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To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists.
This study took place across 4 inpatient hospitals within a large health system in Houston, Texas.
Methods:
We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores.
Results:
Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin.
Conclusions:
Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation.
Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).
Methods
Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.
Results
There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].
Conclusions
Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.
Early Miocene land mammals from eastern North America are exceedingly rare. Over the past several decades a small, but significant, vertebrate fauna has been recovered by paleontologists and citizen scientists from the Belgrade Formation at the Martin Marietta Belgrade Quarry in eastern North Carolina. This assemblage has 12 land mammal taxa, including beaver (Castoridae), stem lagomorph, carnivorans (Mustelidae, Ailuridae), horses (Equidae), rhinoceros (Rhinocerotidae), tapir (Tapiridae), peccary (Tayassuidae), anthracothere (Anthracotheriidae), entelodont (Entelodontidae), and protoceratid (Protoceratidae). Taken together, the biochronology of this Maysville Local Fauna indicates a late Arikareean (Ar3/Ar4) to early Hemingfordian (He1) North American Land Mammal Age (NALMA). This interval, which includes the Runningwater Chronofauna, documents numerous important Holarctic immigrants, including Amphictis, Craterogale, and cf. Menoceras found at this locality. Strontium isotope stratigraphy (SIS) of shark teeth collected in situ from the Belgrade Formation yield an age of 21.4 ± 0.13 Ma, which validates the age of interbedded land mammals within this unit. It also is consistent with the late Arikareean (Ar3/Ar4) biochronology and Aquitanian Neogene marine stage. New SIS analyses of oysters (Striostrea gigantissima) and clams (Chione) from this mine, previously assigned to late Oligocene or Late Miocene, are significantly older (28.0 ± 0.22 Ma and 27.6 ± 0.26 Ma, respectively) than the land mammals. Depending upon stratigraphic interpretations, these may confirm an older marine facies within the Belgrade Formation. This locality is important because of its marine and terrestrial tie-ins that facilitate intercalibration of both NALMAs and Cenozoic marine stages.
Ultra-processed foods (UPFs) have negative health consequences. Food insecurity and Supplemental Nutrition Assistance Program (SNAP) are associated with higher UPF intake in U.S. adults, but this has not been examined in U.S. adolescents. This study assesses associations between food security status and SNAP participation with UPF intake in 3,067 adolescents aged 12–19 years with household incomes at or below 300% of the federal poverty line from the 2007–2016 National Health and Nutrition Examination Survey. UPF is defined using the Nova classification and measured as a percentage of daily total energy intake (TEI). High food security, marginal food security, or food insecurity status was determined through the U.S. Department of Agriculture’s eighteen-item Household Food Security Survey. SNAP participation was deemed affirmative if the household reported receiving SNAP benefits in the last year. Multivariable linear regressions that controlled for TEI and sociodemographic covariates and accounted for the complex survey design examined associations between food insecurity and SNAP participation with UPF intake. In the sample, the prevalence of marginal food security was 15.9%, the prevalence of food insecurity was 33.8%, and the prevalence of SNAP participation was 36.5%. After multivariate adjustment, there were no significant differences in UPF intake by food security status. Adolescents participating in SNAP consumed 2.7% higher UPF intake (95% CI: 0.1%, 5.2%, p = 0.04) compared to adolescents not participating in SNAP. Among lower-income U.S. adolescents, SNAP participation but not food security status was associated with higher UPF intake. Programs and policies promoting the intake of more healthful, minimally processed foods should be strengthened.
Adolescence is a key developmental period associated with an increased risk of experiencing cannabis-related problems. Identifying modifiable risk factors prior to the onset of cannabis use could help inform preventative interventions.
Method
Analysis nested within a UK prospective birth cohort study, the Avon Longitudinal Study of Parents and Children. Participants (n = 6,049) provided data on cannabis use and symptoms of cannabis problems using the Cannabis Abuse Screening Test at two or more time points between the ages of 15–24 years. Risk factors included internalizing and externalizing disorders assessed at age 10 years, and cognitive function assessed at age 8 years via short-term memory, emotion recognition, divided attention, and listening comprehension.
