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To assess the accuracy of provider estimates of ventilator-associated pneumonia (VAP) diagnostic probability in various clinical scenarios.
Design:
We conducted a clinical vignette-based survey of intensive care unit (ICU) physicians to evaluate provider estimates of VAP diagnostic probability before and after isolated cardinal VAP clinical changes and VAP diagnostic test results. Responses were used to calculate imputed diagnostic likelihood ratios (LRs), which were compared to evidence-based LRs.
Setting:
Michigan Medicine University Hospital, a tertiary-care center.
Participants:
This study included 133 ICU clinical faculty and house staff.
Results:
Provider estimates of VAP diagnostic probability were consistently higher than evidence-based diagnostic probabilities. Similarly, imputed LRs from provider-estimated diagnostic probabilities were consistently higher than evidence-based LRs. These differences were most notable for positive bronchoalveolar lavage culture (provider-estimated LR 5.7 vs evidence-based LR 1.4; P < .01), chest radiograph with air bronchogram (provider-estimated LR 6.0 vs evidence-based LR 3.6; P < .01), and isolated purulent endotracheal secretions (provider-estimated LR 1.6 vs evidence-based LR 0.8; P < .01). Attending physicians and infectious disease physicians were more accurate in their LR estimates than trainees (P = .04) and non-ID physicians (P = .03).
Conclusions:
Physicians routinely overestimated the diagnostic probability of VAP as well as the positive LRs of isolated cardinal VAP clinical changes and VAP diagnostic test results. Diagnostic stewardship initiatives, including educational outreach and clinical decision support systems, may be useful adjuncts in minimizing VAP overdiagnosis and ICU antibiotic overuse.
Hospital-acquired Aspergillus rates among coronavirus disease 2019 (COVID-19) patients were initially higher at a hospital with high negative-pressure room utilization compared to a similar hospital with low utilization but with otherwise identical infection control policies. After the index hospital decreased negative-pressure utilization, hospital-acquired Aspergillus case rates at the 2 hospitals converged.
Light has a substantial effect on the behaviour and physiology of nocturnal moths. Ectropis grisescens is a major nocturnal tea pest in China, and light traps are commonly used to control geometrid moths because of their positive phototaxis. However, some moths gather around light traps and enter the light adaptation state, which decreases the efficacy of light traps in controlling this pest. We identified opsin genes and the spectral sensitivities of the photoreceptors of E. grisescens moths. We also determined the effects of several monochromatic lights on opsin gene expression and light adaptation. We detected three types of opsin genes and six spectral sensitive peaks (at 370, 390, 480, 530, 550, and 580 nm). We also observed significant changes in the diurnal rhythm of opsin gene expression under different light conditions. When active males were suddenly exposed to different monochromatic lights, they quickly entered the light adaptation state, and the adaptation time was negatively correlated with the light intensity. Males were most sensitive to 390 nm wavelengths, followed by 544 nm, 457 nm, and 593 nm. Red light (627 nm) did not affect the activity of E. grisescens males but had detectable physiological effects.
We consider the simple random walk on the d-dimensional lattice $\mathbb{Z}^d$ ($d \geq 1$), traveling in potentials which are Bernoulli-distributed. The so-called Lyapunov exponent describes the cost of traveling for the simple random walk in the potential, and it is known that the Lyapunov exponent is strictly monotone in the parameter of the Bernoulli distribution. Hence the aim of this paper is to investigate the effect of the potential on the Lyapunov exponent more precisely, and we derive some Lipschitz-type estimates for the difference between the Lyapunov exponents.
A survey of academic medical-center hospital epidemiologists indicated substantial deviation from Centers for Disease Control and Prevention guidance regarding healthcare providers (HCPs) recovering from coronavirus disease 2019 (COVID-19) returning to work. Many hospitals continue to operate under contingency status and have HCPs return to work earlier than recommended.
In the 2022–2023 season, more than 104,000 tourists visited Antarctica. This represents an increase of more than 40 percent compared to the 2019–2020 pre-pandemic season. This Current Development discusses this trend and the limits of the Antarctic Treaty Consultative Parties, which govern on the basis of consensus, in responding with regulatory action. Options for strengthening regulation in this area are also considered.
