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Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.
Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale – Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).
Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.
These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
To describe national trends in testing and detection of carbapenemases
produced by carbapenem-resistant Enterobacterales (CRE) and associate
testing with culture and facility characteristics.
Retrospective cohort study.
Department of Veterans’ Affairs medical centers (VAMCs).
Patients seen at VAMCs between 2013 and 2018 with cultures positive for CRE,
defined by national VA guidelines.
Microbiology and clinical data were extracted from national VA data sets.
Carbapenemase testing was summarized using descriptive statistics.
Characteristics associated with carbapenemase testing were assessed with
Of 5,778 standard cultures that grew CRE, 1,905 (33.0%) had evidence of
molecular or phenotypic carbapenemase testing and 1,603 (84.1%) of these had
carbapenemases detected. Among these cultures confirmed as
carbapenemase-producing CRE, 1,053 (65.7%) had molecular testing for
≥1 gene. Almost all testing included KPC (n = 1,047, 99.4%), with KPC
detected in 914 of 1,047 (87.3%) cultures. Testing and detection of other
enzymes was less frequent. Carbapenemase testing increased over the study
period from 23.5% of CRE cultures in 2013 to 58.9% in 2018. The South US
Census region (38.6%) and the Northeast (37.2%) region had the highest
proportion of CRE cultures with carbapenemase testing. High complexity (vs
low) and urban (vs rural) facilities were significantly associated with
carbapenemase testing (P < .0001).
Between 2013 and 2018, carbapenemase testing and detection increased in the
VA, largely reflecting increased testing and detection of KPC. Surveillance
of other carbapenemases is important due to global spread and increasing
antibiotic resistance. Efforts supporting the expansion of carbapenemase
testing to low-complexity, rural healthcare facilities and standardization
of reporting of carbapenemase testing are needed.
4D-STEM, in which the 2D diffraction plane is captured for each 2D scan position in the scanning transmission electron microscope (STEM) using a pixelated detector, is complementing, and increasingly replacing existing imaging approaches. However, at present the speed of those detectors, although having drastically improved in the recent years, is still 100 to 1,000 times slower than the current PMT technology operators are used to. Regrettably, this means environmental scanning-distortion often limits the overall performance of the recorded 4D data. Here, we present an extension of existing STEM distortion correction techniques for the treatment of 4D data series. Although applicable to 4D data in general, we use electron ptychography and electric-field mapping as model cases and demonstrate an improvement in spatial fidelity, signal-to-noise ratio (SNR), phase precision, and spatial resolution.
AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
This is an epidemiological study of carbapenem-resistant Enterobacteriaceae (CRE) in Veterans’ Affairs medical centers (VAMCs). In 2017, almost 75% of VAMCs had at least 1 CRE case. We observed substantial geographic variability, with more cases in urban, complex facilities. This supports the benefit of tailoring infection control strategies to facility characteristics.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.
A survey of Veterans’ Affairs Medical Centers on control of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-producing CRE (CP-CRE) demonstrated that most facilities use VA guidelines but few screen for CRE/CP-CRE colonization regularly or regularly communicate CRE/CP-CRE status at patient transfer. Most respondents were knowledgeable about CRE guidelines but cited lack of adequate resources.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.
We detail tentative detections of low-frequency carbon radio recombination lines from within the Orion molecular cloud complex observed at 99–129 MHz. These tentative detections include one alpha transition and one beta transition over three locations and are located within the diffuse regions of dust observed in the infrared at 100 μm, the Hα emission detected in the optical, and the synchrotron radiation observed in the radio. With these observations, we are able to study the radiation mechanism transition from collisionally pumped to radiatively pumped within the H ii regions within the Orion molecular cloud complex.
