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Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure’s feasibility, validity, and reliability.
Design:
Retrospective observational study
Participants:
10 CAHs
Methods:
From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.
Results:
Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).
Conclusions:
Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity—all cases identified as ASB were considered ASB—but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.
The objective of this study was to assess the effect of providing mats in the farrowing pen on behaviour and lesions in sows (n = 38) and piglets. Nineteen of the sows and their litters housed in farrowing crates with metal slatted floors were provided with mats, the remaining 19 acting as controls. Sow skin was inspected pre-farrowing and at weaning: the skin and feet of piglets were examined when they were 6 days old. Skin lesions were scored (on a scale of 0 to 6) according to severity. Total lesion scores per sow and median total lesion scores per litter were calculated. Sow behaviour was recorded by direct observation at feeding. Usage of a heat pad for lying in the presence or absence of mats was assessed over a 2hr observation period. Median skin lesion scores of sows did not differ between treatments. Litters from the control treatment had lower skin lesion scores (median [range] 8 [2-12] vs 10 [5-21]; P < 0.05). Median lesion scores of the front legs tended to be higher for piglets on mats (median [range] 8 [1.5-13] vs 4 [1.5-8]; ns). Sows on metal flooring went from kneeling to lowering their hindquarters faster (median [range] 15 [2—45] s) than sows on mats (23 [11—54] s) (P < 0.05). Furthermore, they slipped more on their front (median [range] 2.7 [0-8.7] vs 0 [0-1.3] slips min1; P < 0.001) and hind (median [range] 5.3 [0.3-31.7] vs 1.9 [0-33.3] slips min1; P < 0.05) feet while standing, than sows on mats. More piglets lay on the heat pad when it was covered by a mat (mean ± SEM 45.97 ± 4.49 %) than when no mat was provided (29.29 ± 4.47 %)(P < 0.05). Mats improve sow comfort and reduce slipping. They encourage piglets to lie on the heat pad but cause damage to the skin of the front legs. Providing pigs with mats in the farrowing house could greatly improve welfare on slatted floors, but further research is needed to identify materials that are less abrasive.
On soils dominated by high proportions of clay and organic matter, soil acidity and poor nutrient use efficiency have a major impact on output potential. Due to the inherent chemical properties of these soils, reducing soil acidity and the prevalence of undesirable metallic cations poses challenges. As a result, these soils have a large capacity for phosphorus (P) fixation, therefore reducing plant P availability. Limestone (CaCO3 or MgCO3) is applied to agricultural soils to counteract soil acidity and reduce P fixation. The current study investigates the effects of four contrasting annual P application rates (0, 50, 100, 150 kg P/ha); split (50:50) between spring and summer, across soils with a range of soil pH values from a previous liming trial. The effect of soil pH ranges and P treatment rates on seasonal herbage growth and herbage P concentration was investigated over three years. Soil nutrient status was also investigated. Soil pH had a significant impact on the rate of mineralization and soil P concentration across each site. A soil pH of 6.2 caused a 1.8 mg/l increase in soil test P. An annual P application was necessary to maintain sufficient herbage P concentration for animal dietary requirements (0.35% DM), however there was no effect of P application or liming rate on herbage productivity across the three sites as all sites possessed sufficient soil P reserves. The current experiment has shown that despite optimal soil fertility status, ensuring sufficient plant available P is a problem on these particular soils.