Results
Participants were mostly female (59.1%) and white (95.73%). Five patterns of adolescent cannabis use problems were identified using longitudinal latent class analysis: stable-no problems (n = 5,157, 85%), early-onset high (n = 104, 2%), late-onset high (n = 153, 3%), early onset low (n = 348, 6%), and late-onset low (n = 287, 5%). In adjusted models, externalizing disorders were associated with early-onset high [RR, 95% CI: 2.82 (1.72, 4.63)], late-onset high [RR, 95% CI: 1.62 (1.02, 2.57)], and early-onset low [RR, 95% CI: 1.82 (1.30, 2.55)] compared to the stable-no problems class. Internalizing disorders were associated with late-onset low only [RR, 95% CI: .50 (.26, .96)], and short-term memory with late-onset high only [RR, 95% CI: 1.09 (1.01, 1.18) compared to the stable-no problems class.
Conclusions
Childhood externalizing disorders were consistently associated with increased risk of problematic patterns of cannabis use over adolescence, particularly early-onset and high levels of problems.
Antibiotic stewardship programs (ASPs) target hospitalized children, but most do not routinely review antibiotic prescriptions at discharge, despite 30% of discharged children receiving additional antibiotics. Our objective is to describe discharge antibiotic prescribing in children hospitalized for uncomplicated community-acquired pneumonia (CAP), skin/soft tissue infection (SSTI), and urinary tract infection (UTI).
Design:
Retrospective cohort study.
Setting:
Four academic children’s hospitals with established ASPs.
Patients:
ICD-10 codes identified 3,847 encounters for children <18 years admitted from January 1, 2021 to December 31, 2021 and prescribed antibiotics at discharge for uncomplicated CAP, SSTI, or UTI. After excluding children with medical complexity and encounters with concomitant infections, >7 days hospital stay, or intensive care unit stay, 1,206 encounters were included.
Methods:
Primary outcomes were the percentage of subjects prescribed optimal (1) total (inpatient plus outpatient) duration of therapy (DOT) and (2) antibiotic choice based on current national guidelines and available evidence.
Results:
Of 226 encounters for CAP, 417 for UTI, and 563 for SSTI, the median age was 4 years, 52% were female, and the median DOT was 9 days (8 for CAP, 10 for UTI, and 9 for SSTI). Antibiotic choice was optimal for 77%, and DOT was optimal for 26%. Only 20% of antibiotic courses included both optimal DOT and antibiotic choice.
Conclusions:
At 4 children’s hospitals with established ASPs, 80% of discharge antibiotic courses for CAP, UTI, and SSTI were suboptimal either by choice of antibiotic or DOT. Discharge antibiotic prescribing represents an opportunity to improve antibiotic use in children.
This paper reports an expansion of the English as a second language (L2) component of the Multilingual Eye Movement Corpus (MECO L2), an international database of eye movements during text reading. While the previous Wave 1 of the MECO project (Kuperman et al., 2023) contained English as a L2 reading data from readers with 12 different first language (L1) backgrounds, the newly collected dataset adds eye-tracking data on English text reading from 13 distinct L1 backgrounds (N = 660) as well as participants’ scores on component skills of English proficiency and information about their demographics and language background and use. The paper reports reliability estimates, descriptive statistics, and correlational analyses as means to validate the expansion dataset. Consistent with prior literature and the MECO Wave 1, trends in the MECO Wave 2 data include a weak correlation between reading comprehension and oculomotor measures of reading fluency and a greater L1-L2 contrast in reading fluency than reading comprehension. Jointly with Wave 1, the MECO project includes English reading data from more than 1,200 readers representing a diversity of native writing systems (logographic, abjad, abugida, and alphabetic) and 19 distinct L1 backgrounds. We provide multiple pointers to new venues of how L2 reading researchers can mine this rich publicly available dataset.
