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Background: Identification of hospitalized patients with enteric multidrug-resistant organism (MDRO) carriage, combined with implementation of targeted infection control interventions, may help reduce MDRO transmission. However, the optimal surveillance approach has not been defined. We sought to determine whether daily serial rectal surveillance for MDROs detects more incident cases (acquisition) of MDRO colonization in medical intensive care unit (MICU) patients than admission and discharge surveillance alone. Methods: Prospective longitudinal observational single-center study from January 11, 2017, to January 11, 2018. Inclusion criteria were ≥3 consecutive MICU days and ≥2 rectal or stool swabs per MICU admission. Daily rectal or stool swabs were collected from patients and cultured for MDROs, including vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacterales (CRE), third-generation cephalosporin-resistant Enterobacterales (3GCR), and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) (as a subset of 3GCR). MDRO detection at any time during the MICU stay was used to calculate prevalent colonization. Incident colonization (acquisition) was defined as new detection of an MDRO after at least 1 prior negative swab. We then determined the proportion of prevalent and incident cases detected by daily testing that were also detected when only first swabs (admission) and last swabs (discharge) were tested. Data were analyzed using SAS version 9.4 software. Results: In total, 939 MICU stays of 842 patients were analyzed. Patient characteristics were median age 64 years (interquartile range [IQR], 51–74), median MICU length of stay 5 days (IQR, 3–8), median number of samples per admission 3 (IQR, 2–5), and median Charlson index 4 (IQR, 2–7). Prevalent colonization with any MDRO was detected by daily swabbing in 401 stays (42.7%). Compared to daily serial swabbing, an admission- and discharge-only approach detected ≥86% of MDRO cases (ie, overall prevalent MDRO colonization). Detection of incident MDRO colonization by an admission- or discharge-only approach would have detected fewer cases than daily swabbing (Figure 1); ≥34% of total MDRO acquisitions would have been missed. Conclusions: Testing patients upon admission and discharge to an MICU may fail to detect MDRO acquisition in more than one-third of patients, thereby reducing the effectiveness of MDRO control programs that are targeted against known MDRO carriers. The poor performance of a single discharge swab may be due to intermittent or low-level MDRO shedding, inadequate sampling, or transient MDRO colonization. Additional research is needed to determine the optimal surveillance approach of enteric MDRO carriage.
This volume examines the emergence of alternative spaces and architectural landscapes of Islamic practice in contemporary Africa through the lens of the masjid, whose definition as a “place of prostration” has enabled Muslim populations across the continent to navigate the murky waters of the contemporary condition through a purposeful renovation of spiritual space. Drawing from multiple disciplines and utilizing a series of diverse case studies, Michelle Apotsos reflects on the shifting realities of Islamic communities as they engage in processes of socio-political and cultural transformation. Illustrated through the growth of forward-thinking and in flexible environments that highlight how Muslim communities have developed unique solutions to the problem of performing identity within diverse contexts across the continent, she re-imagines the major themes surrounding definitions of Islamic architectural space in the contemporary period in Africa and the nature of the “modernity” as it has unfolded across diverse contexts on the continent.
ABSTRACT IMPACT: A robust and collaborative network of expertise and services is essential for successful research commercialization, including timely and scalable educational support for CTSA institutions and individual faculty investigators with biomedical innovations. OBJECTIVES/GOALS: Leverage expertise at the University of Michigan (UM) by creating collaborative and scalable interactive online courses to instruct and prepare internal and external faculty to navigate critical stages of life science academic research commercialization. METHODS/STUDY POPULATION: UM’s Fast Forward Medical Innovation created two online courses with the UM Office of Technology Transfer and the Michigan Institute for Clinical & Health Research (MICHR). Collaborative planning committees, with content and educational experts, set course goals and learning objectives based on audience needs (e.g. preparation for consultations, commercialization concepts, etc.). Draft content was developed, peer reviewed, and revised before Articulate Storyline was used to convert didactic content to active learning content (e.g. interactive slides, scenarios, quizzes, and forms). Pilot testing was conducted prior to the launch to faculty investigators throughout the UM network. RESULTS/ANTICIPATED RESULTS: Intellectual Property in the Academic Setting launched via the FFMI website and newsletter in July 2020 and has had 66 learners to date. Medical Device Regulations launched in October 2020 and has 22 learners. OTT and MICHR have successfully integrated the courses into their consultation process by requesting review from faculty investigators. We suspect that this will lead to more in-depth and meaningful conversation. Additionally, these courses have been integrated into an FFMI commercialization course to instruct on critical concepts. Evaluation and refinement for both use cases will ensue, as well as inform future collaborative courses. DISCUSSION/SIGNIFICANCE OF FINDINGS: Early results suggest that the courses are advantageous and can serve as a model for future collaborations. The opportunity to disseminate the courses across the CTSA network, as well as collaborate with other institutions, to scale localized expertise to a broader network is promising.