Soil acidity and poor nutrient use efficiency are major limiting factors as regards output potential on heavy soils, soils which are dominated by high proportions of clay and organic matter, with impeded drainage, high buffering capacity and located in high rainfall areas. Lime is applied in order to counteract these limiting factors and in turn improve agricultural output and productivity. The current study investigates the effects of two commonly used lime products at three comparable treatment rates, ground lime (7.5, 5 and 2.5 tonne/ha) and granulated lime (7.5, 2.5 and 1.5 tonne/ha), applied across three distinct sites. The ability of each lime product and treatment rate to counteract soil acidity, increase nutrient availability and influence soil physical structure was assessed over time. On average across sites, 1 tonne/ha of each lime product increased soil pH by 0.15 and 0.21 pH units between ground and granulated lime, respectively. Site 3 experienced the greatest increase change in soil pH in comparison to the other two sites, largely due to lower clay content and cation exchange capacity. Granulated lime was 5.7 times more expensive than ground lime in its ability to reduce soil acidity. The high treatment rate showed the greatest reduction in soil acidity, aluminium and iron concentration as a mean across all sites. Morgan's soil test phosphorus concentration increased across all sites, with treatment rates having no effect on the rate of increase. There was evidence of reduced soil compaction and lime application showed no negative implication on soil physical structure.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
The Murchison Widefield Array (MWA) is an open access telescope dedicated to studying the low-frequency (80–300 MHz) southern sky. Since beginning operations in mid-2013, the MWA has opened a new observational window in the southern hemisphere enabling many science areas. The driving science objectives of the original design were to observe 21 cm radiation from the Epoch of Reionisation (EoR), explore the radio time domain, perform Galactic and extragalactic surveys, and monitor solar, heliospheric, and ionospheric phenomena. All together $60+$ programs recorded 20 000 h producing 146 papers to date. In 2016, the telescope underwent a major upgrade resulting in alternating compact and extended configurations. Other upgrades, including digital back-ends and a rapid-response triggering system, have been developed since the original array was commissioned. In this paper, we review the major results from the prior operation of the MWA and then discuss the new science paths enabled by the improved capabilities. We group these science opportunities by the four original science themes but also include ideas for directions outside these categories.
The Murchison Widefield Array (MWA) is an electronically steered low-frequency (<300 MHz) radio interferometer, with a ‘slew’ time less than 8 s. Low-frequency (∼100 MHz) radio telescopes are ideally suited for rapid response follow-up of transients due to their large field of view, the inverted spectrum of coherent emission, and the fact that the dispersion delay between a 1 GHz and 100 MHz pulse is on the order of 1–10 min for dispersion measures of 100–2000 pc/cm3. The MWA has previously been used to provide fast follow-up for transient events including gamma-ray bursts (GRBs), fast radio bursts (FRBs), and gravitational waves, using systems that respond to gamma-ray coordinates network packet-based notifications. We describe a system for automatically triggering MWA observations of such events, based on Virtual Observatory Event standard triggers, which is more flexible, capable, and accurate than previous systems. The system can respond to external multi-messenger triggers, which makes it well-suited to searching for prompt coherent radio emission from GRBs, the study of FRBs and gravitational waves, single pulse studies of pulsars, and rapid follow-up of high-energy superflares from flare stars. The new triggering system has the capability to trigger observations in both the regular correlator mode (limited to ≥0.5 s integrations) and using the Voltage Capture System (VCS, 0.1 ms integration) of the MWA and represents a new mode of operation for the MWA. The upgraded standard correlator triggering capability has been in use since MWA observing semester 2018B (July–Dec 2018), and the VCS and buffered mode triggers will become available for observing in a future semester.
