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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.
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
The objective of this study was to investigate the effect of both cow genetic index (CGI) and feeding system on the performance of second lactation Holstein-Friesian dairy cows on grass-based feeding systems. There was no interaction between CGI and feeding system for any of the parameters measured. Cows of high genetic index (HGI) produced significantly higher yields of milk (P < 0.001), fat (P < 0.001) protein (P < 0.0001) and lactose (P < 0.001) than medium genetic index cows (MGI). CGI had no effect on the concentration of milk constituents. Averaged across four intake measurements the HGI cows had significantly (P < 0.001) higher grass dry-matter intake (GDMI) and total dry-matter intake (TDMI). Live weight was similar for both genotypes during lactation. The HGI cows had significantly (P < 0.05) higher live-weight loss in the first 10 weeks of lactation, significantly lower live-weight gain from week 10 to the end of lactation and higher (P < 0.05) live-weight gain during the dry period. Condition score was significantly lower with the HGI (P < 0.001) at all stages of lactation. There was a higher proportion (P < 0.05) of the HGI cows non-pregnant at the end of the 13-week breeding season. Feeding system had a significant effect on the yield of milk (P < 0.001), fat (P < 0.001), protein (P < 0.001) and lactose (P < 0.001). Feeding system B produced significantly higher (P < 0.05) milk yield and yield of constituents (when compared with feeding systems A and C). Over the period when feeding systems were being applied, feeding system C had significantly higher (P < 0.05) milk protein concentration. Feeding system had a significant effect (P < 0.001) on both GDMI and TDMI. Feeding system had no effect on live weight, condition score or fertility performance.
Here I discuss progress in both the theory and practice of data analysis for the Hydrogen Epoch of Reionization Array (HERA), focusing on techniques to calibrate the instrumental response and preserve the spectral smoothness that is essential to separating the cosmological 21 cm signal from foregrounds that are five orders of magnitude brighter. I explain how mis-calibration can create ruinous spectral structure and how we take advantage of HERA’s highly-redundant configuration for calibration. This proceeding draws from a talk I gave on October 3, 2017. Slides for it and all my talks are available at joshdillon.net.
This work investigates the relative contributions to strengthening from twinning, solid-solution, precipitation, and irradiation hardening mechanisms in sputtered Cu–W thin films irradiated to different doses. A nanograin solid solution strengthening mechanism with a linear compositional dependence is observed for the as-grown alloys and for the alloy samples irradiated to 0.5 dpa. Solid solution strengthening is the major strengthening mechanism for Cu99.5W0.5 at all irradiation doses. Irradiation induces precipitation in samples with W concentrations greater than or equal to 1% at doses above ≈0.5 dpa. The growth of 1–4 nm precipitates enhances the hardness of these alloys, and the degree of strengthening is determined by the interparticle spacing. While the alloys exhibit steady-state properties after a relatively low dose (≈1 dpa), the different time scales associated with detwinning and damage accumulation in pure Cu lead transients at higher doses (>5 dpa).
Dissolved inorganic carbon (DIC) is the main acid buffer in forested lake watersheds in Canada. We used carbon isotopes (13C, 14C) to evaluate the production and cycling of DIC in an acid-sensitive lake watershed of the Precambrian Shield. Soil CO2, groundwater and stream DIC were characterized chemically and isotopically. Soil CO2 concentration profiles reflect both changes in production and in losses due to diffusion. δ13C soil CO2 profiles (δ13C values of −23‰ in summer, slightly enriched during the fall and −25%‰ during the winter) are a reflection of the isotopic composition of the sources and changes in isotopic fractionation due to diffusion. Carbon isotopic composition (13C, 14C) of the groundwater and stream DIC clearly indicate that weathering of silicates by soil CO2 is the main source of DIC in these watersheds. 14C data show that, in addition to recent groundwater, an older groundwater component with depleted 14C activity is also present in the bedrock. The carbon isotope pattern in the groundwater also implies that, besides the main springtime recharge events, contributions to the groundwater may also occur during late winter/early spring.
Cu90Ag10 alloys were subjected to severe plastic deformation at temperatures ranging from 25 to 400 °C and strain rates ranging from 0.1 to 6.25 s−1 using high-pressure torsion. The deformed samples were characterized by x-ray diffraction, transmission electron microscopy, and atom-probe tomography. A dynamic competition between shear-induced mixing and thermally activated decomposition led to the self-organization of the Cu–Ag system at length scales varying from a few atomic distances at room temperature to ≈50 nm at 400 °C. Steady-state microstructural length scales were minimally affected by varying the strain rate, although at 400 °C, the grain morphology did depend on strain-rate. Our results show that diffusion below 300 °C is dominated by nonequilibrium vacancies, and by comparison with previous Kinetic Monte Carlo simulations [D. Schwen et al., J. Mater. Res.28, 2687–2693 (2013)], their concentration could be obtained.
