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In the era of widespread resistance, there are 2 time points at which most empiric prescription errors occur among hospitalized adults: (1) upon admission (UA) when treating patients at risk of multidrug-resistant organisms (MDROs) and (2) during hospitalization, when treating patients at risk of extensively drug-resistant organisms (XDROs). These errors adversely influence patient outcomes and the hospital’s ecology.
Design and setting:
Retrospective cohort study, Shamir Medical Center, Israel, 2016.
Adult patients (aged >18 years) hospitalized with sepsis.
Logistic regressions were used to develop predictive models for (1) MDRO UA and (2) nosocomial XDRO. Their performances on the derivation data sets, and on 7 other validation data sets, were assessed using the area under the receiver operating characteristic curve (ROC AUC).
In total, 4,114 patients were included: 2,472 patients with sepsis UA and 1,642 with nosocomial sepsis. The MDRO UA score included 10 parameters, and with a cutoff of ≥22 points, it had an ROC AUC of 0.85. The nosocomial XDRO score included 7 parameters, and with a cutoff of ≥36 points, it had an ROC AUC of 0.87. The range of ROC AUCs for the validation data sets was 0.7–0.88 for the MDRO UA score and was 0.66–0.75 for nosocomial XDRO score. We created a free web calculator (https://assafharofe.azurewebsites.net).
A simple electronic calculator could aid with empiric prescription during an encounter with a septic patient. Future implementation studies are needed to evaluate its utility in improving patient outcomes and in reducing overall resistances.
The Atacama Large (Sub-)millimeter Array (ALMA) has provided glimpse of the interstellar medium (ISM) properties of galaxies at the Epoch of Reionization (EoR); however, detailed understanding of their internal structure is still lacking. We present properties of molecular cloud complexes (MCCs) in a prototypical galaxy at this epoch studied in cosmological zoom-in simulations (Leung et al. 2019c). Typical MCC mass and size are comparable to nearby spirals and starburst galaxies (Mgas∼106.5Mȯ and R≃45–100 pc). MCCs are highly supersonic, with velocity dispersion of σgas≃20–100 km s−1 and pressure of P/kB ≃107.6Kcm−3, which are comparable to gas-rich starburst galaxies. In addition, we perform stability analysis to understand the origin and dynamical properties of MCCs. We find that MCCs are globally stable in the main disk of Althæa. Densest regions where star formation is expected to take place in clumps and cores on even smaller scales instead have lower virial parameter and Toomre-Q values. Detailed studies of the star-forming gas dynamics at the EoR thus require a spatial resolution of < 40 pc ( ≃ 0.01″), which is within reach of ALMA, to complement studies of stellar populations at EoR using the James Webb Space Telescope (JWST).
Little is known about the association of cortical Aβ with depression and anxiety among cognitively normal (CN) elderly persons.
We conducted a cross-sectional study derived from the population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota; involving CN persons aged ≥ 60 years that underwent PiB-PET scans and completed Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Cognitive diagnosis was made by an expert consensus panel. Participants were classified as having abnormal (≥1.4; PiB+) or normal PiB-PET (<1.4; PiB−) using a global cortical to cerebellar ratio. Multi-variable logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI) after adjusting for age and sex.
Of 1,038 CN participants (53.1% males), 379 were PiB+. Each one point symptom increase in the BDI (OR = 1.03; 1.00–1.06) and BAI (OR = 1.04; 1.01–1.08) was associated with increased odds of PiB-PET+. The number of participants with BDI > 13 (clinical depression) was greater in the PiB-PET+ than PiB-PET- group but the difference was not significant (OR = 1.42; 0.83–2.43). Similarly, the number of participants with BAI > 10 (clinical anxiety) was greater in the PiB-PET+ than PiB-PET− group but the difference was not significant (OR = 1.77; 0.97–3.22).
As expected, depression and anxiety levels were low in this community-dwelling sample, which likely reduced our statistical power. However, we observed an informative albeit weak association between increased BDI and BAI scores and elevated cortical amyloid deposition. This observation needs to be tested in a longitudinal cohort study.