The search for life in the Universe is a fundamental problem of astrobiology and modern science. The current progress in the detection of terrestrial-type exoplanets has opened a new avenue in the characterization of exoplanetary atmospheres and in the search for biosignatures of life with the upcoming ground-based and space missions. To specify the conditions favourable for the origin, development and sustainment of life as we know it in other worlds, we need to understand the nature of global (astrospheric), and local (atmospheric and surface) environments of exoplanets in the habitable zones (HZs) around G-K-M dwarf stars including our young Sun. Global environment is formed by propagated disturbances from the planet-hosting stars in the form of stellar flares, coronal mass ejections, energetic particles and winds collectively known as astrospheric space weather. Its characterization will help in understanding how an exoplanetary ecosystem interacts with its host star, as well as in the specification of the physical, chemical and biochemical conditions that can create favourable and/or detrimental conditions for planetary climate and habitability along with evolution of planetary internal dynamics over geological timescales. A key linkage of (astro)physical, chemical and geological processes can only be understood in the framework of interdisciplinary studies with the incorporation of progress in heliophysics, astrophysics, planetary and Earth sciences. The assessment of the impacts of host stars on the climate and habitability of terrestrial (exo)planets will significantly expand the current definition of the HZ to the biogenic zone and provide new observational strategies for searching for signatures of life. The major goal of this paper is to describe and discuss the current status and recent progress in this interdisciplinary field in light of presentations and discussions during the NASA Nexus for Exoplanetary System Science funded workshop ‘Exoplanetary Space Weather, Climate and Habitability’ and to provide a new roadmap for the future development of the emerging field of exoplanetary science and astrobiology.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
We present techniques developed to calibrate and correct Murchison Widefield Array low-frequency (72–300 MHz) radio observations for polarimetry. The extremely wide field-of-view, excellent instantaneous (u, v)-coverage and sensitivity to degree-scale structure that the Murchison Widefield Array provides enable instrumental calibration, removal of instrumental artefacts, and correction for ionospheric Faraday rotation through imaging techniques. With the demonstrated polarimetric capabilities of the Murchison Widefield Array, we discuss future directions for polarimetric science at low frequencies to answer outstanding questions relating to polarised source counts, source depolarisation, pulsar science, low-mass stars, exoplanets, the nature of the interstellar and intergalactic media, and the solar environment.
We present low-frequency spectral energy distributions of 60 known radio pulsars observed with the Murchison Widefield Array telescope. We searched the GaLactic and Extragalactic All-sky Murchison Widefield Array survey images for 200-MHz continuum radio emission at the position of all pulsars in the Australia Telescope National Facility (ATNF) pulsar catalogue. For the 60 confirmed detections, we have measured flux densities in 20 × 8 MHz bands between 72 and 231 MHz. We compare our results to existing measurements and show that the Murchison Widefield Array flux densities are in good agreement.
We compare first-order (refractive) ionospheric effects seen by the MWA with the ionosphere as inferred from GPS data. The first-order ionosphere manifests itself as a bulk position shift of the observed sources across an MWA field of view. These effects can be computed from global ionosphere maps provided by GPS analysis centres, namely the CODE. However, for precision radio astronomy applications, data from local GPS networks needs to be incorporated into ionospheric modelling. For GPS observations, the ionospheric parameters are biased by GPS receiver instrument delays, among other effects, also known as receiver DCBs. The receiver DCBs need to be estimated for any non-CODE GPS station used for ionosphere modelling. In this work, single GPS station-based ionospheric modelling is performed at a time resolution of 10 min. Also the receiver DCBs are estimated for selected Geoscience Australia GPS receivers, located at Murchison Radio Observatory, Yarragadee, Mount Magnet and Wiluna. The ionospheric gradients estimated from GPS are compared with that inferred from MWA. The ionospheric gradients at all the GPS stations show a correlation with the gradients observed with the MWA. The ionosphere estimates obtained using GPS measurements show promise in terms of providing calibration information for the MWA.
In agricultural production systems, nitrogen (N) losses to the environment can occur through nitrous oxide (N2O) emissions and nitrate (NO3−) leaching. The objectives of the present study were to evaluate: (1) if urine excreted by non-lactating dairy cows pulse-dosed with dicyandiamide (DCD) and applied to lysimeters reduced N2O-N emissions and NO3−-N leaching on two soil types; and (2) if urine + DCD would increase herbage production over winter. Lysimeters were used to measure N2O emissions and NO3-N leaching. The soils used were a free-draining acid brown earth of sandy loam to loam texture (termed free-draining) and a poorly drained silt loam gley (termed poorly drained). Grass plots were established on the free-draining soil to measure herbage production. The N loading rate of the urine + DCD was 508 kg N/ha and the urine without DCD (urine only) was 451 kg N/ha. Total NO3−-N leaching losses from the free-draining and poorly draining soils were reduced from 100 and 81 kg NO3−-N/ha on the urine-only treatment, respectively, to 9 and 11·6 kg NO3−-N/ha on the urine + DCD treatment, respectively. Total N2O-N emissions from the free-draining and poorly drained soils were reduced significantly from 13·6 and 12·1 kg N2O-N/ha on the urine-only treatment, respectively, to 2·23 and 5·24 kg N2O-N/ha on the urine + DCD treatment, respectively. Applying urine with DCD to pastures inhibited the nitrification process for up to 56 days after treatment application. In the current experiment, there was no significant effect on spring herbage production when urine + DCD was applied to grass plots. Therefore, feeding DCD to dairy cows to apply DCD directly in urine patches was shown to be an effective mitigation strategy to reduce NO3−-N leaching and N2O-N emissions but did not appear to increase spring herbage production.
