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The papers in this forum offer an interdisciplinary assessment of the state of the field of Anglican Studies and perspectives on future trajectories. The first three papers, on liturgy, history, and world Anglicanism, offer an assessment of the respective state of these areas of Anglican Studies. The second set, on theology, sociology of religion, and biblical studies, stake out positions on how these disciplines inform the work of Anglican Studies. A concluding essay offers a synthesis of these papers, focusing on the themes of local contexts for Anglicanism, a further complexification of decolonizing processes in Anglicanism, and the critical role of conversation in Anglican Studies regarding disciplines, languages, and power dynamics.
The objectives of this study were (1) to develop and validate a simulation model to estimate daily probabilities of healthcare-associated infections (HAIs), length of stay (LOS), and mortality using time varying patient- and unit-level factors including staffing adequacy and (2) to examine whether HAI incidence varies with staffing adequacy.
The study was conducted at 2 tertiary- and quaternary-care hospitals, a pediatric acute care hospital, and a community hospital within a single New York City healthcare network.
All patients discharged from 2012 through 2016 (N = 562,435).
We developed a non-Markovian simulation to estimate daily conditional probabilities of bloodstream, urinary tract, surgical site, and Clostridioides difficile infection, pneumonia, length of stay, and mortality. Staffing adequacy was modeled based on total nurse staffing (care supply) and the Nursing Intensity of Care Index (care demand). We compared model performance with logistic regression, and we generated case studies to illustrate daily changes in infection risk. We also described infection incidence by unit-level staffing and patient care demand on the day of infection.
Most model estimates fell within 95% confidence intervals of actual outcomes. The predictive power of the simulation model exceeded that of logistic regression (area under the curve [AUC], 0.852 and 0.816, respectively). HAI incidence was greatest when staffing was lowest and nursing care intensity was highest.
This model has potential clinical utility for identifying modifiable conditions in real time, such as low staffing coupled with high care demand.
Background:Pseudomonas aeruginosa is an important nosocomial pathogen associated with intrinsic and acquired resistance mechanisms to major classes of antibiotics. To better understand clinical risk factors for drug-resistant P. aeruginosa infection, decision-tree models for the prediction of fluoroquinolone and carbapenem-resistant P. aeruginosa were constructed and compared to multivariable logistic regression models using performance characteristics. Methods: In total, 5,636 patients admitted to 4 hospitals within a New York City healthcare system from 2010 to 2016 with blood, respiratory, wound, or urine cultures growing PA were included in the analysis. Presence or absence of drug-resistance was defined using the first culture of any source positive for P. aeruginosa during each hospitalization. To train and validate the prediction models, cases were randomly split (60 of 40) into training and validation datasets. Clinical decision-tree models for both fluoroquinolone and carbapenem resistance were built from the training dataset using 21 clinical variables of interest, and multivariable logistic regression models were built using the 16 clinical variables associated with resistance in bivariate analyses. Decision-tree models were optimized using K-fold cross validation, and performance characteristics between the 4 models were compared. Results: From 2010 through 2016, prevalence of fluoroquinolone and carbapenem resistance was 32% and 18%, respectively. For fluoroquinolone resistance, the logistic regression algorithm attained a positive predictive value (PPV) of 0.57 and a negative predictive value (NPV) of 0.73 (sensitivity, 0.27; specificity, 0.90) and the decision-tree algorithm attained a PPV of 0.65 and an NPV of 0.72 (sensitivity 0.21, specificity 0.95). For carbapenem resistance, the logistic regression algorithm attained a PPV of 0.53 and a NPV of 0.85 (sensitivity 0.20, specificity 0.96) and the decision-tree algorithm attained a PPV of 0.59 and an NPV of 0.84 (sensitivity 0.22, specificity 0.96). The decision-tree partitioning algorithm identified prior fluoroquinolone resistance, SNF stay, sex, and length-of-stay as variables of greatest importance for fluoroquinolone resistance compared to prior carbapenem resistance, age, and length-of-stay for carbapenem resistance. The highest-performing decision tree for fluoroquinolone resistance is illustrated in Fig. 1. Conclusions: Supervised machine-learning techniques may facilitate prediction of P. aeruginosa resistance and risk factors driving resistance patterns in hospitalized patients. Such techniques may be applied to readily available clinical information from hospital electronic health records to aid with clinical decision making.