Brief cognitive behavioural therapy (CBT) is effective in working with non-underweight eating disorder patients across transdiagnostic groups. However, it is not clear whether it will be as effective in the treatment of binge-eating disorder, where emotional eating is likely to play a larger role than starvation-driven eating. This case series tested whether brief, 10-session CBT (CBT-T) would be effective in a case series of 53 patients with binge-eating disorder. Attrition rates were comparable to previous research. Eating attitudes, binge frequency, anxiety and depression were measured. Remission was measured comparing different categorical methods: ‘cut-off’; reliable change index (RCI); and clinically significant change (CSC). CBT-T was effective for binge-eating disorder patients, at comparable levels to other non-underweight patients. All measures of pathology were significantly reduced, with large to moderate effect sizes. When categorical changes were used to indicate remission, RCI and CSC levels were more appropriate than existing cut-off methods, potentially because of the lower levels of initial restrained eating in this clinical group. CBT-T’s effectiveness in transdiagnostic groups is replicated in binge-eating disorder patients, despite their greater level of emotionally driven eating. More stringent definitions of remission (CSC and RCI) should be used more widely, to ensure realistic estimates.
Key learning aims
(1) What is necessary for brief CBT to be effective for binge-eating disorder (BED)?
(2) Is CBT for BED effective in the absence of purging behaviours?
(3) What is the most appropriate way to measure remission in CBT for BED?
The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.
Providing a comprehensive exploration of his groundbreaking achievements in cinema, the book considers Schrader’s more overlooked films and provides new insights to their connection with his celebrated work in direction and screenwriting such as Taxi Driver (1976), Cat People (1982) and The Comfort of Strangers (1990).
MEM: Now that the jaunt for First Reformed is over, how are you spending your time?
Schrader: Well, I’ve got to, now, go back on that road again because award season is coming. And so they have a few things planned for me. A24 [the distributors] is going to make a push for both Ethan and myself. And so it’s starting up again. But mostly I’ve been writing and done a number of scripts. But to be honest I’m not in any great hurry. There was something I was going to do in April that I wrote but that fell apart half an hour ago on the West Side Highway.
BB: Wow. What was that?
Schrader: The thing I was doing with Willem and Ethan. But maybe we could put it back together.
BB: So we want to look both kind of back and forward a little bit. You’ve had a very different career from a lot of your contemporaries: [Martin] Scorsese and [Steven] Spielberg and [George] Lucas and [Brian] DePalma and [Francis Ford] Coppola, and those people. What do you think your place is among that generation of filmmakers?
Schrader: Well, I never really was drawn to the big toys. And they all are on— the big toys is the big budgets, the long shooting schedules, all of that, which means that you have to really play in the systems. And because my interest in film began with European cinema in the ‘60s, if I could make films like those, that was enough. If I could do my [Ingmar] Bergman or my [Jean-Luc] Godard films, it was still hard, but I had no real desire to do a big-budget thing. And so for me to do First Reformed at three and a half million is just—I mean, Pickpocket is seventy-five minutes long.
MEM: Now that you’ve been a director for some time, what do you think about auteur theory, now in 2018?
Schrader: I think they’re valid. But they’re valid to the extent that the director in most films is the nozzle through which everything must move. And you’re making decisions very, very fast.
Paul Schrader was late. We called and texted, and when we finally got in touch with him, he apologized, explaining that he was stuck in a car, not moving, on the West Side Highway. All southbound lanes were shut down because there had been a shootout between a fleeing drug dealer and the NYPD and the cops were hunting for the shell casings. When Schrader arrived, we began the interview and asked him what his plans were in the wake of First Reformed. He told us: “There was something I was going to do in April that I wrote but that fell apart half an hour ago on the West Side Highway.” This was a fitting introduction to the writer of Taxi Driver; some latter-day Travis Bickle was holding up traffic and preventing the interview from happening as planned. Bickle is American cinema's quintessential angry young man, sexually frustrated, alienated by a city he despises, fascinated by pornography, and eventually obsessed with guns. As written by Schrader, Travis is a landmine waiting to go off and a template against which the rest of his career would react.
He would continue to explore the themes Travis personified, albeit with a different visual approach than Taxi Driver's director Martin Scorsese, a frequent collaborator. Elsewhere, Schrader seems eager to leave Travis behind altogether, traveling as far afield from his iconic creation as possible. Schrader would remark later in the interview: “Well, you don't have that many stories to tell. I think it was [Jean] Renoir who said, ‘Every director has one movie to make, and he just makes it in different ways.’ And for me, the defining moment is when I realized I needed to get out of an insular community, one which was not only trying to dictate what you did but also what you thought. And you’ll have to do that with a certain amount of propulsion and a certain amount of cruelty. And so when you take that urge and then you mix it with the Christian dogma which is a lot about the dark night of the soul and the need for redemptive blood, and you start mixing those two together, and in an adolescent way, it comes out as Taxi Driver and in an old man's way it comes out in First Reformed.