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Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed.
Methods:
We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros.
Results:
126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57–0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89–0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06–1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman’s coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID.
Conclusions:
The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Method
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Results
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Conclusions
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
USDA uses the concept of “publish-ability” rather than statistical reliability of an estimate for quality validation of USDA estimates, which is solely based on the sample size and the coefficient of variation (CV). We demonstrate conceptually how the reliability of the sample mean can be tested by estimating the upper and lower bounds of the confidence interval for an unknown population mean using the CV. However, the reliability test for the sample mean can be made only under the normality assumption. USDA multiple-way Agricultural Resource Management Survey (ARMS) estimates are used to illustrate the relative measure of precision for sample-based estimators.
The Adaptive Decision Maker argues that people use a variety of strategies to make judgments and choices. The authors introduce a model that shows how decision makers balance effort and accuracy considerations and predicts which strategy a person will use in a given situation. A series of experiments testing the model are presented, and the authors analyse how the model can lead to improved decisions and opportunities for further research.
This manuscript develops the concept of organizational virtue orientation (OVO) and examines differences between family and non-family firms on the six organizational virtue dimensions of Integrity, Empathy, Warmth, Courage, Conscientiousness, and Zeal. Using content analysis of shareholder letters from S&P 500 companies, our analyses find that there are significant differences between family and non-family firms in their espoused OVO, with family firms generally being higher. Specifically, family firms were significantly higher on the dimensions of Empathy, Warmth, and Zeal, but lower on Courage. Based on these findings we further develop the OVO concept through the discussion of implications and areas for future research.
We synthesize a series of polyvinylcarbazole (PVK) monoliths containing varying loadings of triphenyl bismuth as a high-Z dopant and varying fluors, either organic or organometallic, in order to study their use as scintillators capable of gamma ray spectroscopy. A trend of increasing bismuth loading resulting in a better resolved photopeak is observed. For PVK parts with no fluor or a standard organic fluor, diphenylanthracene (DPA), increasing bismuth loading results in decreasing light yield while with samples 1 or 3 % by weight of the triplet harvesting organometallic fluor bis(4,6-difluoropyridinato-N,C2)picolinatoiridium (FIrpic) show increasing light yield with increasing bismuth loading. Our best performing PVK/ BiPh3/FIrpic scintillator with 40 wt % BiPh3 and 3 wt % FIrpic has an emission maximum of 500 nm, a light yield of ∼30,000 photons/MeV, and energy resolution better than 7% FWHM at 662 keV. Replacing the Ir complex with an equal weight of DPA produces a sample with a light yield of ∼6,000 photons/MeV, with an emission maximum at 420 nm and energy resolution of 9% at 662 keV. Transmission electron microscopy studies show that the BiPh3 forms small clusters of approximately 5 nm diameter.
An outbreak of pharyngoconjunctival fever caused by adenovirus type 3 was studied in a boarding school for 800 boys aged 11–18 years. A total of 96 clinical cases were confirmed by laboratory tests. Clinical infection rates were higher in the younger boys but total infection rates did not vary with age. Previous infection provided 88% protection against reinfection.
The techniques of virus isolation, complement fixation and neutralization were compared in the diagnosis of cases. Virus isolation diagnosed 86% of confirmed cases. Where acute sera (collected at onset) and convalescent sera (collected within one month) were available complement fixation and neutralization tests each diagnosed 96% of cases.
The spread of coagulase-positive staphylococci has been studied in a modern hospital in which most of the patients were nursed in 4-bed rooms separated from a common corridor only by low dividing walls. Acquisition of new nasal strains from patients in other bedrooms was nearly as easy as from patients in the neighbouring beds. There was no indication that subdivision of this type hindered the spread of nasal strains as compared with open wards of the ‘Nightingale’ pattern.
1. The direct and indirect effects of low rainfall on the problems of cattle husbandry in East Africa are discussed, and an example of what these problems mean in practice is described.
2. A co-operative experiment is described that was planned to assess the water requirements of Bos indicus type cattle in a semi-arid region of Tanganyika, and to determine the effect of water deprivation on cattle productivity.
