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We analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in antibiotic use after the fluoroquinolone US Food and Drug Administration (FDA) advisory update in 2016. Fluoroquinolone use declined both before and after the FDA announcement, and the use of select, alternative antibiotics increased after the announcement.
Fluoroquinolones are among the 4 most commonly prescribed antibiotic classes.1,2 Postmarketing reports of serious adverse events linked to fluoroquinolones include tendonitis, neuropathy, hypoglycemia, psychiatric side effects, and possible aortic vessel rupture, leading to safety label changes in July 2008 and August 2013.3 In July 2016, the US Food and Drug Administration (FDA) strengthened the “black box” warning following an initial safety announcement in May 2016, recommending avoidance of fluoroquinolones for uncomplicated infections such as acute exacerbation of chronic bronchitis, uncomplicated urinary tract infections, and acute bacterial sinusitis.4 Concerns over safety and the association with Clostridiodes difficile infection have led inpatient antimicrobial stewardship programs (ASPs) to develop initiatives to promote avoidance of quinolones. The objective of this study was to quantify the effect of the 2016 FDA “black box” update on inpatient antibiotic use among a cohort of southeastern US hospitals.
The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.
To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.
A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.
Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.
The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
Young people with 22q11.2 deletion syndrome (22q11.2DS) are at high risk for neurodevelopmental disorders. Sleep problems may play a role in this risk but their prevalence, nature and links to psychopathology and cognitive function remain undescribed in this population.
Sleep problems, psychopathology, developmental coordination and cognitive function were assessed in 140 young people with 22q11.2DS (mean age = 10.1, s.d. = 2.46) and 65 unaffected sibling controls (mean age = 10.8, s.d.SD = 2.26). Primary carers completed questionnaires screening for the children's developmental coordination and autism spectrum disorder.
Sleep problems were identified in 60% of young people with 22q11.2DS compared to 23% of sibling controls (OR 5.00, p < 0.001). Two patterns best-described sleep problems in 22q11.2DS: restless sleep and insomnia. Restless sleep was linked to increased ADHD symptoms (OR 1.16, p < 0.001) and impaired executive function (OR 0.975, p = 0.013). Both patterns were associated with elevated symptoms of anxiety disorder (restless sleep: OR 1.10, p = 0.006 and insomnia: OR 1.07, p = 0.045) and developmental coordination disorder (OR 0.968, p = 0.0023, and OR 0.955, p = 0.009). The insomnia pattern was also linked to elevated conduct disorder symptoms (OR 1.53, p = 0.020).
Clinicians and carers should be aware that sleep problems are common in 22q11.2DS and index psychiatric risk, cognitive deficits and motor coordination problems. Future studies should explore the physiology of sleep and the links with the neurodevelopment in these young people.
Violent hazing has been a longstanding issue within African American, collegiate fraternities and sororities, otherwise known as black Greek‐letter organizations (BGLOs). This article investigates how and what hazing victims know about their hazing experiences. Additionally, the article examines how victims' knowledge of hazing may hold serious implications for tort defense doctrines like assumption of risk and comparative fault. Specifically, the authors conduct two studies—one quantitative and the other qualitative—to find that not only are BGLO pledges aware that their pledge experiences are likely to involve mental and physical hazing, but that they believe such experiences will likely continue throughout the entirety of their induction process. Moreover, appreciation for hazing experiences is often captured in the fraternal chants, greetings, and songs they learn or create, which together reflects some understanding of danger and risk. The authors contend that these elements of black “Greek” hazing culture may serve as evidence of assumption of risk or comparative fault.
We present early results from the first near-IR imaging of the weak X-ray sources discovered in the recent Chandra/ACIS-I survey towards the Galactic Centre (GC) (Wang et al. 2002). These ~800 discrete sources, which contribute significantly to the GC X-ray emission, represent an important and previously unknown population within the Galaxy. From our VLT observations we will identify likely IR counterparts to a sample of the hardest sources, which are most likely X-ray binaries. With these data we can place constraints on the nature of the discrete weak X-ray source population of the GC. Once the data analysis is complete we will discuss our results in the context of binary population synthesis models.