The seemingly aberrant coiling of heteromorphic ammonoids suggests that they underwent more significant changes in hydrostatic properties throughout ontogeny than their planispiral counterparts. Such changes may have been responses to different selective pressures at different life stages. The hydrostatic properties of three species of Didymoceras (D. stevensoni, D. nebrascense, and D. cheyennense) were investigated by creating virtual 3D models at several stages during growth. These models were used to compute the conditions for neutral buoyancy, hydrostatic stability, orientation during life, and thrust angles (efficiency of directional movement). These properties suggest that Didymoceras and similar heteromorphs lived low-energy lifestyles with the ability to hover above the seafloor. The resultant static orientations yielded a downward-facing aperture in the hatchling and a horizontally facing aperture throughout most of the juvenile stage, before terminating in an upward direction at maturity. Relatively high hydrostatic stabilities would not have permitted the orientation of Didymoceras to be considerably modified with active locomotion. During the helical phase, Didymoceras would have been poorly suited for horizontal movement, yet equipped to pirouette about the vertical axis. Two stages throughout growth, however, would have enhanced lateral mobility: a juvenile stage just after the formation of the first bend in the shell and the terminal stage after completion of the U-shaped hook. These two more mobile phases in ontogeny may have improved juvenile dispersal potential and mate acquisition during adulthood, respectively. In general, life orientation and hydrostatic stability change more wildly for these aberrantly coiled ammonoids than their planispiral counterparts.
OBJECTIVES/SPECIFIC AIMS: -Transmit learning and wisdom from past scholars -Predispose new scholars towards a receptive attitude -Normalize struggle and failure on the road to success -Encourage a community of accomplishment and celebration -Connect the scholar METHODS/STUDY POPULATION: The exit presentations were given by NCATS funded junior faculty in the CTSI KL2 Scholars Program who had graduated. All KL2 Scholars take part in the K Scholar Multidisciplinary Seminar Series that meets weekly during the academic calendar. The departed scholars returned for the presentations the following semester. The audience was made up of KL2 who had started with a later cohort, the CTSI KL2 program is a 3-year program, and newly appointed scholars. Scholars were given 12-15 minutes to cover: 1) What was learned, 2) Accomplishments on specific aims, 3) Next steps for project and career, and 4) Recommendations for other scholars. Presentations were collected and reviewed for recurring themes. Themes were grouped and quotes were included to identify nuance. RESULTS/ANTICIPATED RESULTS: From the 17 exit presentations, six themes were identified: 1) Don’t miss the forest for the trees (x10) – “the KL2 program helps to fill in gaps scholars don’t realize they have – it is about more than just the research project, trust in the process and let the program help keep you on track.” 2) Diversify and keep an open mind (x7) – “focus is important but diversifying research and reorganizing priorities is ok.” 3) Don’t be discouraged by failure (x6) –” perseverance is key, all success comes on the heels of many failures.” 4) Importance of building network inside and outside of Scholar program (x6) – “importance of exploring and establishing collaborations” 5) Learn to say no and yes (x5) – “protect your time but be open to opportunities” 6) Seek advice and criticism but don’t follow blindly (x4) DISCUSSION/SIGNIFICANCE OF IMPACT: The use of exit presentations for graduating KL2 Scholars is a useful tool in transmitting wisdom and enhancing subsequent KL2 cohorts. The Scholar’s experience and trajectory, share personal insights and recommendations to help other Scholars get the most out of their KL2 experience, give the community a chance to celebrate the Scholar’s accomplishments, and provide the Scholar with a sense of closure in their KL2 journey. Within the exit presentations, six common themes emerged relating to best practices on making good use of resources and guidance, and learning to interact and navigate within networks and responsibilities in a mature way. Scholars in the audience benefit from hearing the insights and advice from their predecessors. The identification of themes helps the program to understand where it adds value.
Mental illness recovery has been described as an outcome (symptom free) or process (symptom management) where peer supporters are essential. Whereas, substance use disorder recovery endorses outcome alone: achieving recovery once abstinent. Peer supporters with an abstinence agenda use confrontation for those in denial. Herein, we unpack this distinction.
Specimen survivability is a primary concern to those who utilize atom probe tomography (APT) for materials analysis. The state-of-the-art in understanding survivability might best be described as common-sense application of basic physics principles to describe failure mechanisms. For example, APT samples are placed under near-failure mechanical-stress conditions, so reduction in the force required to initiate field evaporation must provide for higher survivability—a common sense explanation of survivability. However, the interplay of various analytical conditions (or instrumentation) and how they influence survivability (e.g., decreasing the applied evaporation field improves survivability), and which factors have more impact than others has not been studied. In this paper, we report on the systematic analysis of a material composed of a silicon-dioxide layer surrounded on two sides by silicon. In total, 261 specimens were fabricated and analyzed under a variety of conditions to correlate statistically significant survivability trends with analysis conditions and other specimen characteristics. The primary result suggests that, while applied field/force plays an obvious role in survivability for this material, the applied field alone does not predict survivability trends for silicon/silicon-dioxide interfaces. The rate at which ions are extracted from the specimen (both in terms of ions-per-pulse and pulse-frequency) has similar importance.
This study examined the effectiveness of a formal postdoctoral education program designed to teach skills in clinical and translational science, using scholar publication rates as a measure of research productivity.
Participants included 70 clinical fellows who were admitted to a master’s or certificate training program in clinical and translational science from 1999 to 2015 and 70 matched control peers. The primary outcomes were the number of publications 5 years post-fellowship matriculation and time to publishing 15 peer-reviewed manuscripts post-matriculation.