3. Ten sets of identical twin zebu (Bos indicus) or part-zebu cattle were used in this experiment. The basic layout consisted of two treatments, an ‘experimental’ and a ‘control’, one twin from each set being placed on one or other of the treatments. Twins in the ‘experimental’ group were used to determine the effect of watering at 24-, 48- and 72-hr. intervals and of forced walking of 3, 6 and 10 miles per day in addition to normal grazing exercise. The experiment lasted 2 years from 16 April 1960 to 11 May 1962.
4. Climate at the experimental site, the experimental layout, the experimental animals and grazings, management of animals and grazings and experimental observations are described in detail.
5. Data on seasonal changes in the nutrient content of forage on the grazings is given, and the effect of these changes on the nutrition of the experimental cattle is discussed briefly.
The difficulties in the semi-arid regions of East Africa where cattle exist during the dry season on forage with a very low nitrogen content is discussed
To compare induction, pre- and post-discharge recovery characteristics and patient preferences between four anaesthetic regimens in adult day-surgery.
Methods
Randomized controlled trial. In all, 1158 adults assigned to: propofol induction and maintenance, propofol induction with isoflurane/N2O, or sevoflurane/N2O maintenance, or sevoflurane/N2O alone. We prospectively recorded induction and pre-discharge recovery characteristics, collected 7-day post-discharge recovery characteristics using patient diaries and patient preferences by telephone follow-up.
Results
Recruitment rate was 73% – of the 425 refusals, 226 were not willing to risk a volatile induction. During induction, excitatory movements and breath holding were more common with sevoflurane only (P < 0.01). Injection pain and hiccup were more common with propofol induction (P < 0.01). In the recovery room and the postoperative ward, both nausea and vomiting were more common with sevoflurane only (P < 0.01). This difference disappeared within 48 h. There was no difference between groups in the mental state on awakening, recovery time, time to discharge or overnight admissions; then was also no difference in pain between the four groups for each of the seven postoperative days (P < 0.01), nor any differences in concentration or forgetfulness. Patients took 6.5 days (95% CI: 6.0–7.0, n = 693) to resume normal activities. Patients who received sevoflurane only were more likely to recall an unpleasant induction and least likely to want the same induction method again (P < 0.01).
Conclusion
Differences in outcome between the four regimens are transient; sevoflurane is not an ideal sole agent for adult day case anaesthesia and, in this setting, patients base their preferences for future anaesthetics on the method of induction.
The introduction of voluntary fortification of some foods with folic acid in Australia has been implemented since evidence of the prevention of neural tube defects with periconceptional folic acid was published. Our objectives were to determine how many women were aware of folate and when they became aware, what was the awareness of labels on foods that mentioned folate, and how much folate-fortified food women ate.
Methods
To address these objectives we collected data by self-administered questionnaire from a random sample of 578 recently pregnant women in Western Australia between September 1997 and March 2000.
Results
Overall, 89% of women had heard, seen or read anything about the link between folate and birth defects such as spina bifida, 62% first became aware of the folate message before their recent pregnancy and 42% of women noticed any labels on foods that mention folate before or during their recent pregnancy. Overall, 53% of women were aware of foods that have folate added to them and 33% usually or always read the labels on food packaging. The folate-fortified foods most often consumed by women were cereals (69%), breads (34%) and milk (15%). Of the women who consumed folate-fortified foods (78%), the earlier they became aware of the folate message and noticed labels on food, the more fortified foods they consumed.
Conclusions
These results indicate that staple foods fortified with folate are consumed by almost 80% of women in the population. Therefore, mandatory fortification of staple foods may reach most women, providing improved opportunity for the prevention of neural tube defects in Australia.
M. Samimy, Ohio State University,K. S. Breuer, Brown University, Rhode Island,L. G. Leal, University of California, Santa Barbara,P. H. Steen, Cornell University, New York
Periodic axisymmetric vortex breakdown in a cylinder with a rotating end wall
When the fluid inside a completely filled cylinder is set in motion by the rotation of the bottom end wall, steady and unsteady axisymmetric vortex breakdown is possible. The onset of unsteadiness is via a Hopf bifurcation.