Objectives: Connectionist theories of brain function took hold with the seminal contributions of Norman Geschwind a half century ago. Modern neuroimaging techniques have expanded the scientific interest in the study of brain connectivity to include the intact as well as disordered brain. Methods: In this review, we describe the most common techniques used to measure functional and structural connectivity, including resting state functional MRI, diffusion MRI, and electroencephalography and magnetoencephalography coherence. We also review the most common analytical approaches used for examining brain interconnectivity associated with these various imaging methods. Results: This review presents a critical analysis of the assumptions, as well as methodological limitations, of each imaging and analysis approach. Conclusions: The overall goal of this review is to provide the reader with an introduction to evaluating the scientific methods underlying investigations that probe the human connectome. (JINS, 2016, 22, 105–119)
The present research examined the perceptions of Australian employees on dimensions of workplace stress. The sample included 664 male (n = 234) and female (n = 430) workers from the public (n = 559) and private (n = 105) sectors. Participants completed the Health and Safety Executive Indicator Tool as a measure of workplace stress. Results indicated that private sector employees rated their employers as being more effective in managing workplace stress, while employees in both sectors rated their employers as less effective in managing Job Content stressors than Job Context stressors. Compared with normative benchmarks, employees overall also reported risks of stress associated with Relationships and Role. Implications of these findings and suggestions for future research were discussed.
To examine how task demands influence bilingual advantage in executive control over monolinguals, we tested 32 Chinese monolinguals and 32 Chinese–English bilinguals with four versions of a color-shape switching task. During switching trials, the task required participants to suppress one set of conflicting (or non-conflicting) responses and simultaneously to activate another set of conflicting (or non-conflicting) responses. The results showed that compared to monolinguals, (i) when suppressing conflicting responses or (ii) activating non-conflicting responses, bilinguals had significantly smaller switching costs though similar mixing costs; (iii) when suppressing one set of conflicting responses and simultaneously activating another set of conflicting responses, bilinguals had significantly smaller switching costs though larger mixing costs; and (iv) when suppressing one set of non-conflicting responses and simultaneously activating another set of non-conflicting responses, bilinguals had similar switching costs and mixing costs. These findings indicate that task demands affect bilingual advantage in executive control.
Eight strains of mice, of contrasting genotypes, infected with Heligmosomoides bakeri were studied to determine whether the anthelmintic efficacy of papaya latex varied between inbred mouse strains and therefore whether there is an underlying genetic influence on the effectiveness of removing the intestinal nematode. Infected mice were treated with 330 nmol of crude papaya latex or with 240 nmol of papaya latex supernatant (PLS). Wide variation of response between different mouse strains was detected. Treatment was most effective in C3H (90·5–99·3% reduction in worm counts) and least effective in CD1 and BALB/c strains (36·0 and 40·5%, respectively). Cimetidine treatment did not improve anthelmintic efficacy of PLS in a poor drug responder mouse strain. Trypsin activity, pH and PLS activity did not differ significantly along the length of the gastro-intestinal (GI) tract between poor (BALB/c) and high (C3H) drug responder mouse strains. Our data indicate that there is a genetic component explaining between-mouse variation in the efficacy of a standard dose of PLS in removing worms, and therefore warrant some caution in developing this therapy for wider scale use in the livestock industry, and even in human medicine.
Part biography, part transnational history, this study details the life and career of Percy Spender, one of Australia’s most prominent twentieth-century political figures. Spender served his country in government, in opposition and as an ambassador to the United States in a long and prestigious career dominated by Australian foreign policy.Spender’s role in moving Australia closer towards American influence – while pushing at the boundaries of Australia's 'Britishness' – is a key element in Lowe’s narrative.