OBJECTIVES/SPECIFIC AIMS: Clostridium difficile is the most common cause of infectious antibiotic associated diarrhea. It is often refractory to antimicrobial therapy and fecal microbiota transplantation (FMT) is emerging as a therapeutic option. The objective is to characterize the direct effects of FMT on the gut microbiota. METHODS/STUDY POPULATION: Fecal specimens were obtained from a cohort of 29 subjects with recurrent C. difficile infection who received FMTs from 1 of 4 healthy donors as part of a phase 2 trial (Rebiotix). Fecal specimens were collected from the subject before FMT and up to 6 months post FMT. 16S rRNA sequencing and whole-genome shotgun sequencing were used to assess microbial community composition as compared by weighted Unifrac. RESULTS/ANTICIPATED RESULTS: Before treatment, the microbial community of subjects with C. difficile infection was highly distinct from the composition of the healthy donors in terms of metabolic profile. Quantification of phylogenetic community distance from donor by weighted Unifrac distance showed a significant decrease within the 1st week (Wilcoxon rank sum, p<0.01). This metric was predictive of both treatment failures and antibiotic resistance gene count (LR=22.45, p<0.0001). DISCUSSION/SIGNIFICANCE OF IMPACT: We conclude that distance from donor is a useful metric to quantify FMT success and that FMTs are a promising treatment for otherwise untreatable carriage of antibiotic resistance genes and organisms.
The geographical distribution of the two species of the genus Parachaenichthys is allopatric and restricted to the inner shelves of South Georgia–South Sandwich Islands (P. georgianus) and South Orkney Islands–South Shetland Islands (P. charcoti). To evaluate the consistency between the geographical patterns of adult distribution and early life history traits of P. charcoti, sagittal otoliths were used to estimate growth rate and pelagic duration in larvae and juveniles of this species collected in the Bransfield Strait in winter and summer, respectively. Individual age was determined through microincrement counts, assuming they were daily increments. The Gompertz model was fitted to age–length estimates, providing a mean growth rate of 0.22 mm day-1 estimated for 28–204-day-old individuals. Larval hatching was spread over a relatively wide period, lasting from July throughout September. The pelagic larval duration of P. charcoti was about six months based on ageing data of larvae and juveniles, as reported for P. georgianus from South Georgia. The strong dependence of larvae on the inshore habitat may hamper their dispersal at large spatial scale limiting the connectivity among distant populations, providing clues to interpret the present geographical distribution of the two species.
Early life history traits of the blackfin notothen, Trematomus scotti, were investigated through otolith microincrement pattern and stomach content analyses. Post-larval specimens of 12–20 mm standard length (SL) were collected in the Bransfield Strait and adjacent waters during the 2010–11 summer. Catches were unevenly distributed across the surveyed area, yielding a relative abundance of 0.3–3.6 specimens per 1000 m3 of filtered sea water. Age estimates ranged from 34 to 67 days, with good consistency and no apparent bias between readings. Based on an exponential model fitted to the age-length dataset, the growth rate was 0.17 mm day-1, corresponding to a daily percentage increment in size of 1.07% SL. In agreement with previous studies, larval hatching occurred at a mean size of 9.0 mm and was spread over a relatively short period, lasting from late December to late January. Prey composition consisted exclusively of copepods, mainly larval stages of copepodites. Feeding intensity ranged from 1–14 prey items per stomach, being positively correlated with larval fish size. In summary, T. scotti shares a common early life history strategy with several other notothenioids, consisting of small larvae hatching in summer and overwintering as pelagic early juveniles until the following summer season.
While recent years have seen rapid growth in the number of galaxy peculiar velocity measurements, disagreements remain about the extent to which the peculiar velocity field - a tracer of the large-scale distribution of mass - agrees with both ΛCDM expectations and with velocity field models derived from redshift surveys. The 6dF Galaxy Survey includes peculiar velocities for nearly 9 000 early-type galaxies (6dFGSv), making it the largest and most homogeneous galaxy peculiar velocity sample to date. We have used the 6dFGS velocity field to determine the amplitude and scale of large-scale cosmic flows in the local universe and test standard cosmological models. We also compare the galaxy density and peculiar velocity fields to establish the distribution of dark and luminous matter and better constrain key cosmological parameters such as the redshift-space distortion parameter.