Figure 1 is a perspective view of the flow inside the cylinder where marker particles have been released from an elliptic ring concentric with the axis of symmetry near the top end wall. This periodic flow corresponds to a Reynolds number Re=2765 and cylinder aspect ratio H/R=2.5. Neighboring particles have been grouped to define a sheet of marker fluid and the local transparency of the sheet has been made proportional to its local stretching. The resultant dye sheet takes on an asymmetric shape, even though the flow is axisymmetric, due to the unsteadiness and the asymmetric release of marker particles.When the release is symmetric, as in Fig. 2, the dye sheet is also symmetric. These two figures are snapshots of the dye sheet after three periods of the oscillation (a period is approximately 36.3 rotations of the end wall). Figure 3 is a cross section of the dye sheet in Fig. 2 after 26 periods of the oscillation. Here only the marker particles are shown. They are colored according to their time of release, the oldest being blue, through green and yellow, and the most recently released being red. Comparison with Escudier's experiment shows very close agreement.
The particle equations of motion correspond to a Hamiltonian dynamical system and an appropriate.
Background and objective: In October 2000, we conducted a national postal survey of consultant day case anaesthetists in the UK to explore the range and variation in the practice of anaesthetizing a patient for day case surgery (paediatrics, urology and orthopaedics). The survey was carried out as part of a larger study that comprised a major two-centre randomized controlled trial designed to investigate the costs and outcome of several anaesthetic techniques during day care surgery in paediatric and adult patients (cost-effectiveness study of anaesthesia in day case surgery). We report the findings of this national survey of adult urology and orthopaedic day case anaesthetic practice in the UK.
Methods: The survey used a structured postal questionnaire and collected data on the duration of the surgical procedure; the use of premedication; the anaesthetic agents used for induction and maintenance; the fresh gas flows used for anaesthesia; the use of antiemetics; and the administration of local anaesthesia and analgesia.
Results: The overall response rate for the survey was 74% (63% for urology, 67% for orthopaedics). The survey indicated the following practice in adult urology and adult orthopaedic day case surgery: 6 and 12% used premedication; propofol was the preferred induction agent (96 and 97%) and isoflurane the preferred maintenance agent (56 and 58%); 32 and 41% used prophylactic antiemetics; 86 and 93% used a laryngeal mask.
Conclusions: This survey identifies the variation in current clinical practice in adult day surgery anaesthesia in the UK and discusses this variation in the context of current published evidence.
Background and objective: In October 2000, we conducted a national postal survey of day case consultant anaesthetists in the UK to explore the range and variation in practice of anaesthetizing a patient for day case surgery (paediatrics, urology and orthopaedics). This paper reports the findings of this national survey of paediatric day case anaesthetic practice carried out as part of a major two-centre randomized controlled trial designed to investigate the costs and outcome of several anaesthetic techniques during day care surgery in paediatric and adult patients (cost-effectiveness study of anaesthesia in day case surgery).
Methods: The survey used a structured postal questionnaire and collected data on the duration of surgical procedure; the use of premedication; the anaesthetic agents used for induction and maintenance; the fresh gas flow rates used for general anaesthesia; the use of antiemetics; and the administration of local anaesthesia and analgesia.
Results: The overall response rate for the survey was 74 and 63% for the paediatric section of the survey. Respondents indicated that 19% used premedication, 63% used propofol for induction, 54% used isoflurane for maintenance, 24% used prophylactic antiemetics and 85% used a laryngeal mask. The findings of this national survey are discussed and compared with published evidence.
Conclusions: This survey identifies the variation in clinical practice in paediatric day surgery anaesthesia in the UK.
The AS/AGU rat provides an alternative to experimentally produced laboratory models of basal ganglia disorders. This mutant is characterised by disturbances of movement including clumsy gait, whole body tremor, rigidity and difficulty in initiating movement. From an early age, there is a profound depletion of extracellular dopamine in the dorsal caudate-putamen as measured via in vivo microdialysis; levels are only 10–20% of those found in the parent Albino Swiss (AS) strain. Subsequently a depletion of whole tissue dopamine levels occurs and, later still, loss of dopaminergic cells in the substantia nigra pars compacta. The dysfunction in movement and the nigrostriatal dopaminergic system are clearly linked, since movement can be ameliorated by L-DOPA administration. Furthermore, there are depletions in glucose utilisation in several regions of the basal ganglia circuitry, including the substantia nigra pars compacta, the subthalamic nucleus and the ventrolateral thalamus. The AS/AGU rat represents a unique opportunity to investigate the intrinsic factors controlling the integrity of dopaminergic systems and the recent successful positional cloning of the agu gene will allow the molecular mechanisms underlying this interesting phenotype to be analysed.