We present the first results from a new backend on the Australian Square Kilometre Array Pathfinder, the Commensal Realtime ASKAP Fast Transient COherent (CRACO) upgrade. CRACO records millisecond time resolution visibility data, and searches for dispersed fast transient signals including fast radio bursts (FRB), pulsars, and ultra-long period objects (ULPO). With the visibility data, CRACO can localise the transient events to arcsecond-level precision after the detection. Here, we describe the CRACO system and report the result from a sky survey carried out by CRACO at 110-ms resolution during its commissioning phase. During the survey, CRACO detected two FRBs (including one discovered solely with CRACO, FRB 20231027A), reported more precise localisations for four pulsars, discovered two new RRATs, and detected one known ULPO, GPM J1839 $-$10, through its sub-pulse structure. We present a sensitivity calibration of CRACO, finding that it achieves the expected sensitivity of 11.6 Jy ms to bursts of 110 ms duration or less. CRACO is currently running at a 13.8 ms time resolution and aims at a 1.7 ms time resolution before the end of 2024. The planned CRACO has an expected sensitivity of 1.5 Jy ms to bursts of 1.7 ms duration or less and can detect $10\times$ more FRBs than the current CRAFT incoherent sum system (i.e. 0.5 $-$2 localised FRBs per day), enabling us to better constrain the models for FRBs and use them as cosmological probes.
Pirrie v McFarlane remains an enigmatic case. Decided a few years after the landmark decision of Engineers it reflected an application of the reciprocal nature of the principle applied in that case. The thrust of the decision in Engineers was that the Commonwealth Parliament had power under s 51(xxxv) to make laws binding on the States. In the course of judgment the majority judges had also observed as follows:
The principle we apply to the Commonwealth we apply also to the States, leaving their respective acts of legislation full operation within their respective areas and subject matters, but, in case of conflict, giving to valid Commonwealth legislation the supremacy expressly declared by the Constitution, measuring that supremacy according to the very words of sec. 109.
Coming so soon after Engineers, the decision in Pirrie v McFarlane is clearly consistent with this observation of the majority judges. However, given the subsequent developments in cases such as Cigamatic and Bogle, the authority of Pirrie v McFarlane has been questioned.
The well known writings and other contributions of Professor Zines on the High Court's interpretation of Australia’s Constitution and public law generally have justly earned him the admiration and deep respect of eminent jurists both within Australia and abroad. His interests extended to courts in other western liberal democracies.
In a book based on a series of lectures delivered at the University of Cambridge under the auspices of the Smuts Memorial Fund, Professor Leslie Zines ventured into a comparative study of, inter alia, the role of the courts in the United Kingdom, Canada, Australia and New Zealand. He noted that Canada, Australia and New Zealand share the common feature of the perplexing difficulty of pin-pointing an exact date when these countries obtained their independence from Britain. In other countries which were former British colonies, the date of independence could largely be identified by the date when the Union Jack was lowered and a new national flag was unfurled.
In a federal system there is a constant need to resolve problems created by conflicting provisions of laws enacted by. the federal legislature and those enacted by a state or provincial legislature. In the case of a unitary system it is merely the question of a later statute conflicting with an earlier statute enacted by the same legislature, and in such an instance, the conflict is resolved by regarding the earlier law as having been impliedly repealed by the later law.
In the Australian federal system the conflict is resolved by resorting to the express provisions of s 109 of the Commonwealth Constitution, which reads as follows:
When a law of a State is inconsistent with a law of the Commonwealth, the latter shall prevail, and the former shall, to the extent of the inconsistency, be invalid.
