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In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 conducted prior to the COVID-19 pandemic.
To demonstrate that a syndromic stewardship intervention can safely reduce antipseudomonal antibiotic use in the treatment of inpatient diabetic foot infections (DFIs).
Intervention and method:
From November 2017 through March 2018, we performed an antimicrobial stewardship intervention that included creation of a DFI best-practice guideline, implementation of an electronic medical record order set, and targeted education of key providers. We conducted a retrospective before-and-after study evaluating guideline adherent antipseudomonal antibiotic use 1 year before and after the intervention using interrupted time-series analysis.
Setting:
University of Nebraska Medical Center, a 718-bed academic medical center in Omaha, Nebraska.
Patients:
The study included 193 adults aged ≥19 years (105 in the preintervention group and 88 in the postintervention group) admitted to non–intensive care units whose primary reason for antibiotic treatment was diabetic foot infection (DFI).
Results:
Guideline-adherent use of antipseudomonal antibiotics increased from 39% before the intervention to 68% after the intervention (P ≤ .0001). Antipseudomonal antibiotic use decreased from 538 days of therapy (DOT) per 1,000 DFI patient days (PD) before the intervention to 272 DOT per 1,000 DFI PD after the intervention (P < .0001), with a statistically significant decrease in both level of use and slope of change. We did not detect any changes in length of stay, readmission, amputation rate, subsequent positive Clostridioides difficile testing, or mortality.
Conclusions:
Our 3-component intervention of guideline creation, implementation of an order set, and targeted education was associated with a significant decrease in antipseudomonal antibiotic use in the management of inpatient DFIs. DFIs are common and should be considered as opportunities for syndromic stewardship intervention.
During capture, in order to separate him from a possessive adult female and return him to his mother, a newborn male in a laboratory group of Cebus capucinus monkeys was found to have a seriously infected compound fracture of the humerus associated with a deep and extensive slash wound. Amputation of the affected limb was deemed necessary. Shortly after surgery the newborn was returned to his mother, in isolation from the group, with periodic removal for post-surgical care. Three weeks later the mother-newborn pair was returned to the social group and no further intervention occurred. Regular observations revealed mutual behavioural adjustments to the handicap by the mother and newborn. Compared to a normal age-mate, the amputee received more positive social attention from the mother and other group-members. Despite his showing delays in locomotor and manipulatory activities, the handicapped infant showed good behavioural progress. Early resocialization thus appears feasible following emergency surgery in newborn primates.
Efforts to promote the psychological well-being of captive non-human primates through the application of environmental enrichment techniques are becoming more common. However, from this perspective relatively little empirical work has been done on the effects of manipulation of the social environment. The data currently available indicate that primates kept in solitary confinement are likely to develop a variety of behavioural and physiological disturbances reflecting reduced well-being, whereas most compatibly socially housed primates appear better adapted. There is always some risk associated with manipulating the social environment for experimental or husbandry reasons, but the risk of deleterious consequences can be reduced by a good knowledge of the animals’ normal repertoire and careful monitoring of how the animals adjust to the new conditions. Attending to the social environment of captive primates is fundamental to their welfare.
A captive group of white-faced capuchins, Cebus capucinus, was presented with four deep litters in simultaneous choice (or preference) tests. A floor covering of ground corn cob, woodchips, wood wool or peat was presented once in each quarter of the group ‘s indoor floor-area for 14 consecutive days, and the layout of the litters was rotated after each such period. The monkeys were observed on 10 days in each period to determine the occurrence of locomotion, foraging, play, and social contact on each of the litters. The ground corn cob was clearly the least attractive floor covering for the monkeys, while peat and wood wool proved to be the most attractive. Most instances of social contact occurred on the peat, due to the occurrence of communal peat-bathing, while wood wool afforded the most play. The provision of different litter types in different areas of the indoor enclosure is a simple means of promoting a greater range of natural activities in captive primates, and probably also in other animals.
In order to assess the environmental enrichment value of a small swimming pool for captive juvenile rhesus macaques (Macaca mulatta), observations of social and individual behaviours were made during baseline and experimental (pool) conditions. When the pool was available there was less social grooming and cage manipulation, and more play. Most of the monkeys engaged in diving and underwater swimming. The presence of pieces of banana at the bottom of the pool reduced these water-related activities, whereas when raisins were spread along the bottom or when there was no food in the water, there was more diving and less aggression. Certain effects tended to vary with dominance status, but individual differences appeared more important than social status in determining reactions to the water. The provision of a small swimming pool for captive macaques is an effective contribution to improving their welfare.
Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
Methods:
In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
Results:
In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
Conclusion:
When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
The causal impacts of recreational cannabis legalization are not well understood due to the number of potential confounds. We sought to quantify possible causal effects of recreational cannabis legalization on substance use, substance use disorder, and psychosocial functioning, and whether vulnerable individuals are more susceptible to the effects of cannabis legalization than others.
