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Patients discharged from emergency departments (ED) with antibiotics for common infections often receive unnecessarily prolonged durations, representing a target for transition of care (TOC) antimicrobial stewardship intervention.
Methods:
This study aimed to evaluate the effectiveness of TOC pharmacists’ review on decreasing the duration of discharge oral antibiotics in patients discharged from the ED at an academic medical center. Pharmacist interventions were guided by an antibiotic duration of therapy guidance focused on respiratory, urinary, and skin infections developed and implemented by the antimicrobial stewardship program. Pharmacist interventions from January 27, 2023, to December 29, 2023, were analyzed to quantify the total number of antibiotic days saved and the percentage of provider acceptance.
Results:
The ED TOC pharmacists reviewed a total of 157 oral antibiotic prescriptions. 86.6% percent of the reviews required pharmacist interventions. The most common indications for the discharge antibiotics were urinary tract infections (50.0%) and skin infections (23.4%). The total number of antibiotic days saved was 155 days with the provider acceptance rate of 76.5%. In 21% of cases, providers did not count the antibiotic doses administered in the ED, contributing to unnecessarily prolonged duration. 10.2% of patients re-presented to the ED while 6.4% of patients were hospitalized within 30 days of index ED discharge.
Conclusion:
The transitions of care pharmacist-led intervention was successful in optimizing the duration of discharge oral antibiotics in the ED utilizing prospective audit and feedback based on institutional guidance. The ED represents a high-yield setting for TOC-directed antimicrobial stewardship.
Young stellar objects (YSOs) are protostars that exhibit bipolar outflows fed by accretion disks. Theories of the transition between disk and outflow often involve a complex magnetic field structure thought to be created by the disk coiling field lines at the jet base; however, due to limited resolution, these theories cannot be confirmed with observation and thus may benefit from laboratory astrophysics studies. We create a dynamically similar laboratory system by driving a $\sim$1 MA current pulse with a 200 ns rise through a $\approx$2 mm-tall Al cylindrical wire array mounted to a three-dimensional (3-D)-printed, stainless steel scaffolding. This system creates a plasma that converges on the centre axis and ejects cm-scale bipolar outflows. Depending on the chosen 3-D-printed load path, the system may be designed to push the ablated plasma flow radially inwards or off-axis to make rotation. In this paper, we present results from the simplest iteration of the load which generates radially converging streams that launch non-rotating jets. The temperature, velocity and density of the radial inflows and axial outflows are characterized using interferometry, gated optical and ultraviolet imaging, and Thomson scattering diagnostics. We show that experimental measurements of the Reynolds number and sonic Mach number in three different stages of the experiment scale favourably to the observed properties of YSO jets with $Re\sim 10^5\unicode{x2013}10^9$ and $M\sim 1\unicode{x2013}10$, while our magnetic Reynolds number of $Re_M\sim 1\unicode{x2013}15$ indicates that the magnetic field diffuses out of our plasma over multiple hydrodynamical time scales. We compare our results with 3-D numerical simulations in the PERSEUS extended magnetohydrodynamics code.
Community advisory boards (CABs) are a promising approach for strengthening patient and partner voices in community health center (CHC) evidence-based decision-making. This paper aims to describe how CHCs used CABs during the COVID-19 pandemic to improve the reach of testing among populations experiencing health disparities and identify transferable lessons for future implementation.
Methods:
This mixed methods study integrates brief quantitative surveys of community engagement (N = 20) and one-on-one qualitative interviews (N = 13) of staff and community partners engaged in CHC CABs with a cost analysis and qualitative feedback from CHC staff participating in an online learning community (N = 17).
Results:
Community partners and staff engaged in the CHC CABs reported high ratings of engagement, with all mean ratings of community engagement principles above a 4 (“very good” or “often”) out of 5. Qualitative findings provided a more in-depth understanding of experiences serving on the CHC CAB and highlighted how engagement principles such as trust and mutual respect were reflected in CAB practices. We developed a CHC CAB toolkit with strategies for governance and prioritization, cost estimates to ensure sustainment, guidance on integrating quality improvement expertise, testimonies from community members on the benefits of joining, and template agendas and facilitator training to ensure meeting success.
Conclusion:
In alignment with the Translational Science Benefits Model, this study expands research impact through comprehensive mixed methods measurement of community engagement and by transforming findings into an action-orientated guide for CHCs to implement CABs to guide evidence-based decision-making for community and public health impact.
