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Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.
Methods:
This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.
Results:
There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.
Conclusions:
Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.
People with psychosis experience worse cardiometabolic health than the same-aged general population. In New Zealand, Indigenous Māori experiencing psychosis have greater risk of cardiometabolic and other physical health problems.
Aims
To identify a cohort of adults accessing secondary mental health and addiction services in New Zealand, with a previous psychosis diagnosis as of 1 January 2018, and compare odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening between Māori and non-Māori in the following 2 years.
Method
Crude and adjusted logistic regression models compared odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening (lipids and haemoglobin A1c) between Māori and non-Māori, occurring between 1 January 2018 and 31 December 2019.
Results
A cohort (N = 21 214) of Māori (n = 7274) and non-Māori (n = 13 940) was identified. Māori had higher adjusted risk of mortality (odds ratio 1.26, 95% CI 1.03–1.54), and hospital admission with diabetes (odds ratio 1.64, 95% CI 1.43–1.87), cardiovascular disease (odds ratio 1.54, 95% CI 1.25–1.88) and any physical health condition (odds ratio 1.07, 95% CI 1.00–1.15) than non-Māori. Around a third of people did not receive recommended cardiometabolic blood screening, with no difference between Māori and non-Māori after covariate adjustment.
Conclusions
Māori experiencing psychosis are more likely to die and be admitted to hospital with cardiovascular disease or diabetes than non-Māori. Because of the higher cardiometabolic risk borne by Māori, it is suggested that cardiometabolic screening shortfalls will lead to worsening physical health inequities for Māori experiencing psychosis.
There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. Psychiatry resident’s duty hours in Spain comprise a regular working schedule of 37.5h per week and a minimum of 4 mandatory on-call shifts. The most recent duty hours regulations in Spain were transposed from the European Working Time Directive (EWTD). According to Spanish Law, doctors cannot work for more than 48h per week and need to have resting times per day (at least 12h), per week (at least 36h) as well as annual leave (at least a month). However, there is practically no data on this situation in psychiatry resident physicians.
Objectives
Our aim is firstly, to describe the number of shifts performed by psychiatry resident physicians in Spain. Secondly, to describe compliance with the daily and weekly rests compared to those set in national and European law. Finally, to analyse the difference by demographic variables (gender and year of residency), in both the number of on-call duty shifts and compliance with rests.
Methods
A descriptive cross-sectional study was designed through an online survey adapted from the existing literature. The target population were Spanish psychiatry resident physicians undergoing PGT who started their specialist training during the years 2018–2021. The survey was disseminated through the Spanish regional medical councils to all active psychiatry resident physicians by mail as well as through informal communication channels. The study was authorised by the Spanish Medical Organization’s General Assembly which is the highest ethical and deontological body of physicians in Spain.
Results
55 responses were obtained, of which 61.82% identified as females. The mean number of on-call shifts in the last 3 months was 14.05. This mean was highest in women 14,32 and in the cohort of 2020 15.46 (first year of residency). Among the resident physicians surveyed, 66.07% exceeded the 48h per week limit set by the EWTD and 7% of them did not rest after a 24-h on-call shift. Furthermore, 22% of respondents did not have a day-off after a Saturday on-call shift. The mean working hours when not resting after an on-call-shift were 7 hours. The comparison by gender and year of residency of the main variables can be seen in figures 1 and 2 respectively.
Image:
Image 2:
Conclusions
Psychiatry resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labour regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed. Differences can be seen by gender and year of residency. The situation described could potentially create a high-risk situation for the health and psychosocial well-being of resident physicians, hinder learning outcomes and could lead to suboptimal patient care.
A variational principle is proposed to derive the governing equations for the problem of ocean wave interactions with a floating ice shelf, where the ice shelf is modelled by the full linear equations of elasticity and has an Archimedean draught. The variational principle is used to form a thin-plate approximation for the ice shelf, which includes water–ice coupling at the shelf front and extensional waves in the shelf, in contrast to the benchmark thin-plate approximation for ocean wave interactions with an ice shelf. The thin-plate approximation is combined with a single-mode approximation in the water, where the vertical motion is constrained to the eigenfunction that supports propagating waves. The new terms in the approximation are shown to have a major impact on predictions of ice shelf strains for wave periods in the swell regime.