To understand increasing rates of hepatitis C virus (HCV) infection in Tennessee, we conducted testing, risk factor analysis and a nested case–control study among persons who use drugs. During June–October 2016, HCV testing with risk factor assessment was conducted in sexually transmitted disease clinics, family planning clinics and an addiction treatment facility in eastern Tennessee; data were analysed by using multivariable logistic regression. A nested case–control study was conducted to assess drug-using risks and behaviours among persons who reported intranasal or injection drug use (IDU). Of 4753 persons tested, 397 (8.4%) were HCV-antibody positive. HCV infection was significantly associated with a history of both intranasal and IDU (adjusted odds ratio (aOR) 35.4, 95% confidence interval (CI) 24.1–51.9), IDU alone (aOR 52.7, CI 25.3–109.9), intranasal drug use alone (aOR 2.6, CI 1.8–3.9) and incarceration (aOR 2.7, CI 2.0–3.8). By 4 October 2016, 574 persons with a reported history of drug use; 63 (11%) were interviewed further. Of 31 persons who used both intranasal and injection drugs, 26 (84%) reported previous intranasal drug use, occurring 1–18 years (median 5.5 years) before their first IDU. Our findings provide evidence that reported IDU, intranasal drug use and incarceration are independent indicators of risk for past or present HCV infection in the study population.
Dairy cows are increasingly being fed high levels of starch to increase energy intake and promote milk protein content. However, too high levels of degradable starch can cause rumen acidotic effects leading to poor rumen health, laminitis and ultimately reduced efficiency of milk production. Fibrous feeds have known benefits on rumen health by helping to buffer rumen pH, but little is known of the effects of replacing starch with fibre in high maize silage based rations for dairy cows. The objective of this trial was to determine the effects of incremental replacement of cereal grain with sugar beet feed in a total mixed ration on dry matter intake, milk yield, milk composition and yield of milk constituents of lactating dairy cows receiving a high starch diet based on maize silage.
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.
Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.
Retrospective cohort study.
Tertiary-care burn center.
Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.
HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.
Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.
Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.
The Bembridge Limestone Formation (BLF), Late Eocene of Headon Hill, Isle of Wight, England, contains a diverse array of mammals (around 50 spp.) distributed through 10 levels. Its lower part (“lower fauna”) marks the appearance of a significant number of species, genera and one family unknown from earlier English Late Eocene strata. Towards the top of the BLF there is a reversion to faunas (“upper fauna”) more typical of the underlying Headon Hill Formation. This represents their last appearance in England. The succeeding Bembridge Marls Member fauna is similar to that in the lower part of the BLF. These changes are provincial in scale and may be climate induced (reflecting a slight warming followed by terminal Eocene cooling). Superimposed on these changes are smaller-scale more frequent fluctuations linked to alternating marl and black mud lithologies which may represent local habitat changes. In order to obtain overall understanding of the environment of deposition and taphonomic bias influencing these mammalian assemblages an integrated multidisciplinary study is being undertaken.
Plant macrofossils are unfortunately extremely rare in this sequence. Those few which are present typify the fresh-water marsh vegetation widespread in the Late Eocene/Early Oligocene of England. In contrast mammalian faunas indicate more wooded conditions. Seeds like those of the modern free-floating fresh-water plant Stratiotes occur in three levels. However, they are poorly-preserved. The chemical composition of the seed coat as revealed by flash pyrolysis gas chromatography indicates a very simple polyphenol macromolecule probably resulting from transformations of more complex polyphenols in well-preserved Stratiotes seeds.
Determinable palynomorphs are very rare and largely restricted to the part of the sequence which contains the “upper fauna”. They suggest a tranquil fresh-water depositional setting as do several molluscs and charophytes. Palynomorphs also include fungal remains, fern spores and a few tree pollen, the latter possibly from regional vegetation. However, the bulk of the palynological organic matter consists of brown structureless organic matter (SOM), resin-like particles and “platy kerogen”. In the lower beds, pale shelly muds with potamidids and corbiculids lack mammals and contain palynological organic matter dominated by resin-like particles and with abundant pyrite. These beds probably reflect brackish influence, the loss of which largely coincides with the reappearance of abundant mammals (“lower fauna”), occurrence of Stratiotes and of charophytes. Resin-like particles remain dominant in the palynological organic matter. “Platy kerogen” dominates three units including that containing the first occurrence of the “upper fauna”. Subsequently resin-like particles again dominate. Brown SOM is scattered throughout but is well represented in two units one of which contains “lower fauna” the other “upper fauna”.
