature of the warm dust at high brightness is driven by young massive stars, evolved stellar populations appear to drive the temperature of the cold dust. Plane-parallel models of photon dominated regions (PDRs) fail to reproduce fully the [C ii], [O i], and CO maps obtained in a first spectroscopic study of one 2′ × 2′ subregion of M 33, located on the inner, northern spiral arm and encompassing the H ii region BCLMP 302.