The technique of scanning force microscopy (SFM) was used to study the nanometer-scale structure of Cu(II)-exchanged hectorite thin films. Supporting data were also obtained from Electron Spin Resonance (ESR) and X-ray diffraction (XRD) techniques. The surfaces studied included pure Cu(II)-exchanged hectorite, Cu(II)-exchanged hectorite exposed to benzene and Cu(II)-exchanged hectorite exposed to aniline. SFM images of the unexposed Cu(II)-exchanged hectorite surface revealed a smooth surface composed of interlocking platelets. The lateral dimension of these platelets ranged from a few nm to about 1 μm. After exposure to refluxing benzene, the SFM showed that the platelets underwent vertical shifts in position. This is believed to have occurred from intercalated benzene that polymerized in the interlayer region. No SFM evidence was obtained for benzene polymerization on the surface of the hectorite. Hectorite films exposed to aniline at room temperature revealed a post-polymerization structure on the hectorite surface consisting of small polymer bundles. The diameter of these bundles was measured to be 300–3000 Å, similar to the structure seen on electropolymerized polyaniline films. Aniline polymerized on the surface of hectorite films at 180 °C revealed a structure similar to undoped n-methyl-pyrrolidinone (NMP) cast polyaniline films. In this case, the polymer bundles are only 300 Å in dimension on average. XRD and ESR data also indicated interlayer aniline polymerization in Cu(II) exchanged hectorite. Mechanistic considerations affecting these polymerization reactions are presented.
We created a relational database that captures every author and work ever selected for The Norton Anthology of American Literature. Given this anthology's influence, our database reveals changes in the literary canon over the past half century. We find that the common story of increased diversity is true, albeit truer with respect to race than gender. However, the biggest structural change has been a substantial growth in the number of anthologized authors. We argue that, while that strategy has produced real gains, it also creates a canon that less effectively manages reader attention, affords women and people of color a less valuable position than many white male authors once enjoyed, and tacitly accepts the notion that the new additions do not have greater literary merit than authors on the original roster, whom we show editors too rarely cut.
Standardized observation of bed baths and showers for 100 residents in 8 nursing homes revealed inadequate cleansing of body sites (88%–100% failure) and >90% process failure involving lather, firm massage, changing dirty wipes or cloths, and following clean-to-dirty sequence. Insufficient water warmth affected 86% of bathing opportunities. Bathing training and adequate resources are needed.
Do short stories cohere into a genre, different from other prose fiction, merely by virtue of their length, or, as some critics have argued, are there narrative and thematic differences that go beyond the question of how long they are? In this chapter, we turn to Digital Humanities methods to explore these questions in a corpus of around 10,000 short stories published in twentieth-century women’s magazines. As we analyze the deployment of characters, the narrative patterns, and the linguistic variety of the short stories in our corpus, we reveal the ways that these popular short stories trace a new history of short story writing. The constraints of “mere” length, our analysis shows, allow short fiction to develop a new kind of narrative, one different from that of the novel. Rather than simply a side-effect of the genre, the shortness of the short story is fundamental to understanding its narrative possibilities.
In November 1995, the Laboratory of Archaeology at the University of Georgia submitted inventories and summaries of Indigenous ancestors and funerary objects in its holdings to comply with the passage of the Native American Graves Protection and Repatriation Act (NAGPRA). However, after this submission, the Laboratory attempts at consultation with federally recognized descendant Tribal communities who have cultural ties in the state of Georgia were not successful, and NAGPRA-related activities essentially stalled at the Laboratory. Beginning in 2019, the Laboratory's staff recognized a lack of formal NAGPRA policies or standards, which led to a complete reevaluation of the Laboratory's approach to NAGPRA. In essence, it was the Laboratory's renewed engagement with NAGPRA and descendan tribal communities that became the catalyst for change in the Laboratory's philosophy as a curation repository. This shift in thinking set the Laboratory on a path toward building a descendant community–informed institutional integrity (DCIII) level of engagement with consultation and collaborative efforts in all aspects of collections management and archaeological research. In this article, we outline steps that the Laboratory has taken toward implementing meaningful policies and practices created with descendant Tribal communities that both fulfill and extend bounds of NAGPRA compliance.
Background: The advent of real-time quaking-induced conversion (RT-QuIC) assays has transformed the diagnostic approach to sporadic Creutzfeldt-Jakob disease (CJD) facilitating earlier recognition of affected patients. Recognizing this, we evaluated the performance of clinical features and diagnostic tests for CJD in the modern era. Methods: Clinical data were extracted from the electronic medical records of 115 patients with probable or definite CJD assessed at Mayo Clinic from 2014-2021. Clinical features and diagnostic tests were evaluated at presentation, and associations with diagnosis and prognosis determined. Results: Mean age-at-symptom onset was 64.8±9.4 years; 68 patients were female (59%). The sensitivity of clinical markers (myoclonus) and tests historically considered in patients with suspected CJD was poor (stereotyped EEG abnormalities, 16%; CSF 14-3-3, 60%). Conversely, RT-QuIC (93%), t-tau >1149 pg/mL (88%), and characteristic signal abnormalities on MRI (77%) identified most patients. Multivariable linear regression confirmed shorter days-to-death in patients with myoclonus (125.9, CI95% 23.3-15.5, p=0.026), visual/cerebellar signs (180.19, CI95% 282.2-78.2, p<0.001), positive 14-3-3 (193, CI95% 304.9-82.9; p<0.001), and elevated t-tau (9.0, CI95% 1.0-18.0, for every 1000 pg/ml elevation; p=0.041). Conclusions: CSF RT-QuIC and elevated t-tau, and stereotyped MRI abnormalities were consistently detected in CJD patients. Myoclonus, EEG findings, and CSF protein 14-3-3 were less useful in the modern era.
