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We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Animal models of early postnatal mother–infant interactions have highlighted the importance of tactile contact for biobehavioral outcomes via the modification of DNA methylation (DNAm). The role of normative variation in contact in early human development has yet to be explored. In an effort to translate the animal work on tactile contact to humans, we applied a naturalistic daily diary strategy to assess the link between maternal contact with infants and epigenetic signatures in children 4–5 years later, with respect to multiple levels of child-level factors, including genetic variation and infant distress. We first investigated DNAm at four candidate genes: the glucocorticoid receptor gene, nuclear receptor subfamily 3, group C, member 1 (NR3C1), μ-opioid receptor M1 (OPRM1) and oxytocin receptor (OXTR; related to the neurobiology of social bonds), and brain-derived neurotrophic factor (BDNF; involved in postnatal plasticity). Although no candidate gene DNAm sites significantly associated with early postnatal contact, when we next examined DNAm across the genome, differentially methylated regions were identified between high and low contact groups. Using a different application of epigenomic information, we also quantified epigenetic age, and report that for infants who received low contact from caregivers, greater infant distress was associated with younger epigenetic age. These results suggested that early postnatal contact has lasting associations with child biology.
The Molonglo Observatory Synthesis Telescope (MOST) is an 18000 m2 radio telescope located 40 km from Canberra, Australia. Its operating band (820–851 MHz) is partly allocated to telecommunications, making radio astronomy challenging. We describe how the deployment of new digital receivers, Field Programmable Gate Array-based filterbanks, and server-class computers equipped with 43 Graphics Processing Units, has transformed the telescope into a versatile new instrument (UTMOST) for studying the radio sky on millisecond timescales. UTMOST has 10 times the bandwidth and double the field of view compared to the MOST, and voltage record and playback capability has facilitated rapid implementaton of many new observing modes, most of which operate commensally. UTMOST can simultaneously excise interference, make maps, coherently dedisperse pulsars, and perform real-time searches of coherent fan-beams for dispersed single pulses. UTMOST operates as a robotic facility, deciding how to efficiently target pulsars and how long to stay on source via real-time pulsar folding, while searching for single pulse events. Regular timing of over 300 pulsars has yielded seven pulsar glitches and three Fast Radio Bursts during commissioning. UTMOST demonstrates that if sufficient signal processing is applied to voltage streams, innovative science remains possible even in hostile radio frequency environments.
The linearly polarized component of a pulsar signal at different radio frequencies can help to constrain the parallel component of the magnetic field along the line of sight. In this work we measured the polarimetric properties of the pulsars in the globular cluster 47 Tucanae and we report the Rotation Measure (RM) for 13 of them. A gradient in the RM values of the pulsars across the cluster is detected suggesting the presence of significant variations in the magnetic field across the very small angular scales associated with the lines of sight to the pulsars in 47 Tucanae. Both magnetic fields located in the globular cluster or in the Galactic disk in the direction of the cluster are taken into consideration. However, more detailed modelling of the dynamics of the cluster and deeper observations with the MeerKAT and/or the SKA1 radio telescopes are necessary to discriminate among the models.
The class of radio transients called Fast Radio Bursts (FRBs) encompasses enigmatic single pulses, each unique in its own way, hindering a consensus for their origin. The key to demystifying FRBs lies in discovering many of them in order to identity commonalities – and in real time, in order to find potential counterparts at other wavelengths. The recently upgraded UTMOST in Australia, is undergoing a backend transformation to rise as a fast transient detection machine. The first interferometric detections of FRBs with UTMOST, place their origin beyond the near-field region of the telescope thus ruling out local sources of interference as a possible origin. We have localised these bursts to much better than the ones discovered at the Parkes radio telescope and have plans to upgrade UTMOST to be capable of much better localisation still.
The Square Kilometre Array will be an amazing instrument for pulsar astronomy. While the full SKA will be sensitive enough to detect all pulsars in the Galaxy visible from Earth, already with SKA1, pulsar searches will discover enough pulsars to increase the currently known population by a factor of four, no doubt including a range of amazing unknown sources. Real time processing is needed to deal with the 60 PB of pulsar search data collected per day, using a signal processing pipeline required to perform more than 10 POps. Here we present the suggested design of the pulsar search engine for the SKA and discuss challenges and solutions to the pulsar search venture.
Patterns of turnover in the mammalian fossil record have been interpreted as reflecting “pulses” of originations and extinctions hypothesized to be driven by climate change. However, criteria for determining what constitutes a meaningful pulse have been idiosyncratic, and investigations of turnover patterns in mammals have yielded mixed results.
This study presents simple simulations of fossil records in which origination and extinction probabilities for each lineage are held constant. Nonetheless, the total number of turnover events per time bin varies stochastically, producing statistical “noise.” Various simulation and analytical assumptions are examined to determine their impact on the type I error rate (i.e., how often “pulses” are detected in a purely stochastic process).