The Murchison Widefield Array is a new low-frequency interferometric radio telescope built in Western Australia at one of the locations of the future Square Kilometre Array. We describe the automated radio-frequency interference detection strategy implemented for the Murchison Widefield Array, which is based on the aoflagger platform, and present 72–231 MHz radio-frequency interference statistics from 10 observing nights. Radio-frequency interference detection removes 1.1% of the data. Radio-frequency interference from digital TV is observed 3% of the time due to occasional ionospheric or atmospheric propagation. After radio-frequency interference detection and excision, almost all data can be calibrated and imaged without further radio-frequency interference mitigation efforts, including observations within the FM and digital TV bands. The results are compared to a previously published Low-Frequency Array radio-frequency interference survey. The remote location of the Murchison Widefield Array results in a substantially cleaner radio-frequency interference environment compared to Low-Frequency Array’s radio environment, but adequate detection of radio-frequency interference is still required before data can be analysed. We include specific recommendations designed to make the Square Kilometre Array more robust to radio-frequency interference, including: the availability of sufficient computing power for radio-frequency interference detection; accounting for radio-frequency interference in the receiver design; a smooth band-pass response; and the capability of radio-frequency interference detection at high time and frequency resolution (second and kHz-scale respectively).
Depression is characterized by poor executive function, but – counterintuitively – in some studies, it has been associated with highly accurate performance on certain cognitively demanding tasks. The psychological mechanisms responsible for this paradoxical finding are unclear. To address this issue, we applied a drift diffusion model (DDM) to flanker task data from depressed and healthy adults participating in the multi-site Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC) study.
One hundred unmedicated, depressed adults and 40 healthy controls completed a flanker task. We investigated the effect of flanker interference on accuracy and response time, and used the DDM to examine group differences in three cognitive processes: prepotent response bias (tendency to respond to the distracting flankers), response inhibition (necessary to resist prepotency), and executive control (required for execution of correct response on incongruent trials).
Consistent with prior reports, depressed participants responded more slowly and accurately than controls on incongruent trials. The DDM indicated that although executive control was sluggish in depressed participants, this was more than offset by decreased prepotent response bias. Among the depressed participants, anhedonia was negatively correlated with a parameter indexing the speed of executive control (r = −0.28, p = 0.007).
Executive control was delayed in depression but this was counterbalanced by reduced prepotent response bias, demonstrating how participants with executive function deficits can nevertheless perform accurately in a cognitive control task. Drawing on data from neural network simulations, we speculate that these results may reflect tonically reduced striatal dopamine in depression.
Fibrous polyethylene terephthalate (PET) was modified by organometallic vapor exposure to form hybrid materials with unique photoluminescent characteristics. Using a sequential vapor infiltration (SVI) process, the elongated exposures of trimethylaluminum (TMA) to PET were examined. As the infiltration temperature increased, the evidence of changes in the reaction between the organometallic vapor and the polymer was observed as well as significant changes in the infiltration depth into the polymer fiber, owing to the variation in the reaction mechanisms of the hybrid material formation. At TMA exposures of 60 °C, the mass of the polymer fiber increased by ∼55 wt%, whereas exposures at 150 °C were limited to ∼25 wt% infiltration. Photoluminescence analysis of PET after TMA infiltration shows an intensity increase of up to ∼13x and an increase in red shift with increasing infiltration temperature, attributed to the variations in the reaction mechanism to form the hybrid modification observed through the spectroscopy analysis.
Electronic measures of surgical site infections (SSIs) are being used more frequently in place of labor-intensive measures. This study compares performance characteristics of 2 electronic measures of SSIs with a clinical measure and studies the implications of using electronic measures to estimate risk factors and costs of SSIs among surgery patients.
Data included 1,066 general and vascular surgery patients at a single academic center between 2007 and 2008. Clinical data were from the National Surgical Quality Improvement Program (NSQIP) database, which includes a nurse-derived measure of SSI. We compared the NSQIP SSI measure with 2 electronic measures of SSI: MedMined Nosocomial Infection Marker (NIM) and International Classification of Diseases, Ninth Revision (ICD-9) coding for SSIs. We compared infection rates for each measure, estimated sensitivity and specificity of electronic measures, compared effects of SSI measures on risk factors for mortality using logistic regression, and compared estimated costs of SSIs for measures using linear regression.
SSIs were observed in 8.8% of patients according to the NSQIP definition, 2.6% of patients according to the NIM definition, and 5.8% according to the ICD-9 definition. Logistic regression for each SSI measure revealed large differences in estimated risk factors. NIM and ICD-9 measures overestimated the cost of SSIs by 134% and 33%, respectively.
Caution should be taken when relying on electronic measures for SSI surveillance and when estimating risk and costs attributable to SSIs. Electronic measures are convenient, but in this data set they did not correlate well with a clinical measure of infection.