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We examined Clostridioides difficile infection (CDI) prevention practices and their relationship with hospital-onset healthcare facility-associated CDI rates (CDI rates) in Veterans Affairs (VA) acute-care facilities.
From January 2017 to February 2017, we conducted an electronic survey of CDI prevention practices and hospital characteristics in the VA. We linked survey data with CDI rate data for the period January 2015 to December 2016. We stratified facilities according to whether their overall CDI rate per 10,000 bed days of care was above or below the national VA mean CDI rate. We examined whether specific CDI prevention practices were associated with an increased risk of a CDI rate above the national VA mean CDI rate.
All 126 facilities responded (100% response rate). Since implementing CDI prevention practices in July 2012, 60 of 123 facilities (49%) reported a decrease in CDI rates; 22 of 123 facilities (18%) reported an increase, and 41 of 123 (33%) reported no change. Facilities reporting an increase in the CDI rate (vs those reporting a decrease) after implementing prevention practices were 2.54 times more likely to have CDI rates that were above the national mean CDI rate. Whether a facility’s CDI rates were above or below the national mean CDI rate was not associated with self-reported cleaning practices, duration of contact precautions, availability of private rooms, or certification of infection preventionists in infection prevention.
We found considerable variation in CDI rates. We were unable to identify which particular CDI prevention practices (i.e., bundle components) were associated with lower CDI rates.
Depression is a clinically heterogeneous disorder. Previous large-scale genetic studies of depression have explored genetic risk factors of depression case–control status or aggregated sums of depressive symptoms, ignoring possible clinical or genetic heterogeneity.
We analyse data from 148 752 subjects of white British ancestry in the UK Biobank who completed nine items of a self-rated measure of current depressive symptoms: the Patient Health Questionnaire (PHQ-9). Genome-Wide Association analyses were conducted for nine symptoms and two composite measures. LD Score Regression was used to calculate SNP-based heritability (h2SNP) and genetic correlations (rg) across symptoms and to investigate genetic correlations with 25 external phenotypes. Genomic structural equation modelling was used to test the genetic factor structure across the nine symptoms.
We identified nine genome-wide significant genomic loci (8 novel), with no overlap in loci across symptoms. h2SNP ranged from 6% (concentration problems) to 9% (appetite changes). Genetic correlations ranged from 0.54 to 0.96 (all p < 1.39 × 10−3) with 30 of 36 correlations being significantly smaller than one. A two-factor model provided the best fit to the genetic covariance matrix, with factors representing ‘psychological’ and ‘somatic’ symptoms. The genetic correlations with external phenotypes showed large variation across the nine symptoms.
Patterns of SNP associations and genetic correlations differ across the nine symptoms, suggesting that current depressive symptoms are genetically heterogeneous. Our study highlights the value of symptom-level analyses in understanding the genetic architecture of a psychiatric trait. Future studies should investigate whether genetic heterogeneity is recapitulated in clinical symptoms of major depression.
The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009–2010 to 2015–2016. We carried out weighted regression among young adults (20–39 years) and adults (40–59 years) separately. In total, 5230 men and 5794 women aged 20–59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15–1.15) among young adults and adults (1.61, 95% CI 1.61–1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.
The environmental and biotic history of the late Quaternary represents a critical junction between ecology, global change studies, and pre-Quaternary paleobiology. Late Quaternary records indicate the modes and mechanisms of environmental variation and biotic responses at timescales of 101–104 years. Climatic changes of the late Quaternary have occurred continuously across a wide range of temporal scales, with the magnitude of change generally increasing with time span. Responses of terrestrial plant populations have ranged from tolerance in situ to moderate shifts in habitat to migration and/or extinction, depending on magnitudes and rates of environmental change. Species assemblages have been disaggregated and recombined, forming a changing array of vegetation patterns on the landscape. These patterns of change are characteristic of terrestrial plants and animals but may not be representative of all other life-forms or habitats. Complexity of response, particularly extent of species recombination, depends in part on the nature of the underlying environmental gradients and how they change through time. Environmental gradients in certain habitats may change in relatively simple fashion, allowing long-term persistence of species associations and spatial patterns. Consideration of late Quaternary climatic changes indicates that both the rate and magnitude of climatic changes anticipated for the coming century are unprecedented, presenting unique challenges to the biota of the planet.