Vaccines have revolutionised the field of medicine, eradicating and controlling many diseases. Recent pandemic vaccine successes have highlighted the accelerated pace of vaccine development and deployment. Leveraging this momentum, attention has shifted to cancer vaccines and personalised cancer vaccines, aimed at targeting individual tumour-specific abnormalities. The UK, now regarded for its vaccine capabilities, is an ideal nation for pioneering cancer vaccine trials. This article convened experts to share insights and approaches to navigate the challenges of cancer vaccine development with personalised or precision cancer vaccines, as well as fixed vaccines. Emphasising partnership and proactive strategies, this article outlines the ambition to harness national and local system capabilities in the UK; to work in collaboration with potential pharmaceutic partners; and to seize the opportunity to deliver the pace for rapid advances in cancer vaccine technology.
Transdisciplinary sustainability scientists work with many different actors in pursuit of change. In so doing they make choices about why and how to engage with different perspectives in their research. Reflexivity – active individual and collective critical reflection – is considered an important capacity for researchers to address the resulting ethical and practical challenges. We developed a framework for reflexivity as a transformative capacity in sustainability science through a critical systems approach, which helps make any decisions that influence which perspectives are included or excluded in research explicit. We suggest that transdisciplinary sustainability research can become more transformative by nurturing reflexivity.
Technical summary
Transdisciplinary sustainability science is increasingly applied to study transformative change. Yet, transdisciplinary research involves diverse actors who hold contrasting and sometimes conflicting perspectives and worldviews. Reflexivity is cited as a crucial capacity for navigating the resulting challenges, yet notions of reflexivity are often focused on individual researcher reflections that lack explicit links to the collective transdisciplinary research process and predominant modes of inquiry in the field. This gap presents the risk that reflexivity remains on the periphery of sustainability science and becomes ‘unreflexive’, as crucial dimensions are left unacknowledged. Our objective was to establish a framework for reflexivity as a transformative capacity in sustainability science through a critical systems approach. We developed and refined the framework through a rapid scoping review of literature on transdisciplinarity, transformation, and reflexivity, and reflection on a scenario study in the Red River Basin (US, Canada). The framework characterizes reflexivity as the capacity to nurture a dynamic, embedded, and collective process of self-scrutiny and mutual learning in service of transformative change, which manifests through interacting boundary processes – boundary delineation, interaction, and transformation. The case study reflection suggests how embedding this framework in research can expose boundary processes that block transformation and nurture more reflexive and transformative research.
Social media summary
Transdisciplinary sustainability research may become more transformative by nurturing reflexivity as a dynamic, embedded, and collective learning process.
Fully relativistic particle-in-cell (PIC) simulations are crucial for advancing our knowledge of plasma physics. Modern supercomputers based on graphics processing units (GPUs) offer the potential to perform PIC simulations of unprecedented scale, but require robust and feature-rich codes that can fully leverage their computational resources. In this work, this demand is addressed by adding GPU acceleration to the PIC code Osiris. An overview of the algorithm, which features a CUDA extension to the underlying Fortran architecture, is given. Detailed performance benchmarks for thermal plasmas are presented, which demonstrate excellent weak scaling on NERSC's Perlmutter supercomputer and high levels of absolute performance. The robustness of the code to model a variety of physical systems is demonstrated via simulations of Weibel filamentation and laser-wakefield acceleration run with dynamic load balancing. Finally, measurements and analysis of energy consumption are provided that indicate that the GPU algorithm is up to ${\sim }$14 times faster and $\sim$7 times more energy efficient than the optimized CPU algorithm on a node-to-node basis. The described development addresses the PIC simulation community's computational demands both by contributing a robust and performant GPU-accelerated PIC code and by providing insight into efficient use of GPU hardware.
The frequencies of m independent p-way contingency tables are analyzed by a model that assumes that the ordinal categorical data in each of m groups are generated from a latent continuous multivariate normal distribution. The parameters of these multivariate distributions and of the relations between the ordinal and latent variables are estimated by maximum likelihood. Goodness-of-fit statistics based on the likelihood ratio criterion and the Pearsonian chisquare are provided to test the hypothesis that the proposed model is correct, that is, it fits the observed sample data. Hypotheses on the invariance of means, variances, and polychoric correlations of the latent variables across populations are tested by Wald statistics. The method is illustrated on an example involving data on three five-point ordinal scales obtained from male and female samples.
