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Multidrug-resistant organisms (MDROs) cause ~5%–10% of infections in hospitalized children, leading to an increased risk of death, prolonged hospitalization, and additional costs. Antibiotic exposure is considered a driving factor of MDRO acquisition; however, consensus regarding the impact of antibiotic factors, especially in children, is lacking. We conducted a systematic review to examine the relationship between antibiotic use and subsequent healthcare-associated infection or colonization with an MDRO in children.
Systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline.
We searched PubMed and Embase for all English, peer-reviewed original research studies published before September 2018. Included studies evaluated hospitalized children, antibiotic use as an exposure, and bacterial MDRO as an outcome.
Of the 535 studies initially identified, 29 met the inclusion criteria. Overall, a positive association was identified in most studies evaluating a specific antibiotic exposure (17 of 21, 81%), duration of antibiotics (9 of 12, 75%), and number of antibiotics received (2 of 3, 67%). Those studies that evaluated any antibiotic exposure had mixed results (5 of 10, 50%). Study sites, populations, and definitions of antibiotic use and MDROs varied widely.
Published studies evaluating this relationship are limited and are of mixed quality. Limitations include observation bias in recall of antibiotic exposure, variations in case definitions, and lack of evaluation of antibiotic dosing and appropriateness. Additional studies exploring the impact of antibiotic use and MDRO acquisition may be needed to develop effective antibiotic stewardship programs for hospitalized children.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Both India and Nepal are prone to a wide range of natural and man-made disasters. Almost 85% of India’s area is vulnerable to one or more hazards, and more than 80% of the total population of Nepal is at risk of natural hazards. In terms of the number of people affected in reported disastrous events, India is in the top 10 and Nepal is in the top 20 globally. Over the last two decades, India and Nepal have taken steps to establish their respective National Disaster Management organizations, which provide essential disaster responses. However, key gaps still remain in trained clinical capacity for managing impacts from various disasters. Our review of the region has shown that large parts of the population suffer injuries, diseases, disabilities, psychosocial, and other health-related problems from disasters.
Develop disaster medicine clinical capacity to reduce morbidities and mortalities from disasters.
Independent published data and work undertaken by the lead author in various disasters in India and Nepal since 1993 formed the basis of establishing the Faculty of Disaster Medicine for South Asia. The Faculty of Disaster Medicine - India and Nepal (FDMIN) was launched from Pune in March 2015. This initiative is supported by the National Association of Primary Care (UK), Public Health England, Faculty of Pre-hospital Care of Royal College of Surgeons - Edinburgh and CRIMEDIM (Novara) - Italy.
FDMIN has international expert advisors and has outlined 16 modules training curriculum for health care professionals. FDMIN currently has partnerships for teaching disaster medicine program with 3 medical universities and 12 major health care providers. Six pilot training programmes have been conducted in Pune, Delhi, Chennai, and Kochin. Work is underway to submit an application to the Indian regulatory bodies for approval to establish a post-graduate diploma and Master’s for Disaster Medicine.
Introduction: With the increasing volume of medical literature published each year, it is difficult for clinicians to translate the latest research into practice. Awareness is the first step of knowledge translation and journals have begun using social media to increase the dissemination and awareness of their publications. Infographics can describe research findings visually, are shared broadly on social media, and may be a more effective way to convey information. We hypothesized that infographic abstracts would increase the social media dissemination and online readership of research articles relative to traditional abstracts. Methods: In this randomized controlled trial, 24 original research articles were chosen from the six issues of the Canadian Journal of Emergency Medicine (CJEM) published between July 2016 and May 2017 (4 articles per issue). Half were randomized to the infographic and control groups within each issue. Infographic articles were promoted using a visual infographic outlining the findings of the article. Control articles were promoted using a screen capture image of each articles abstract. Both were disseminated through the journals social media accounts (Twitter and Facebook) along with the link to the selected article. Infographics were also published on CanadiEM.org. Abstract views, full text views, and the change in Altmetric score were tracked for 30 days and compared between groups. Unpaired two-tailed t-tests were used to detect significant differences. Results: Abstract views (mean, SD) were significantly higher for infographic articles (378.9, 162.0) than control articles (175.5, 69.2, p<0.001). Mean Altmetric scores were significantly higher for infographic articles (26.4, 13.8) than control articles (3.4, 1.7, p<0.0001). There was no statistically significant difference in full-text views between infographic (49.7, 90.4) and control articles (25.3, 12.3). Conclusion: CJEM articles promoted on social media using infographics had higher abstract viewership and Altmetric scores than those promoted with traditional abstracts. Although there was no difference in full-text readership, our results suggest that infographic abstracts may have a role in increasing the dissemination of medical literature.