GLEAM, the GaLactic and Extragalactic All-sky MWA survey, is a survey of the entire radio sky south of declination + 25° at frequencies between 72 and 231 MHz, made with the MWA using a drift scan method that makes efficient use of the MWA’s very large field-of-view. We present the observation details, imaging strategies, and theoretical sensitivity for GLEAM. The survey ran for two years, the first year using 40-kHz frequency resolution and 0.5-s time resolution; the second year using 10-kHz frequency resolution and 2 s time resolution. The resulting image resolution and sensitivity depends on observing frequency, sky pointing, and image weighting scheme. At 154 MHz, the image resolution is approximately 2.5 × 2.2/cos (δ + 26.7°) arcmin with sensitivity to structures up to ~ 10° in angular size. We provide tables to calculate the expected thermal noise for GLEAM mosaics depending on pointing and frequency and discuss limitations to achieving theoretical noise in Stokes I images. We discuss challenges, and their solutions, that arise for GLEAM including ionospheric effects on source positions and linearly polarised emission, and the instrumental polarisation effects inherent to the MWA’s primary beam.
Non-compliance with food record submission can induce bias in nutritional epidemiological analysis and make it difficult to draw inference from study findings. We examined the impact of demographic, lifestyle and psychosocial factors on such non-compliance during the first 3 years of participation in a multidisciplinary prospective paediatric study.
Design
The Environmental Determinants of Diabetes in the Young (TEDDY) study collects a 3 d food record quarterly during the first year of life and semi-annually thereafter. High compliance with food record completion was defined as the participating families submitting one or more days of food record at every scheduled clinic visit.
Setting
Three centres in the USA (Colorado, Georgia/Florida and Washington) and three in Europe (Finland, Germany and Sweden).
Subjects
Families who finished the first 3 years of TEDDY participation (n 8096).
Results
High compliance was associated with having a single child, older maternal age, higher maternal education and father responding to study questionnaires. Families showing poor compliance were more likely to be living far from the study centres, from ethnic minority groups, living in a crowded household and not attending clinic visits regularly. Postpartum depression, maternal smoking behaviour and mother working outside the home were also independently associated with poor compliance.
Conclusions
These findings identified specific groups for targeted strategies to encourage completion of food records, thereby reducing potential bias in multidisciplinary collaborative research.
The Murchison Widefield Array is a Square Kilometre Array Precursor. The telescope is located at the Murchison Radio–astronomy Observatory in Western Australia. The MWA consists of 4 096 dipoles arranged into 128 dual polarisation aperture arrays forming a connected element interferometer that cross-correlates signals from all 256 inputs. A hybrid approach to the correlation task is employed, with some processing stages being performed by bespoke hardware, based on Field Programmable Gate Arrays, and others by Graphics Processing Units housed in general purpose rack mounted servers. The correlation capability required is approximately 8 tera floating point operations per second. The MWA has commenced operations and the correlator is generating 8.3 TB day−1 of correlation products, that are subsequently transferred 700 km from the MRO to Perth (WA) in real-time for storage and offline processing. In this paper, we outline the correlator design, signal path, and processing elements and present the data format for the internal and external interfaces.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided.
Methods
We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82).
Results
The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson’s disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history.
Conclusion
Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.