To describe the association between duration of antimicrobial prophylaxis (AMP) and 30-day surgical site infection (SSI), 7-day acute kidney injury (AKI), 90-day Clostridioides difficile infection (CDI), prolonged hospitalization, and 30-day reoperation after lumbar spine surgery for noninfectious indications, and to report adherence to current guidelines.
Design:
Survey.
Participants and setting:
The study cohort comprised 6,198 patients who underwent lumbar spine surgery for noninfectious indications across 137 Veterans’ Health Administration surgery centers between 2016 and 2020.
Methods:
Used univariate and multivariate logistic regression to determine the association between type and duration of AMP with 30-day SSI, 7-day AKI, 90-day CDI, prolonged hospitalization, and 30-day reoperation.
Results:
Only 1,160 participants (18.7%) received the recommended duration of AMP. On multivariate analysis, the use of multiple prophylactic antimicrobials was associated with increased odds of 90-day CDI (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.1–28.2) and 30-day reoperation (aOR, 2.3; 95% CI, 1.2–4.4). Courses of antimicrobials ≥3 days were associated with increased odds of prolonged hospitalization (aOR,1.8; 95% CI, 1.4–2.3) and 30-day reoperation (aOR, 3.5; 95% CI, 2.2–5.7). In univariate analysis, increasing days of AMP was associated with a trend toward increasing odds of 90-day CDI (cOR, 1.4; 95% CI, 1.0–1.8 per additional day; P = .056).
Conclusions:
Longer courses of AMP after lumbar spine surgery were associated with higher odds of CDI, prolonged hospitalization, and reoperation, but not with lower odds of SSI. However, adherence to the recommended duration of AMP is very low, hinting at a wide evidence-to-practice gap that needs to be addressed by spine surgeons and antimicrobial stewardship programs.
Background: Assays capable of detecting prions in CSF (e.g., RT-QuIC) have greatly improved the antemortem diagnosis of Creutzfeldt-Jakob disease (CJD) yet take time to conduct and are not widely accessible. There is a need to identify clinical features and common tests that identify mimics at presentation. Methods: Mimics were identified within longitudinal studies of rapidly progressive dementia at study sites. Mimics met clinical criteria for probable CJD but did not have CJD. Clinical features were compared between mimics and patients with CJD assessed at Mayo Clinic Enterprise (n=79) and Washington University in St. Louis (n=10; Jan-2014 to Oct-2020). Results: Mimics (10/155; 6.5%) were diagnosed with autoimmune encephalitis (n=7), neurosarcoidosis, frontotemporal lobar degeneration with motor neuron disease, and unknown dementia. Age-at-symptom onset, gender, presenting symptoms, and EEG and MRI findings were similar between mimics and CJD patients. Focal motor abnormalities (49/93, 10/10), elevations in CSF leukocytosis (4/92, 5/10) and protein (39/92, 9/10) were more common in mimics (p<0.01). Neural-specific autoantibodies associated with autoimmune encephalitis were detected within the serum (4/9) and CSF (5/10) of mimics, but not CJD cases. Conclusions: Autoimmune encephalitis, neurosarcoidosis and neurodegenerative diseases may mimic CJD at presentation and should be considered in patients with early motor dysfunction and abnormal CSF studies.
To date there has not been much digital humanities work on Ralph Ellison, simply because the field tends not to produce single-author studies. Yet Ellison's work is well-suited to digital methods. In this chapter I examine the DH affordances of Ellison’s work, surveying potential projects before turning to a case study, in which I use existing digital methods to examine the influences on Ellison's style from writers like Eliot, Wright, Hemingway, and others. His deployment of those styles will serve as the basis for a broader discussion of what DH practices might apply to—or learn from—Ellison studies.