For livestock production systems to play a positive role in global food security, the balance between their benefits and disbenefits to society must be appropriately managed. Based on the evidence provided by field-scale randomised controlled trials around the world, this debate has traditionally centred on the concept of economic-environmental trade-offs, of which existence is theoretically assured when resource allocation is perfect on the farm. Recent research conducted on commercial farms indicates, however, that the economic-environmental nexus is not nearly as straightforward in the real world, with environmental performances of enterprises often positively correlated with their economic profitability. Using high-resolution primary data from the North Wyke Farm Platform, an intensively instrumented farm-scale ruminant research facility located in southwest United Kingdom, this paper proposes a novel, information-driven approach to carry out comprehensive assessments of economic-environmental trade-offs inherent within pasture-based cattle and sheep production systems. The results of a data-mining exercise suggest that a potentially systematic interaction exists between ‘soil health’, ecological surroundings and livestock grazing, whereby a higher level of soil organic carbon (SOC) stock is associated with a better animal performance and less nutrient losses into watercourses, and a higher stocking density with greater botanical diversity and elevated SOC. We contend that a combination of farming system-wide trials and environmental instrumentation provides an ideal setting for enrolling scientifically sound and biologically informative metrics for agricultural sustainability, through which agricultural producers could obtain guidance to manage soils, water, pasture and livestock in an economically and environmentally acceptable manner. Priority areas for future farm-scale research to ensure long-term sustainability are also discussed.
The aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration.
Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context.
This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.
A total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.
A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.
This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.
The P300 amplitude and latency were not associated (regression coef. −0.06, 95% CI −0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10–0.28, p < 0.001). There was no evidence of associations between lateral ventricular volume and the other measures (all p > 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.
The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.
We present δ13C, δ15N, and δ34S measurements on archaeological human and animal bone collagen samples from a shell midden dating to the Neolithic ca. 4000–3500 cal BC, together with measurements on modern fish and shellfish. These data were used in conjunction with the Bayesian mixing model, Food Reconstruction Using Isotopic Transferred Signals (FRUITS), to reconstruct human diet at the site. We demonstrate the importance of using a geographically appropriate faunal baseline in stable isotope paleodietary studies, and suggest that Neolithic individuals at this site consumed up to ca. 21% of dietary protein from marine resources, despite stable isotope ratios that imply a wholly terrestrial diet. This marine resource consumption does not significantly shift the radiocarbon (14C) dates of these individuals, so although we must consider the use of marine resources at the site, the chronology that has previously been established is secure. The δ13C and δ15N measurements from the archaeological herbivore bone collagen indicate that it is unlikely they ate plants enriched with fertilisers such as manure or seaweed. The δ34S values reveal a sea-spray effect; therefore, in this instance, δ34S cannot be used as a dietary indicator but can be used to demonstrate the likely locality of the fauna.
We review an improved statistical model of extra-galactic point-source foregrounds first introduced in Murray et al. (2017), in the context of the Epoch of Reionization. This model extends the instrumentally-convolved foreground covariance used in inverse-covariance foreground mitigation schemes, by considering the cosmological clustering of the sources. In this short work, we show that over scales of k ∼ (0.6, 40.)hMpc−1, ignoring source clustering is a valid approximation. This is in contrast to Murray et al. (2017), who found a possibility of false detection if the clustering was ignored. The dominant cause for this change is the introduction of a Galactic synchrotron component which shadows the clustering of sources.
We have developed a new numerical technique for simulating dusty-gas flows. Our code incorporates gas hydrodynamics, self-gravity and dust drag to follow the dynamical evolution of a dusty-gas medium. We have incorporated several descriptions for the drag between gas and dust phases and can model flows with submillimetre, centimetre and metre size “dust”. We present calculations run on the APAC1 supercomputer following the evolution of the dust distribution in the pre-solar nebula.
A new implementation of a calving model, using the finite-element code Elmer, is presented and used to investigate the effects of surface water within crevasses on calving rate. For this work, we use a two-dimensional flowline model of Columbia Glacier, Alaska. Using the glacier’s 1993 geometry as a starting point, we apply a crevasse-depth calving criterion, which predicts calving at the location where surface crevasses cross the waterline. Crevasse depth is calculated using the Nye formulation. We find that calving rate in such a regime is highly dependent on the depth of water in surface crevasses, with a change of just a few metres in water depth causing the glacier to change from advancing at a rate of 3.5 kma–1 to retreating at a rate of 1.9 km a–1. These results highlight the potential for atmospheric warming and surface meltwater to trigger glacier retreat, but also the difficulty of modelling calving rates, as crevasse water depth is difficult to determine either by measurement in situ or surface mass-balance modelling.