Results suggest that simple analytical parameters (length of time bins and turnover-pulse criterion) have predictable and straightforward effects on false-positive rates. Furthermore, “pulses” of turnover of a magnitude similar to that observed in the terrestrial mammalian fossil record may be quite common under realistic analytical conditions.
The null turnover model offers a practical way to evaluate the significance of observed turnover events in future empirical studies of the fossil record. In evaluating the significance of a “pulse” of fossil origination or extinction events, analytical parameters can be explored using this null model to determine the approximate type I error rate for a set of parameters. Because false-positive rates are shown to be quite high, functional trait-based approaches may offer more reliable indicators of the impact of climate change on turnover dynamics.
Here, we present a catalogue of known Fast Radio Burst sources in the form of an online catalogue, FRBCAT. The catalogue includes information about the instrumentation used for the observations for each detected burst, the measured quantities from each observation, and model-dependent quantities derived from observed quantities. To aid in consistent comparisons of burst properties such as width and signal-to-noise ratios, we have re-processed all the bursts for which we have access to the raw data, with software which we make available. The originally derived properties are also listed for comparison. The catalogue is hosted online as a Mysql database which can also be downloaded in tabular or plain text format for off-line use. This database will be maintained for use by the community for studies of the Fast Radio Burst population as it grows.
Recent EXOSAT observations of active galactic nuclei are presented. Unlike earlier X-ray satellites (all of which flew in low earth orbit), the deep orbit of EXOSAT allows long continuous observations of celestial X-ray sources, uninterrupted by earth occultation etc. We present the results of EXOSAT observations of several AGN which have been seen to vary rapidly (timescale 0.2–6 hours). We also consider the implications of rapid variability in AGN. For Seyfert galaxies and quasars, we find a highly significant correlation between the timescale of variability and their X-ray luminosity. They are not, howwever, bounded either by the (classical) Eddington limit nor by efficiency arguments. We sugest, rather, that the emitting plasma is dominated by electron-positron pairs.
Since the Admiralty's instructions to Captain Sir John Franklin for his attempt at a transit of the northwest passage in HMS Erebus and Terror in 1845 specified that he should proceed to Cape Walker at the northeastern tip of Russell Island, and head southwest from there to the waterways already explored along the mainland coast of North America, as far as ice conditions and any intervening land permitted, it was natural that the first search expedition to come within striking distance of Cape Walker, should make this one of the starting points of its detailed search. This was the squadron of Captain Horatio Austin that wintered off the northeast coast of Griffith Island in 1850–1851. Following his orders, in the spring of 1851 Captain Erasmus Ommanney of HMS Assistance set off with an impressive cavalcade of seven man-hauled sledges, most of them support sledges. From Cape Walker Lt. William Browne searched the east coast of Prince of Wales Island, that is the western shores of Peel Sound while Ommanney himself and Lt. Sherard Osborn searched the west coast of Prince of Wales Island, that is the east shore of McClintock Channel. No traces of Franklin's expedition were found. Their conclusions were that both McClintock Channel and Peel Sound were permanently blocked with ice, and that Franklin's ships could not have travelled south by either route. While the conclusion as regards McClintock Channel was absolutely correct, that with regard to Peel Sound was incorrect. This must have been the route whereby Erebus and Terror had reached the vicinity of King William Island, and the conclusion that Peel Sound never cleared of ice was very unfortunate in that the next search expedition dispatched by the Admiralty, that of Captain Sir Edward Belcher in 1852–1854 made no attempt to penetrate south, when it is possible that Peel Sound was clear of ice.
Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996–2014), Embase (1980–2014) and PsycINFO (1806–2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.
To explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents.
In the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis.
Vancouver, Canada, in 2012–2013.
Twenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention.
The mean age of participants was 14 (sd 1·9) years, 77 % were female and their mean BMI Z-score was 2·4 (sd 0·6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents.
Adolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.
Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)
The microstructure of narrow metal conductors in the electrical interconnections on IC chips has often been identified as of major importance in the reliability of these devices. The stresses and stress gradients that develop in the conductors as a result of thermal expansion differences in the materials and of electromigration at high current densities are believed to be strongly dependent on the details of the grain structure. The present work discusses new techniques based on microbeam x-ray diffraction (MBXRD) that have enabled measurement not only of the microstructure of totally encapsulated conductors but also of the local stresses in them on a micron and submicron scale. White x-rays from the Advanced Light Source were focused to a micron spot size by Kirkpatrick-Baez mirrors. The sample was stepped under the micro-beam and Laue images obtained at each sample location using a CCD area detector. Microstructure and local strain were deduced from these images. Cu lines with widths ranging from 0.8 [.proportional]m to 5 [.proportional]m and thickness of 1 [.proportional]m were investigated. Comparisons are made between the capabilities of MBXRD and the well established techniques of broad beam XRD, electron back scatter diffraction (EBSD) and focused ion beam imagining (FIB).