Clinical and translational science program graduates published significantly more peer-reviewed manuscripts at 5 years post-matriculation (median 8 vs 5, p=0.041) and had a faster time to publication of 15 peer-reviewed manuscripts (matched hazard ratio = 2.91, p=0.002). Additionally, program graduates’ publications yielded a significantly higher average H-index (11 vs. 7, p=0.013).
These findings support the effectiveness of formal training programs in clinical and translational science by increasing academic productivity.
OBJECTIVES/SPECIFIC AIMS: The NIH states, “The training of the biomedical workforce has always been an integral part of the NIH mission… It takes just one good mentor to influence the career of a new investigator; it takes a robust culture of mentorship across the research community to strengthen, sustain and diversify the entire biomedical research enterprise.” The University of Minnesota’s CTSI-Education core strives to build and maintain a strong culture of mentoring by providing CTSI KL2 scholars an opportunity to mentor an undergraduate student participating in the Pathways to Research Program (PReP). Using this mentoring model, participants gain valuable benefits and CTSI’s culture of mentoring is strengthened. METHODS/STUDY POPULATION: Participating KL2 scholars are matched with a promising PReP scholar for a 12-week mentored research project. The PReP program selects top candidates through a highly competitive application process. Students work in their mentor’s lab full-time, funded by CTSI-Ed. They engage in additional activities together including a mentor/mentee, an interview activity and 2 social events. Junior faculty scholars are asked to participate as judges at CTSI’s Poster Session and are invited to present at PReP seminars. The program culminates with the announcement of the Junior Mentor of the Year, in which scholars nominate their mentors for the award. Junior faculty mentors receive support through a training course, Optimizing the Practice of Mentoring, mentor orientation and a roundtable discussion with the program director and other mentors. The program’s infrastructure is designed to foster mentee/mentor relationships through faculty and staff support. Junior faculty receive one-on-one coaching when faced with difficult mentoring situations and are recognized for their mentoring successes. RESULTS/ANTICIPATED RESULTS: Junior faculty mentors highly rate the program on the following points; the experience was a good use of time, I am satisfied with my experience, I would recommend this program to faculty colleagues and students. Undergraduates and Professional students rated their mentoring relationship as 1 of 3 best outcomes of the program. In exit surveys, their highly rated program successes include having a network that helps move their career forward, and confidence to persist through training to become a successful researcher. DISCUSSION/SIGNIFICANCE OF IMPACT: Creating a culture of mentoring is important to the strengthen, sustain and diversify the biomedical research workforce. This mentoring model contributes to the mission while vertically integrating CTSI-Ed’s KL2 and PReP programs. On an individual level, junior faculty improve communication and management skills, develop leadership qualities, increase their network, provide a sense of fulfilment and personal growth, and reinforce their own skills and knowledge of subject. They are also provided a top undergraduate student worker fully funded by the program.
OBJECTIVES/SPECIFIC AIMS: The 2 primary objectives were to (i) insure that Scholars can effectively communicate the translational impact of their research to a lay audience and (ii) assess the benefits and efficacy of having community, as well as faculty members, judge the translational impact of KL2 Scholar’s poster presentations. An explicit secondary goal was to further the engagement of community members in CTSI-sponsored translational research. METHODS/STUDY POPULATION: CTSI’s Education, Community Engagement, Discovery and Translation, and Translational Workforce Development Cores created the translational impact questions and evaluation sheets. The Community Engagement and Office of Discovery and Translation recruited community judges from their respective networks and they were assigned to relevant studies. Scholars were provided with the judges scoring template in advance. After the Research Poster Session, the KL2 Scholars evaluated the quality of their presentations and the impact of having feedback from Community Judges. The Community Judges evaluated their perceived “added value” to the research presentations and their interactions with the Scholars. Both Scholars and judges completed evaluations of the poster presentation and judging process, performed on a 5-point Likert scale. RESULTS/ANTICIPATED RESULTS: KL2 Scholars felt that the community impact judges provided valuable feedback on their research (3.8/5) and were satisfied overall with the poster session (3.4/5). In evaluating their own presentations, Scholars tended to rate themselves higher (4.2–4.6/5) on the clarity of their translational impact presentations than the community judges rated the Scholars (4.1–4.2/5). Scholars also rated themselves somewhat higher in the quality of their dealing with any ethical issues and their dissemination plan (4.0/5) than the community judges (3.8/5). Judges were very positive and felt they brought value to the experience (4.2–4.4/5). DISCUSSION/SIGNIFICANCE OF IMPACT: Community judges added qualitative value to the Scholar presentations based on the Scholar and community judge evaluations and based on comparison based on prior year poster sessions. Documenting the degree of impact of the combination of this proscribed poster format and community-judging process awaits future assessment of Scholar presentations before and after the next annual poster presentation.