Variations in palynological organic matter are reflected in the chemical composition of residues studied. Results from five black muds show that samples which mainly contain resin-like particles are dominated by n-alkanes and n-alk-1-enes in their pyrolysates. However, there is no indication of known resin chemical signatures. This indicates that the organic matter in these residues is mainly derived from cuticles (cutan) and/or cell wall remains (algaenan) of fresh-water algae. Samples containing “platy kerogen” and brown SOM are dominated by aromatics and phenols in their pyrolysates indicating an origin from woody materials. Work in progress on stable isotope analyses of the residues may further clarify the nature of the organic input.
The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location.
We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score–matched subsample.
Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85–2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22–1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39–3.21) and colonizations (RR, 1.32; 95% CI, 1.22–1.50) had an increased risk of death at 30 days.
We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations.
Ventilator-associated pneumonia (VAP) is a frequent complication of severe burn injury. Comparing the current ventilator-associated event-possible VAP definition to the pre-2013 VAP definition, we identified considerably fewer VAP cases in our burn ICU. The new definition does not capture many VAP cases that would have been reported using the pre-2013 definition.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
In the 1998-99 flight, BOOMERanG has produced maps of ∼4% of the sky at high Galactic latitudes, at frequencies of 90, 150, 240 and 410 GHz, with resolution ≳ 10'. The faint structure of the Cosmic Microwave Background at horizon and sub-horizon scales is evident in these maps. These maps compare well to the maps recently obtained at lower frequencies by the WMAP experiment. Here we compare the amplitude and morphology of the structures observed in the two sets of maps. We also outline the polarization sensitive version of BOOMERanG, which was flown early this year to measure the linear polarization of the microwave sky at 150, 240 and 350 GHz.
The Southern Hemisphere VLBI Experiment (SHEVE) program is aimed at producing high-resolution images of southern radio sources. The radio telescopes of the present SHEVE array are described below and some recent results presented.
In consequence of the decision made by the Fifth General Assembly of the I.A.U. I have been entrusted, from January 1936, with the direction of the Central Bureau for the International Service of Latitudes.
I am much indebted to Prof. Kimura, who preceded me as Director and to Prof. Kohlschütter, Director of the Geodetic Institute of Potsdam, for information and advice, which has been of great assistance to me; therefore I desire to acknowledge to them my deep gratitude.
Commission 46 is dedicated to Teaching of Astronomy. Commission 46 can be seen as an
extension of the IAU Executive Committee in the sense that each adhering country has
appointed a national representative to the Commission. National Representatives maintain
liaison between the Commission and the home country, and write national triennial reports
on development of astronomy on their nations. Other IAU astronomers, with special interest in education, can become regular individual members of the Commission. Non-IAU
members can be invited by the Commission to serve for one triennial term. Commission
46 considers that one of its major duties is to contribute to enhance astronomy education
in developing countries. The Newsletter, the International School for Young Astronomers,
the Visiting Lecturer Program and the Travelling Telescope are examples of such activities administered by the Commission. The strength of Commission 46 comes from the hard
work that its members do in order to promote astronomy education worldwide.
La centralisation au Bureau international de l’Heure des résultats d’observations de l’Opération internationale de 1933 a été très lente, puisque les dernières données attendues ont été reçues vers la fin de 1937.
Le nombre des stations ayant coopéré à l’Opération internationale et ayant transmis leurs observations à l’organisme centralisateur s’élève à soixante et onze. Ainsi qu’il a été expliqué à notre Commission mixte, lors du Congrès de l’Union géodésique et géophysique internationale tenu à Édimbourg en 1936, ces stations ont été réparties en trois groupes:
Le Ier comprenant vingt Observatoires, disposant chacun de plusieurs horloges de première classe (soit à poids sous pression et à température constantes, soit à quartz piézoélectrique);