Methods
We used a longitudinal, co-twin control design in 4043 twins (N = 240 pairs discordant on residence), first assessed in adolescence and now age 24–49, currently residing in states with different cannabis policies (40% resided in a recreationally legal state). We tested the effect of legalization on outcomes of interest and whether legalization interacts with established vulnerability factors (age, sex, or externalizing psychopathology).
Results
In the co-twin control design accounting for earlier cannabis frequency and alcohol use disorder (AUD) symptoms respectively, the twin living in a recreational state used cannabis on average more often (βw = 0.11, p = 1.3 × 10−3), and had fewer AUD symptoms (βw = −0.11, p = 6.7 × 10−3) than their co-twin living in an non-recreational state. Cannabis legalization was associated with no other adverse outcome in the co-twin design, including cannabis use disorder. No risk factor significantly interacted with legalization status to predict any outcome.
Conclusions
Recreational legalization was associated with increased cannabis use and decreased AUD symptoms but was not associated with other maladaptations. These effects were maintained within twin pairs discordant for residence. Moreover, vulnerabilities to cannabis use were not exacerbated by the legal cannabis environment. Future research may investigate causal links between cannabis consumption and outcomes.
Much controversy surrounds the welfare of elephants within zoological institutions. Among the many concerns are lack of exercise and the prevention of sedentary health and welfare issues due to smaller exhibits in comparison to the home-range sizes for elephants in Africa and Asia. While many scientists have used GPS to examine distances travelled by wild elephants, there is currently little information on distance travelled by elephants within zoological institutions. In the wild, it is necessary to chemically immobilise elephants using a dart gun in order to put on or take off collars which are used to acquire GPS data. Within a zoological institution, elephants can be trained to wear a collar with a GPS device but this training can be time consuming and also dangerous depending on the level of expertise of animal care staff. However, training an elephant within a zoological institution to wear an anklet outfitted with a GPS device can be much safer and less time consuming. The purpose of the current research was to validate methods for examining the walking rates of elephants in a zoological facility. This included testing GPS units, examining walking rates of eight elephants at the San Diego Zoo Safari Park using collars and conducting trials on a subset of elephants wearing both a collar and anklet outfitted with GPS devices to determine reliability. The average distance travelled by eight African elephants (Loxodonta africana) within a 24-h period was 8.65 (± 0.64) km which corresponds to a rate of 0.360 (± 0.033) kph. Trials comparing anklets to collars were found to be highly reliable except on days when weather conditions were overcast or there was rainfall at the park. The methods used for the current study can be utilised in future studies to examine walking rates as a component of animal welfare for elephants or other large mammals within zoological institutions.
Many popular books and articles that purport to explain how people, companies, or ideas succeed highlight a few successes chosen to fit a particular narrative. We investigate what effect these highly selected “success narratives” have on readers’ beliefs and decisions. We conducted a large, randomized, pre-registered experiment, showing participants successful firms with founders that all either dropped out of or graduated college, and asked them to make incentive-compatible bets on a new firm. Despite acknowledging biases in the examples, participants’ decisions were very strongly influenced by them. People shown dropout founders were 55 percentage points more likely to bet on a dropout-founded company than people who were shown graduate founders. Most reported medium to high confidence in their bets, and many wrote causal explanations justifying their decision. In light of recent concerns about false information, our findings demonstrate how true but biased information can strongly alter beliefs and decisions.
The objective of this study was to determine antibiotic appropriateness based on Loeb minimum criteria (LMC) in patients with and without altered mental status (AMS).
Design:
Retrospective, quasi-experimental study assessing pooled data from 3 periods pertaining to the implementation of a UTI management guideline.
Setting:
Academic medical center in Lexington, Kentucky.
Patients:
Adult patients aged ≥18 years with a collected urinalysis receiving antimicrobial therapy for a UTI indication.
Methods:
Appropriateness of UTI management was assessed in patients prior to an institutional UTI guideline, after guideline introduction and education, and after implementation of a prospective audit-and-feedback stewardship intervention from September to November 2017–2019. Patient data were pooled and compared between patients noted to have AMS versus those with classic UTI symptoms. Loeb minimum criteria were used to determine whether UTI diagnosis and treatment was warranted.
Results:
In total, 600 patients were included in the study. AMS was one of the most common indications for testing across the 3 periods (19%–30.5%). Among those with AMS, 25 patients (16.7%) met LMC, significantly less than the 151 points (33.6%) without AMS (P < .001).
Conclusions:
Patients with AMS are prescribed antibiotic therapy without symptoms indicative of UTI at a higher rate than those without AMS, according to LMC. Further antimicrobial stewardship efforts should focus on prescriber education and development of clearly defined criteria for patients with and without AMS.