The theoretical limit for absorption of energy in monochromatic water waves of wavelength $\lambda$ by axisymmetric wave energy converters operating in rigid-body motion was established in the 1970s. The maximum mean power generated by a device absorbing due to heave motion is equivalent to that contained in $\lambda /2{\rm \pi}$ length of an incident wave crest. For devices absorbing through surge and/or pitch motions the so-called capture width doubles to $\lambda /{\rm \pi}$. For devices absorbing in both heave and surge/pitch the capture width increases further to $3\lambda /2{\rm \pi}$. In this paper it is demonstrated that it is theoretically possible to extend the capture width for axisymmetric wave energy converters without bound through the use of generalised (non-rigid-body) modes of motion. This concept is applied to vertical cylinders whose surface is surrounded by an array of narrow vertical absorbing paddles. A continuum approximation is made to the paddle motion which simplifies the problem and allows strategies to be developed for setting the springs and dampers that control the power absorption. Results demonstrate that a cylinder of fixed size can absorb as much power as demanded from a plane incident wave although the practical limitations of linear theory are rapidly breached as that demand increases unless the size of the cylinder increases in proportion. In this paper we do not explore these limits in detail or further practical design considerations, such as imposing motion constraints. The continuum approximation is tested against a discrete paddle simulation for accuracy.
To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
Design:
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Setting:
Twenty-two higher education institutions.
Participants:
College students (n 17 686) enrolled at one of twenty-two participating universities.
Results:
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
Conclusions:
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
In this paper, a semi-analytical model based on linear potential flow theory and an eigenfunction expansion method is developed to study wave scattering by an array of structured cylinders in water of finite depth. Each cylinder is formed by a closely spaced array of thin vertical plates, between which fluid can flow, extending through the depth. In order to consider the wave attenuation and energy dissipation in narrow gaps between the thin vertical plates, a damping mechanism is introduced at the surface of the fluid occupied by the structured cylinders. In addition to a direct calculation of the energy dissipation, an indirect method based on Kochin functions is derived with the employment of energy identities. The present model is shown to be in excellent agreement with both the published data and those obtained by using different methods. The validated model is then applied to study the effect of a pair of structured cylinders on wave focusing/blocking, scattered far-field amplitude and wave power dissipation. Results show that wave focusing/blocking can be achieved by the appropriate choice of plate alignment. The structured cylinders hold profound potential for wave power extraction.
Whether enjoying the lucid prose of a favourite author or slogging through some other writer’s cumbersome, heavy-set prattle (full of parentheses, em dashes, compound adjectives, and Oxford commas), readers will notice stylistic signatures not only in word choice and grammar but also in punctuation itself. Indeed, visual sequences of punctuation from different authors produce marvellously different (and visually striking) sequences. Punctuation is a largely overlooked stylistic feature in stylometry, the quantitative analysis of written text. In this paper, we examine punctuation sequences in a corpus of literary documents and ask the following questions: Are the properties of such sequences a distinctive feature of different authors? Is it possible to distinguish literary genres based on their punctuation sequences? Do the punctuation styles of authors evolve over time? Are we on to something interesting in trying to do stylometry without words, or are we full of sound and fury (signifying nothing)?
In our investigation, we examine a large corpus of documents from Project Gutenberg (a digital library with many possible editorial influences). We extract punctuation sequences from each document in our corpus and record the number of words that separate punctuation marks. Using such information about punctuation-usage patterns, we attempt both author and genre recognition, and we also examine the evolution of punctuation usage over time. Our efforts at author recognition are particularly successful. Among the features that we consider, the one that seems to carry the most explanatory power is an empirical approximation of the joint probability of the successive occurrence of two punctuation marks. In our conclusions, we suggest several directions for future work, including the application of similar analyses for investigating translations and other types of categorical time series.
The 2017 solar eclipse was associated with mass gatherings in many of the 14 states along the path of totality. The Kentucky Department for Public Health implemented an enhanced syndromic surveillance system to detect increases in emergency department (ED) visits and other health care needs near Hopkinsville, Kentucky, where the point of greatest eclipse occurred.
Methods:
EDs flagged visits of patients who participated in eclipse events from August 17–22. Data from 14 area emergency medical services and 26 first-aid stations were also monitored to detect health-related events occurring during the eclipse period.
Results:
Forty-four potential eclipse event-related visits were identified, primarily injuries, gastrointestinal illness, and heat-related illness. First-aid stations and emergency medical services commonly attended to patients with pain and heat-related illness.
Conclusions:
Kentucky’s experience during the eclipse demonstrated the value of patient visit flagging to describe the disease burden during a mass gathering and to investigate epidemiological links between cases. A close collaboration between public health authorities within and across jurisdictions, health information exchanges, hospitals, and other first-response care providers will optimize health surveillance activities before, during, and after mass gatherings.