To introduce the Emory 10-element Complex Figure (CF) scoring system and recognition task. We evaluated the relationship between Emory CF scoring and traditional Osterrieth CF scoring approach in cognitively healthy volunteers. Additionally, a cohort of patients undergoing deep brain stimulation (DBS) evaluation was assessed to compare the scoring methods in a clinical population.
Method:
The study included 315 volunteers from the Emory Healthy Brain Study (EHBS) with Montreal Cognitive Assessment (MoCA) scores of 24/30 or higher. The clinical group consisted of 84 DBS candidates. Scoring time differences were analyzed in a subset of 48 DBS candidates.
Results:
High correlations between scoring methods were present for non-recognition components in both cohorts (EHBS: Copy r = 0.76, Immediate r = 0.86, Delayed r = 0.85, Recognition r = 47; DBS: Copy r = 0.80, Immediate r = 0.84, Delayed Recall r = 0.85, Recognition r = 0.37). Emory CF scoring times were significantly shorter than Osterrieth times across non-recognition conditions (all p < 0.00001, individual Cohen’s d: 1.4–2.4), resulting in an average time savings of 57%. DBS patients scored lower than EHBS participants across CF memory measures, with larger effect sizes for Emory CF scoring (Cohen’s d range = 1.0–1.2). Emory CF scoring demonstrated better group classification in logistic regression models, improving DBS candidate classification from 16.7% to 32.1% compared to Osterrieth scoring.
Conclusions:
Emory CF scoring yields results that are highly correlated with traditional Osterrieth scoring, significantly reduces scoring time burden, and demonstrates greater sensitivity to memory decline in DBS candidates. Its efficiency and sensitivity make Emory CF scoring well-suited for broader implementation in clinical research.
Pharmacist-led initiatives providing optimization of medications during transitions of care (TOC) have shown to have a positive impact on prescribing practices and patient outcomes. This study aims to evaluate the role and impact of TOC pharmacist review of outpatient parenteral antimicrobial therapy (OPAT) prescriptions prior to hospital discharge.
Methods:
In a retrospective chart review, patients with OPAT prescriptions between November 1, 2022 and January 31, 2023 were evaluated using prescription-specific and intervention-specific data points. Prescription-specific data points included intravenous antimicrobials prescribed, indication, prescribing team, and time from OPAT prescription to TOC pharmacist review. Intervention-specific data points included antimicrobial optimization (dose/frequency, duration, and other), prescription clarification, and laboratory monitoring.
Results:
Of the 137 OPAT prescriptions evaluated, 67 required intervention by TOC pharmacists (48.9%). The General Infectious Disease Consult team placed 71.5% of OPAT prescriptions and required interventions less frequently (42.9%) compared to the other teams. Antimicrobial optimization interventions accounted for 54.2% of interventions, which were primarily related to medication dose and frequency.
Conclusion:
The TOC pharmacists can play a key role in the evaluation of OPAT prescriptions at hospital discharge. This intervention demonstrated how TOC pharmacists can effectively collaborate with the OPAT team, which builds on prior evidence of the role and value of pharmacists in the transitional care setting.
OBJECTIVES/GOALS: Studies to improve uptake of Chronic Obstructive Pulmonary Disease Clinical Practice Guidelines (COPD CPG) have yielded inconsistent results. We hypothesized that using implementation science would facilitate rigorous site ‘diagnosis’, and promote effective contextual tailoring of COPD CPG, while piloting the use of telehealth for this. METHODS/STUDY POPULATION: The study was conducted in two Veterans Affairs primary care clinics located in a small sized city. A detailed formative evaluation was conducted using key informant interviews (with VA staff and veterans with COPD who received care at this location) and quantitative data. Multidisciplinary stakeholder group was engaged and strategies to address the determinants identified through the previous step were identified. Telehealth was strongly encouraged as the primary modality for implementing the COPD CPG and we are collecting pilot data on this. Tele-Facilitation, used as the meta-strategy was employed in conjunction with other strategies such as develop/distribute educational materials, tailor strategies, change record systems and revise professional roles. RESULTS/ANTICIPATED RESULTS: Primary Care at the VA is provided by Patient Aligned Care Teams (PACT-teams), where each team consists of multiple health professionals to provide collaborative care to the patient. Discussions with the multidisciplinary stakeholder team suggested that any implementation effort primarily focused on physician and nursing efforts was unlikely to succeed due to competing demands. A pharmacy-centric model that allowed for the PACT-team clinical pharmacist to address most of the COPD CPG (inhaler technique education/assessment, inhaler choice optimization, COPD-specific patient education, spirometry use, smoking and immunization) was developed and implemented with incorporation of telehealth (video visits and telephone). We will present pilot implementation outcomes using RE-AIM framework elements. DISCUSSION/SIGNIFICANCE: This use of implementation science to implement COPD CPG and novel use of telehealth has enormous potential for impact. Increasing reach/adoption by targeting primary care practices can help permeate quality care to the underserved population. This data will allow us to explore generalizability through wider scale implementation studies.