The GaLactic and Extragalactic All-sky Murchison Widefield Array survey is a radio continuum survey at 72–231 MHz of the whole sky south of declination +30º, carried out with the Murchison Widefield Array. In this paper, we derive source counts from the GaLactic and Extragalactic All-sky Murchison data at 200, 154, 118, and 88 MHz, to a flux density limit of 50, 80, 120, and 290 mJy respectively, correcting for ionospheric smearing, incompleteness and source blending. These counts are more accurate than other counts in the literature at similar frequencies as a result of the large area of sky covered and this survey’s sensitivity to extended emission missed by other surveys. At S154 MHz > 0.5 Jy, there is no evidence of flattening in the average spectral index (α ≈ −0.8 where S ∝ vα) towards the lower frequencies. We demonstrate that the Square Kilometre Array Design Study model by Wilman et al. significantly underpredicts the observed 154-MHz GaLactic and Extragalactic All-sky Murchison counts, particularly at the bright end. Using deeper Low-Frequency Array counts and the Square Kilometre Array Design Study model, we find that sidelobe confusion dominates the thermal noise and classical confusion at v ≳ 100 MHz due to both the limited CLEANing depth and the undeconvolved sources outside the field-of-view. We show that we can approach the theoretical noise limit using a more efficient and automated CLEAN algorithm.
The patterns and drivers of late Quaternary vegetation dynamics in the southeastern United States are poorly understood due to low site density, problematic chronologies, and a paucity of independent paleoclimate proxy records. We present a well-dated (15 accelerator mass spectrometry 14C dates) 30,000-yr record from White Pond, South Carolina that consists of high-resolution analyses of fossil pollen, macroscopic charcoal, and Sporormiella spores, and an independent paleotemperature reconstruction based on branched glycerol dialkyl tetraethers. Between 30,000 and 20,000 cal yr BP, open Pinus-Picea forest grew under cold and dry conditions; elevated Quercus before 26,000 cal yr BP, however, suggest warmer conditions in the Southeast before the last glacial maximum, possibly corresponding to regionally warmer conditions associated with Heinrich event H2. Warming between 19,700 and 10,400 cal yr BP was accompanied by a transition from conifer-dominated to mesic hardwood forest. Sporormiella spores were not detected and charcoal was low during the late glacial period, suggesting megaherbivore grazers and fire were not locally important agents of vegetation change. Pinus returned to dominance during the Holocene, with step-like increases in Pinus at 10,400 and 6400 cal yr BP, while charcoal abundance increased tenfold, likely due to increased biomass burning associated with warmer conditions. Low-intensity surface fires increased after 1200 cal yr BP, possibly related to the establishment of the Mississippian culture in the Southeast.
Chapter 13 addresses issues associated with experimental techniques for investigating hydrodynamic instabilties. These issues include the experimental facility, model configuration and instrumentation, all of which impact our understanding of hydrodynamic instabilities.
The instability of geophysical flows are covered in Chapter 7. From the class of geophysical flows, there are three classes that are distinct and that illustrate the salient properties when viewed from the basis of perturbations. These cases include the effects of density variations and rotation. The cases considered in this chapter are stratified flow, rotation (Rossby waves) and the Ekman layer.
Chapter 4 addresses the important topic of spatial instability for spatially evolving flows, such as shear layers, jets and wakes. The chapter starts out with a derivation of Gaster’s transformation that allows spatial growth rates to be computed from temporal growth rates. The chapter also presents a dicussion of absolute and convective instabilites, and of wavepackets. It concludes with a discussion of dicrete and continuous spectra.
Chapter 1 introduces the basic concepts of hydrodynamic stability theory. The chapter begins with a discussion of the classical experiments of Reynolds, and moves the reader quickly through other examples of instability found in nature. The basic equations of motion and their linearization are then introduced, which sets the up the foundation for the rest of the book.
Chapter 10 discusses the breakdown of hydrodynamic instability theory and the transition from laminar to turbulent flow. This chapter will expose the reader to issues effecting hydrodynamic instabilities, as well as the nonlinear breakdown of modes after linear growth, ending with a summary of a condensed history of methods that have been used to predict loss of laminar flow and the onset of transition to turbulence.
Chapter 6 presents a discussion of instabilities in coordinate systems other than Cartesian. In this context, the Taylor problem, Görtler vortices, pipe flow, the rotating disk problem, the trailing vortex and the round jet are all presented. In each case the linearized disturbance equations are derived.
Chapter 2 is devoted to the temporal stability of incompressible flows. The equations of motion are linearized, and the Rayleigh and Orr–Sommerfeld equations are derived using normal mode analysis. Kelvin–Helmhotlz theory is then introduced for invisicd flows, followed by a number of important theorems related to invisicd flows such as Rayleigh’s Inflection Point Theorem, Fjotroft’s Thoerem and Howard’s Semicircle Theorem, all of which are discussed in detail. The chapter concludes with the stability of the laminar mixing layer.