We conducted a seismic and radar survey of the central part of midtre Lovénbreen, a small, polythermal valley glacier in Svalbard. We determined the physical properties of the material beneath the glacier by measuring the reflection coefficient of the bed by comparing the energy of the primary and multiple reflections, and deriving the acoustic impedance. By making reasonable assumptions about the properties of the basal ice, we determined the acoustic impedance of the bed material as (6.78 ± 1.53) × 106 kg m−2 s−1. We interpret the material beneath the glacier to be permafrost with up to 50% ice, and we speculate that the material may be frozen talus similar to a deposit observed directly by others beneath another Svalbard glacier. The implication for midtre Lovénbreen is that the basal material beneath the present glacier is not able to support fast flow. We conclude that midtre Lovénbreen has most likely had limited capability for faster flow in the past, with motion dominated by internal deformation. Midtre Lovénbreen is used as a ‘study glacier’ for the scientific community in Svalbard, and a large number of studies have been based there. Our results show that it cannot be used as an analogue for larger glaciers in Svalbard, having distinct basal boundary conditions.
High-resolution surface velocity measurements and passive seismic observations from Rutford Ice Stream, West Antarctica, 40 km upstream from the grounding line are presented. These measurements indicate a complex relationship between the ocean tides and currents, basal conditions and ice-stream flow. Both the mean basal seismicity and the velocity of the ice stream are modulated by the tides. Seismic activity increases twice during each semi-diurnal tidal cycle. The tidal analysis shows the largest velocity variation is at the fortnightly period, with smaller variations superimposed at diurnal and semi-diurnal frequencies. The general pattern of the observed velocity is two velocity peaks during each semi-diurnal tidal cycle, but sometimes three peaks are observed. This pattern of two or three peaks is more regular during spring tides, when the largest-amplitude velocity variations are observed, than during neap tides. This is the first time that velocity and level of seismicity are shown to correlate and respond to tidal forcing as far as 40 km upstream from the grounding line of a large ice stream.
There is now evidence that at least some cometary nuclei are dark and red. Cometary ices prepared from combinations of CH4 with H2O and sometimes NH3 were irradiated at 77 K by corona discharge. CH4 - containing ice reddened and darkened at a dose ~1011 erg cm−2 over a period of ~1 hour. Upon evaporation of the now yellowish, irradiated ice, a slightly yellowish colored solid film remains on the walls of the container at room temperature. Transmission measurements of this organic film (called cometary tholin) were made from 0.2 μm to 50 μm wavelength. Strong UV absorption is seen from 0.45 μm to 0.2 μm. Above 0.45 μm, the spectrum remains flat to ~1.3 μm in the near infrared, except for a very small feature near 1.15 μm. A medium sized feature appears centered at 1.4 μm with shoulders at both sides and a nearby weaker feature at 1.52 μm. A strong feature appears at 1.9 μm accompanied by a smaller feature at 1.78 μm. in the region 2.5 μm to 50 μm, the infrared spectrum was taken by dispersing the film in a CsI matrix. Bands are found at 2.92(M), 3.36(S), 3.40(S), 3.46(M), 3.48(M), 5.75(M), 5.99(S), 6.21(M), 6.83(M), 7.30(S), 7.81(W), 8.89(M), 9.26(M), 20.00(W), 22.22(W), and 28.57(W) micrometers, suggesting complex organics including alkane, alkene, aldehyde, and carboxylic acid functional groups. These results are also relevant to UV and cosmic ray processing of interstellar grains, and to icy bodies in the outer solar system.
In the prevailing icy conglomerate model of the cometary nucleus, the outer surface is processed by galactic cosmic rays in the Oort cloud. Most ices composed of CH4, along with H2O and/or NH3, studied in our laboratory redden and darken upon charged particle irradiation from a high frequency corona discharge at 77 K. Spectral reflectance relative to a BaSO4 standard in the wavelength interval 0.39 μm to 0.70 μm was measured for incidence angle, i = 0° and emission angle, ε = −4°. CH4-containing ice at 77 K was modified at a dose ~1011 erg cm−2 over a period of ~1 hour. Progressive darkening followed continued irradiation. The ratio of the red to blue reflectance [R(λ = 0.70 μm)/R(λ = 0.40 μm)] changed from 0.9 to ~1.4. Using techniques of ellipsometric polarimetry, we are investigating the detailed optical properties (complex refractive index) of these ices before and after irradiation. These results may then be compared with the properties of cometary coma particles predicted by recent light scattering models to determine which classes of laboratory-produced materials best match the population of dark, reddish particles which seem to be prevalent in some cometary comae.