The Rey Complex Figure (CF) is a popular test to assess visuospatial construction and visual memory, but its broader use in clinical research is limited by scoring complexity. To widen its application, we developed a new CF scoring system similar to the Benson Figure in which 10 primary CF elements are scored according to presence and location. A novel recognition task was also created for each of these 10 items consisting of a 4-choice recognition condition containing the primary rectangle and major interior lines with qualitative variations of target elements as distractors. The current investigation was designed to characterize the relationship between scoring methods and establish whether comparable results are obtained across both traditional and new CF scoring approaches.
Participants and Methods:
Participants from the Emory Health Brain Study (EHBS) who had completed the Rey CF copy during their cognitive study visit were studied. All participants were self-identified as normal, and administered the CF according to our previously published procedure that included the Copy, Immediate Recall (∼ 30 seconds), and 30-minute Delayed Recall (Loring et al., 1990). Following delayed recall, CF recognition was assessed using the Meyers and Myers (1995) recognition followed by the newly developed forced choice recognition. The final sample included 155 participants ranging in age from 51.6 years to 80.0 years (M=64.9, SD=6.6). The average MoCA score was 26.8/30 (SD=6.6).
Results:
Mean performance levels across conditions and scoring approaches are included in the table. Correlations between Copy, Immediate Recall, Delayed Recall, and Recognition were calculated to evaluate the relationship between the traditional 18 item/36 point Osterrieth criteria and newly developed CF scoring criteria using both parametric and non-parametric approaches. Pearson correlations demonstrated high agreement between approaches when characterizing performance levels across all CF conditions (Copy r=.72, Immediate Recall r=.87, Delayed Recall r=.90, and Recognition r=.52). Similar correlations were present using non-parametric analyses (Copy ρ=.46, Immediate Recall ρ=.83, Delayed Recall ρ=.91, and Recognition ρ=.42). Table. Mean performance levels across conditions and scoring approaches
Conclusions:
The high correlations, particularly for Immediate and Delayed Recall conditions, suggest that the modified simpler scoring system is comparable to the traditional approach, thereby suggesting potential equivalence between scoring methods. When comparing Rey’s original 47 point scoring approach to his 36 point scoring system, Osterrieth (1944) reported a correlation in fifty adults of ρ=.95 and a correlation in twenty 6-year-olds of ρ=.92. In this investigation, lower correlations were observed for copy and recognition conditions, in part representing smaller response distribution across participants. Although these preliminary results are encouraging, to implement the new EHBS scoring method in clinical evaluation, we are developing normative data in participants across the entire EHBS series, many of whom were not administered the new CF Recognition. We are also examining performances in patients undergoing DBS evaluation for Parkinson Disease to explore its clinical sensitivity. Simpler scoring will permit greater CF clinical and research application.
As historians have begun to conceptualize the U.S. Civil War as a global event, so too must they consider Reconstruction as a political process that transcended national boundaries. The United States and Colombia both abolished slavery during civil wars; ex-slaves in both societies struggled for full citizenship and landholding, partially succeeding for a time; in both societies, a harsh reaction ripped full citizenship from the freedpeople and denied their claims to the land. These events, usually studied only as part of a national story in either the United States or Colombia, can also be understood, and perhaps be better understood, as a history of hemispheric and transnational processes—of race, of republican politics, of contests over equality, of capitalism. This essay examines the words and actions of historical actors, especially U.S. African Americans and afrocolombianos, to note the impressive commonalities of discourse (which was almost exactly the same in many cases) and political repertoires. This article focuses first on the agency of African Americans in both societies to create post-emancipation social movements for citizenship and land and then on the, largely successful, reactions against these movements.