We interpret the Taylor–Green cellular vortex model in terms of the Kolmogorov length and velocity scales, in order to study the balance between aggregation and breakup of cohesive sediment in fine-scale turbulence. One-way coupled numerical simulations, which capture the effects of cohesive, lubrication and direct contact forces on the flocculation process, reproduce the non-monotonic relationship between the equilibrium floc size and shear rate observed in previous experiments. The one-way coupled results are confirmed by select two-way coupled simulations. Intermediate shear gives rise to the largest flocs, as it promotes preferential concentration of the primary particles without generating sufficiently strong turbulent stresses to break up the emerging aggregates. We find that the optimal intermediate shear rate increases for stronger cohesion and smaller particle-to-fluid density ratios, and we propose a simple model for the equilibrium floc size that agrees well with experimental data reported in the literature.
This is the first study reporting parasites from the freshwater cyprinid Oxynoemacheilus angorae (Steindachner 1897) caught in Nilüfer Stream, Bursa, in the Northwest Anatolian Region of Turkey. Allocreadium bursensis n. sp. was described from the intesine of O.angorae based on morphological and genetic characteristics. Allocreadium bursensis n. sp. was differentiated from other Allocreadium spp. in having a combination of external (ventral and oral suckers ratio; body length and width and its ratio to forebody) and internal (cirrus pouch position; uterus extension in hindbody; egg size; disposition of anterior border of vitellarium; esophagus length) features. Phylogenetic hypotheses based on maximum parsimony, maximum likelihood, Bayesian inferrence, and neighbor joining analyses of sequence data strongly supported the hypothesis that A. bursensis is nested within the clade of Allocreadium species hosted by cypriniform fish, and it is more closely related to the Far Eastern species A. pseudoisoporum (Primorsky region, Russia) than to the African A. apokryfi. According to genetic p-distances, the taxonomic status of trematodes collected in Turkey was established as independent relative to nine of the valid Allocreadium spp.: 1.8–5.8% in 28S gene and 18.8–22.6% in cox1 gene. The present study increases the number of Allocreadium species and their definitive hosts recorded in Turkey and raises the number of Palearctic representatives of Allocreadium spp. to 26.
Memory complaint in the absence of organic pathology is a common phenomenon accounting for up to one third of patients presenting to memory clinics. Health anxiety has been specifically linked to dementia worry and repeated presentations to the National Health Service (NHS). Providing reassurance that an individual does not have dementia appears ineffective in reducing presentations to primary and secondary care services.
Aims:
This study sought to evaluate and establish the effectiveness of a 1-hour pilot training workshop to enhance healthcare professionals’ knowledge and confidence to those with health anxiety around cognitive decline.
Method:
The one-session pilot training workshop was developed and informed by previous work and consultation with the 2Gether NHS Foundation Trust Memory Assessment Service staff. The training workshop was then evaluated by employing an idiosyncratic self-report questionnaire. Participants completed the questionnaire prior to and after the training workshop.
Results:
Pre- and post-training questionnaires revealed that the pilot training workshop was effective in increasing perceived knowledge and confidence in staff responding to patients presenting with health anxiety and co-occurring subjective memory complaints.
Conclusions:
The findings suggest that healthcare professionals may benefit from training in identifying and addressing health-anxious individuals with subjective memory complaints. This may have implications in the provision of psychologically informed care offered in a memory assessment service. Recommendations are made for further enhancing the effectiveness of staff training and promoting alternative service treatment pathways.
In this article, I present a novel argument against abortion. In short, what makes it wrong to kill someone is that they are a counterfactual person; counterfactual persons are individuals such that, were they not killed, they would have been persons. My view accommodates two intuitions which many views concerning the wrongness of killing fail to account for: embryo rescue cases and the impermissibility of infanticide. The view avoids embryo rescue cases because embryos in the rescue scenarios are not counterfactual people: they are not counterfactual people because it is false to say that, were they not killed, they would have been persons. As a result, it does not follow from my account that there is a prohibition against allowing embryos to die. On the other hand, infants are counterfactual people: an infant is an individual such that, were she not killed, she would have been a person.
The cemetery at Sutton Hoo in East Suffolk includes tumuli dating to the sixth–seventh centuries ad. The largest contained an intact ship-burial. The man commemorated is not identifiable, but is often presumed to be Rædwald, rex Anglorum c ad599–624/5. Excavation was curtailed by the outbreak of war in 1939. Despite subsequent re-excavation and lengthy research, questions remain.