This paper is concerned with the analysis of structural equation models with polytomous variables. A computationally efficient three-stage estimator of the thresholds and the covariance structure parameters, based on partition maximum likelihood and generalized least squares estimation, is proposed. An example is presented to illustrate the method.
A special case of Bloxom's version of Tucker's three-mode model is developed statistically. A distinction is made between modes in terms of whether they are fixed or random. Parameter matrices are associated with the fixed modes, while no parameters are associated with the mode representing random observation vectors. The identification problem is discussed, and unknown parameters of the model are estimated by a weighted least squares method based upon a Gauss-Newton algorithm. A goodness-of-fit statistic is presented. An example based upon self-report and peer-report measures of personality shows that the model is applicable to real data. The model represents a generalization of Thurstonian factor analysis; weighted least squares estimators and maximum likelihood estimators of the factor model can be obtained using the proposed theory.
A two-stage procedure is developed for analyzing structural equation models with continuous and polytomous variables. At the first stage, the maximum likelihood estimates of the thresholds, polychoric covariances and variances, and polyserial covariances are simultaneously obtained with the help of an appropriate transformation that significantly simplifies the computation. An asymptotic covariance matrix of the estimates is also computed. At the second stage, the parameters in the structural covariance model are obtained via the generalized least squares approach. Basic statistical properties of the estimates are derived and some illustrative examples and a small simulation study are reported.
Multi-site and multi-organizational teams are increasingly common in epidemiologic research; however, there is a lack of standards or best practices for achieving success in collaborative research networks in epidemiology. We summarize our experiences and lessons learned from the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network, a collaborative agreement between the Centers for Disease Control and Prevention and research teams at Drexel University, New York University, Johns Hopkins University and Geisinger, and the University of Alabama at Birmingham. We present a roadmap for success in collaborative epidemiologic research, with recommendations focused on the following areas to maximize efficiency and success in collaborative research agreements: 1) operational and administrative considerations; 2) data access and sharing of sensitive data; 3) aligning network research aims; 4) harmonization of methods and measures; and 5) dissemination of findings. Future collaborations can be informed by our experiences and ultimately dedicate more resources to achieving scientific aims and efficiently disseminating scientific work products.
Food production accounts for one third of global greenhouse gas emissions(1). Similarly, the demand on the food system depends in part on people’s food choices. Thus, several studies have estimated the environmental impact of dietary patterns based on food consumption data from developed countries(2,3). This has led to literature reviews comparing the evidence for the impact of different diets on the environment and health status(4,5). However, similar analyses from developing countries are scarce. In this context, this systematic review sought to analyse and compare the available literature on the environmental impact of the diet of Latin American populations.
Out of 3007 papers, 30 were included in this review. Eight Latin American countries have reported the environmental impact of diet, with the majority coming from Brazil (n = 8), followed by Mexico (n = 6), Argentina (n = 3), Chile (n = 3), and Peru (n = 2) while only study was available for Colombia, Costa Rica and Guatemala. Water and carbon footprint were the most commonly used measures of the environmental impact of people’s diets. The average (IC 95%) carbon footprint reported were 2.3 (2,1; 2,3); 2.6 (2.6; 4.4); 3.4 (2.4; 4.7); 4.5 (4.4; 4.6) and 8.3 (4.5; 12.4) KgCO2eq/person/day in Guatemala, Peru, Chile, Brazil and Argentina, respectively. In general, men, middle-aged adults and people with higher educational and socio-economic levels were positively associated with a higher diet-related environmental footprint. In addition, beef and vegetables were the foods with the highest and lowest environmental impact attribution, respectively.
Our review reveals a significant lack of research on the environmental impact of diet in Latin American populations. This underlines the need to establish a regional database documenting the environmental footprint of commonly consumed foods in Latin America. This would allow for the development of studies to provide evidence to promote public policies to achieve more sustainable diets in the region.