There was little time to pause and reflect on electoral success and Percy's latest tilt towards leadership of the party. Two very different developments dominated the immediate aftermath of the election. One was his purchase of Headingly House, and the other was preparation for a Commonwealth foreign ministers' conference, the first of its kind, to be held in Colombo in January. Within three weeks of the election Spender was flying to Ceylon, via Djakarta. In the eyes of many, the year 1950 also marked the spread of the Cold War into Asia. In February Stalin signed a friendship treaty with Mao's new Chinese People's Republic and in the middle months of the year communist-led pro-independence groups launched or intensified attacks against governments in Vietnam, Malaya and the Philippines. More than these developments, the North Korean invasion of South Korea on 25 June marked the start of a new prospect of escalating wars in Asia. The attack triggered a military response by a US-led United Nations force, and from November, Chinese involvement in support of North Korea.
Spender was only Minister for External Affairs (and for Territories) for sixteenth months, and he treated this period as a long-awaited window of opportunity in which to realize some of the reforms he sought in Australia's overseas relations.
The four years between the end of the Second World War and the 1949 election campaign saw fierce political debates about the future of Australia's democracy. The Chifley government, from 1945, pushed ahead with an ambitious programme of social welfare, nationalisation of key industries and extending the Commonwealth's control over prices, rents, banking and other aspects of commercial activity. The backlash to such measures assisted the new Liberal Party in developing some momentum in parliament. This period also saw a substantial adjustment from Spender on the issue of central powers versus individuals' and states' rights. By the end of 1947, ten years after he had first entered parliament, he had abandoned his dogged preparedness to side with Labor in the interests of a strong central government providing direction for the economy.
It appeared such a change of heart that it attracted derision from Labor politicians, and puzzled some of his supporters. The reasons for his shift were several. In general terms, they stemmed partly from his growing conviction that Labor was debasing parliamentary democracy and deliberately extending wartime exigency into its post-war planning, but also from his first-hand observation of socialism overseas, and of the implications of the Cold War for Australia. Importantly, the change also meant that Spender became a far more effective and reliable frontbencher in parliament.
Anything after Washington brought the risk of severe anti-climax, and there were aspects of The Hague that tested Percy and Jean. Their accommodation was a modest townhouse around the corner from the Palace of Peace where the Court sat. Several Australian visitors who passed through The Hague felt that Spender seemed lonely, perhaps missing the cut and thrust of political and international debates. He and Jean escaped occasionally to the flat they purchased in London, in Hyde Park Place, which was also their son John's base as he completed a law degree in London (and was called to the bar, Gray's Inn, in 1960). The transition to The Hague was harder on Jean, who struggled with illness from the start. She was ill for periods during 1958–9, without conclusive diagnosis; she suffered from insomnia, and appeared drawn and nervous at dinners with others, and spoke across and over Percy, stirring minor fights. Unlike in Washington, the Spenders struggled to make friends. The judges seldom stayed in Holland when the Court was in recess, and only around half of them lived in The Hague. Nor was it easy for any newcomers to establish quick rapport with the Dutch upper class; and for gregarious lovers of high society perched in a small townhouse, without butler, rather than a grand embassy, it was all the more difficult.
Exploring the life of a politician active during the years 1939 to 1945 always runs the risk of assuming that the war so dominated life as to render inconsequential more private aspects – personal crises and thoughts stretching beyond either the contours of planning, reacting and mobilizing, when in government, or a blend of common ‘war-effort-mindedness’ and alternative policy when in opposition. In Spender's case, it would be imprudent not to allow the war a major structuring role, as he held ministerial positions until October 1941 and then continued on the bipartisan Advisory War Council (established October 1940) until its disbandment in August 1945. This chapter and the following one cover the war years in broadly chronological manner, divided by the fall of the short-lived Fadden government, and therefore the end of Spender's ministerial responsibilities, in October 1941. In the broad, the two chapters are separated by this division in Spender's war, with some extra space in Chapter 4 both to reflect further on some of the themes raised below, and to consider Spender's life beyond the dictates of the war.
War intensified Spender's preoccupation with the incomplete state of Australia's progress from colony to a developed outpost of the British world.