We compared the effectiveness of 4 sampling methods to recover Staphylococcus aureus, Klebsiella pneumoniae and Clostridioides difficile from contaminated environmental surfaces: cotton swabs, RODAC culture plates, sponge sticks with manual agitation, and sponge sticks with a stomacher. Organism type was the most important factor in bacterial recovery.
We present WALLABY pilot data release 1, the first public release of H i pilot survey data from the Wide-field ASKAP L-band Legacy All-sky Blind Survey (WALLABY) on the Australian Square Kilometre Array Pathfinder. Phase 1 of the WALLABY pilot survey targeted three
$60\,\mathrm{deg}^{2}$
regions on the sky in the direction of the Hydra and Norma galaxy clusters and the NGC 4636 galaxy group, covering the redshift range of
$z \lesssim 0.08$
. The source catalogue, images and spectra of nearly 600 extragalactic H i detections and kinematic models for 109 spatially resolved galaxies are available. As the pilot survey targeted regions containing nearby group and cluster environments, the median redshift of the sample of
$z \approx 0.014$
is relatively low compared to the full WALLABY survey. The median galaxy H i mass is
$2.3 \times 10^{9}\,{\rm M}_{{\odot}}$
. The target noise level of
$1.6\,\mathrm{mJy}$
per 30′′ beam and
$18.5\,\mathrm{kHz}$
channel translates into a
$5 \sigma$
H i mass sensitivity for point sources of about
$5.2 \times 10^{8} \, (D_{\rm L} / \mathrm{100\,Mpc})^{2} \, {\rm M}_{{\odot}}$
across 50 spectral channels (
${\approx} 200\,\mathrm{km \, s}^{-1}$
) and a
$5 \sigma$
H i column density sensitivity of about
$8.6 \times 10^{19} \, (1 + z)^{4}\,\mathrm{cm}^{-2}$
across 5 channels (
${\approx} 20\,\mathrm{km \, s}^{-1}$
) for emission filling the 30′′ beam. As expected for a pilot survey, several technical issues and artefacts are still affecting the data quality. Most notably, there are systematic flux errors of up to several 10% caused by uncertainties about the exact size and shape of each of the primary beams as well as the presence of sidelobes due to the finite deconvolution threshold. In addition, artefacts such as residual continuum emission and bandpass ripples have affected some of the data. The pilot survey has been highly successful in uncovering such technical problems, most of which are expected to be addressed and rectified before the start of the full WALLABY survey.
This article demonstrates a method to measure the extent and variation of ethnoracial disproportion in world prison populations. Using a novel data set covering eighteen democracies for the year 2016, this method shows that conspicuous ethnoracial disproportion in prisons is pervasive in democracies for which data is available. Socioeconomically marginalized ethnic and racial groups are overrepresented in the prisons of every case. Further, this pattern extends to countries known for penal progressivism, which otherwise are regarded as models of fair and rational criminal justice implementation. Correlation between prison disproportion and national socioeconomic and criminal justice characteristics suggests the complexity of the issue. A selection of single-case analyses drawn from the sample describe prison disproportion emerging under significantly varied national conditions. I discuss causal hypotheses for why ethnoracial disproportion would occur in such differing places.
For the past thirty years, the imprint “Editorial Joaquín Mortiz” has stood for innovation, quality, and prestige in Mexican literature. After it was founded in 1962, Joaquín Mortiz quickly emerged as the premier literary publisher in Mexico and has provided readers with many of the novels and short stories now recognized as landmarks defining the contemporary canon of Mexican fiction. Most studies of Mexican narrative of the 1960s have tended to emphasize the dichotomy between the elitist self-conscious experimentation of escritura writing and the irreverent youthful exuberance of onda writing. Shifting the focus from texts to publishers, however, reveals a different configuration. Editorial Joaquín Mortiz actually encouraged both these trends by cultivating the work of escritura authors such as Salvador Elizondo, Juan García Ponce, and José Emilio Pacheco along with those of onda authors like Gustavo Sainz and José Agustín. Moreover, during its first two years, Joaquín Mortiz staked much of its early reputation on promoting two Mexican novels now fundamental to women's writing throughout Latin America: Oficio de tinieblas (1962) by Rosario Castellanos and Los recuerdos del porvenir (1963) by Elena Garro. Thus Editorial Joaquín Mortiz has greatly influenced the development of contemporary Mexican narrative.
Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample.
Methods
Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of ‘Genetic’ models (solely fitted with PRS-SZ), ‘Environmental’ models (solely fitted with each environmental stressor), ‘Independent’ models (with PRS-SZ and each environmental factor), and ‘Interaction’ models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models.
Results
There were no genes-environment associations. PRS-SZ was associated with positive dimensions (β = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension.
Conclusions
This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.