This essay explores the various ways Mexicans and Colombians envisioned and employed modernity in the nineteenth century, especially the flourishing and collapse of an alternative mentalité I call American republican modernity. I argue that in the late 1840s a vision of civilization emerged that privileged political progress, measured by the success of republican projects and the enactment of extensive citizens' rights, as a marker of modernity over older visions, defined by high culture or wealth. Because conceptions of modernity deeply affected the hegemonic rules of political life in Spanish America, I also suggest how such a discourse enabled subalterns to exploit this language to promote their inclusion in new nation-states. The article concludes by exploring the collapse of this alternative modernity in the last quarter of the nineteenth century, as Western notions of modernity—involving technological innovation, industrialization, and state power—became dominant.
Ethical decision making has long been recognized as critical for industrial-organizational (I-O) psychologists in the variety of roles they fill in education, research, and practice. Decisions with ethical implications are not always readily apparent and often require consideration of competing concerns. The American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct are the principles and standards to which all Society for Industrial and Organizational Psychology (SIOP) members are held accountable, and these principles serve to aid in decision making. To this end, the primary focus of this article is the presentation and application of an integrative ethical decision-making framework rooted in and inspired by empirical, philosophical, and practical considerations of professional ethics. The purpose of this framework is to provide a generalizable model that can be used to identify, evaluate, resolve, and engage in discourse about topics involving ethical issues. To demonstrate the efficacy of this general framework to contexts germane to I-O psychologists, we subsequently present and apply this framework to five scenarios, each involving an ethical situation relevant to academia, practice, or graduate education in I-O psychology. With this article, we hope to stimulate the refinement of this ethical decision-making model, illustrate its application in our profession, and, most importantly, advance conversations about ethical decision making in I-O psychology.
Families in War and Peace: Chile from Colony to Nation. By Sarah C. Chambers. Durham, NC: Duke University Press, 2015. Pp. xi + 288. $25.95 paperback. ISBN: 9780822358831.
Of Love and Other Passions: Elites, Politics, and Family in Bogotá, Colombia, 1778–1870. By Guiomar Dueñas-Vargas. Albuquerque: University of New Mexico Press, 2015. Pp. xii + 268. $55.00 hardcover. ISBN: 9780826355850.
The Oligarchy and the Old Regime in Latin America, 1880–1970. By Dennis Gilbert. Lanham: Rowman and Littlefield, 2017. Pp. x + 293. $29.95 paperback. ISBN: 9781442270909.
Los terratenientes de la pampa argentina: Una historia social y política. By Roy Hora. Buenos Aires: Siglo XXI, 2015. Pp. 390. $21.96 paperback. ISBN: 9789876295567.
Una familia de la elite argentina: Los Senillosa, 1810–1930. By Roy Hora and Leandro Losada. Buenos Aires: Prometeo Libros, 2015. Pp. 166. $46.72 paperback. ISBN: 9789875747463.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
The coronavirus disease 2019 (COVID-2019)-induced changes in the workplace present a timely opportunity for human resource management practitioners to consider and remediate the deleterious effects of noise, a commonly cited complaint of employees working in open-plan office (OPO) environments. While self-reports suggest that OPO noise is perceived as a stressor, there is little experimental research comprehensively investigating the effects of noise on employees in terms of their cognitive performance, physiological indicators of stress, and affect. Employing a simulated office setting, we compared the effects of a typical OPO auditory environment to a quieter private office auditory environment on a range of objective and subjective measures of well-being and performance. While OPO noise did not reduce immediate cognitive task performance compared to the quieter environment, it did reduce psychological well-being as evidenced by self-reports of mood, facial expressions of emotion, and physiological indicators of stress in the form of heartrate and skin conductivity. Our research highlights the importance of using a multimodal approach to assess the impact of workplace stressors such as noise. Such an approach will allow HR practitioners to make data-driven recommendations about the design and modification of workspaces to minimize negative effects and support employee well-being.
Develop strong network of science teachers interested in promoting scientific research to their students.
Place students in an immersive summer research internship that, when possible, matches their career interests.
Expose students to the numerous career paths within the STEM field.
METHODS/STUDY POPULATION:
The program recruits socio-economically disadvantaged students and provides them a stipend, and also accepts students who can participate unpaid.