Information dispersed in the definitive publication is correlated and developed. Digital 3D imaging of the ship’s iron fastenings are used here to extrapolate curved lines of missing rivets and superimpose them on the burial chamber plan. A digital roof reconstruction is also presented.
Mechanisms of collapse of the objects are deduced from their positioning and damage, revealing space for access to the chamber. A cross-section depicts the calculated height of the deck and known tilt of the ship. Residues of phosphate, Middle Eastern bitumen, tar and tape cumulatively suggest embalming practices. A temporary coffin and a bed on which possessions were placed are proposed.
The most valuable object relinquished is deduced to be the ship. Fragments of a possible anchor are identified. The suggested identification of the iron stand as a raised light would allow supporting ships to follow.
Grassland habitats currently face severe anthropogenic exploitation, thereby affecting the survival of grassland-dependent biodiversity globally. The biodiversity-rich grasslands of India lack quantitative spatiotemporal information on their status. We evaluated the status of upper Gangetic Plains grasslands in 2015 and compared it with those from 1985, 1995 and 2005. On-ground mapping and visual classifications revealed a 57% decline in these grasslands between 1985 (418 km2) and 2015 (178 km2), mostly driven by habitat conversion (74% contribution by cropland). Limited radiotelemetry data from endemic swamp deer indicated a possible grassland-dominated average home range size of 1.02 km2, and these patches were highly preferred (average Ivlev’s index = 0.85) over other land-use classes at both spatial and temporal scales. Camera-trapping within the core habitats suggests the critical use of these patches as fawning/breeding grounds. Habitat suitability analysis indicates only c. 17% of the area along the Ganges is suitable as swamp deer habitat. We recommend the protection of these critical grassland patches to maintain ‘dynamic corridors’, with restoration and other management approaches involving multiple stakeholders to ensure the survival of this critical ecosystem.
Se presentan los primeros resultados del análisis de pieles procesadas recuperadas en el sitio Puerto Tranquilo 1, ubicado en el extremo norte de la Isla Victoria, en el Parque Nacional Nahuel Huapi, Provincia de Neuquén, Argentina. El material estudiado proviene de un nivel tardío, por encima de un fogón fechado en 640 ± 60 años aP (1288–1431 cal dC). El conjunto incluye tanto fragmentos de piel con pelo como depilados, con costuras de tendón y pelo, pintados y con reparaciones. Se aplicó una metodología específica para el análisis de las pieles y las fibras, con una descripción técnico-morfológica detallada a partir del análisis macro- y microscópico (SEM/óptico). Las características de la médula y de la cutícula de las fibras permitieron la identificación de Lama guanicoe y Mustelidae (cf. Galictis). Se aplicaron estrategias analíticas y metodológicas novedosas y se generaron datos acerca de las diferentes dimensiones del uso humano de los recursos faunísticos y de la producción de tecnologías en el área boscoso-lacustre norpatagónica. La comparación con otras evidencias arqueológicas, etnográficas y etnohistóricas permitió reconocer rasgos tecnológicos recurrentes en la preparación de las pieles y en la manufactura de artefactos, como parte del proceso productivo del cuero en Norpatagonia.
Family functioning may serve as protective or risk factors in the development of youth psychopathology. However, few studies have examined the potentially reciprocal relation between child psychopathology and family functioning. To fill this gap in the literature, this study tested for time-ordered associations between measures of family functioning (e.g., cohesion, conflict, and emotional expressiveness) and child psychopathology (e.g., total behavior problems, externalizing, and internalizing problems) using data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1143, 52.3% female, Nwaves = 5). We used a random-intercept cross-lagged panel model to identify whether child psychopathology preceded and predicted family functioning, the reverse, or both processes occurred simultaneously. At the between-person level, families who tended to have more cohesion, who lacked conflict, and who expressed their emotions had lower levels of child psychopathology. At the within-person level in childhood, we found minimal evidence for time-ordered associations. In adolescence, however, a clear pattern whereby early psychopathology consistently predicted subsequent family functioning emerged, and the reverse direction was rarely found. Results indicate a complex dynamic relation between the family unit and child that have important implications for developmental models that contextualize risk and resilience within the family unit.