Local school teachers are engaged in a summer fellowship to learn biotechnologies and research. In Spring these teachers help recruit students and during the subsequent Fall help students with college and scholarship applications.
Students are placed in a variety of laboratories within the Schools of Medicine, Science, Dentistry, Public Health, Informatics, Health and Human Sciences, Engineering and Technology, especially in biomedical engineering. Students are also placed in industry laboratories such as Eli Lilly and the Indiana Bioscience Research Institute.
Long-term program follow-up is done through post-internship surveys to assess impact on graduate and professional school admission.
RESULTS/ANTICIPATED RESULTS:
Since the Indiana CTSI was established in 2008, 872 students have participated in the summer internship.
71% of past interns are underrepresented minorities in science or classified as disadvantaged by NIH criteria.
17% of students interned during grade 10, 72% during grade 11, and 11% during grade 12.
21% of students engage in the program for more than one year.
100% of past interns are currently enrolled in or have graduated college.
Over 60% of those with a bachelors degree proceed to graduate and professional schools and over 80% stay in STEM related fields. These rates are equal for interns from underrepresented minorities or those classified as disadvantaged by NIH criteria.
DISCUSSION/SIGNIFICANCE OF IMPACT:
Students engaged in the Indiana CTSI STEM program are progressing through the translational science pipeline based on their graduating from college and remaining in the STEM field.
− Agency is one of five core analytical problems in the Earth System Governance (ESG) Project’s research framework, which offers a unique approach to the study of environmental governance. − Agency in Earth System Governance draws lessons from ESG–Agency research through a systematic review of 322 peer-reviewed journal articles published between 2008 and 2016 and contained in the ESG–Agency Harvesting Database.− ESG–Agency research draws on diverse disciplinary perspectives with distinct clusters of scholars rooted in the fields of global environmental politics, policy studies, and socio-ecological systems. − Collectively, the chapters in Agency in Earth System Governance provide an accessible synthesis of some of the field’s major questions and debates and a state-of-the-art understanding of how diverse actors engage with and exercise authority in environmental governance.
− The role of the state as an agent of earth system governance has become more complex, contingent, and interdependent. − Although participatory and collaborative processes have contributed to more effective, equitable, and legitimate environmental governance outcomes in some instances, analyses of these processes should be situated within a broader governance perspective, which recasts questions of policy change around questions of power and justice. −The complexity and normative aspects of agency in earth system governance requires new forms of policy evaluation that account for social impacts and the ability of governance systems to adapt. − Many of the core analytical concepts in ESG–Agency scholarship, such as agency, power, authority, and accountability, remain under-theorized. In addition, some types of actors, including women, labor, non-human agents, those who work against earth system governance, and many voices from the Global South, remain largely hidden. − ESG–Agency scholars need to develop research projects and collaborations in understudied regions while also recruiting and supporting scholars in those regions to engage with this research agenda.
This paper reports the results of preparing alloy nanoparticles by mechanical grinding followed by filtration to sort the particles according to size. Although the long-term goal of this work is to prepare icosahedral quasicrystalline nanoparticles, the alloy used in this study is of Al65Cu25Fe15 composition and multi phases, under the assumption that the established procedure is applicable to future quasicrystalline nanoparticle fabrication. The obtained particle size and elemental information were investigated using scanning electron microscopy and energy dispersive x-ray spectroscopy. Problems with filter fragment fall-out and salt contamination were encountered and procedures to address the problems have been suggested and tested. The study is successful in obtaining alloy particles with reduced sizes.
Previously known to form only under high pressure synthetic conditions, here we report that the T′-type 214-structure cuprate based on the rare earth atom Tb is stabilized for ambient pressure synthesis through partial substitution of Pd for Cu. The new material is obtained in purest form for mixtures of nominal composition Tb1.96Cu0.8Pd0.2O4. The refined formula, in orthorhombic space group Pbca, with a = 5.5117(1) Å, b = 5.5088(1) Å, and c = 11.8818(1) Å, is Tb2Cu0.83Pd0.17O4. An incommensurate structural modulation is seen along the a axis by electron diffraction and high resolution imaging. Magnetic susceptibility measurements reveal long-range antiferromagnetic ordering at 7.9 K, with a less pronounced feature at 95 K; a magnetic moment reorientation transition is observed to onset at a field of approximately 1.1 T at 3 K. The material is an n-type semiconductor.