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Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital
- Danielle A. Rankin, Maroya Spalding Walters, Luz Caicedo, Paige Gable, Heather A. Moulton-Meissner, Allison Chan, Albert Burks, Kendra Edwards, Gillian McAllister, Alyssa Kent, Alison Laufer Halpin, Christina Moore, Tracy McLemore, Linda Thomas, Nychie Q. Dotson, Alvina K. Chu
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 3 / March 2024
- Published online by Cambridge University Press:
- 10 January 2024, pp. 292-301
- Print publication:
- March 2024
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Objective:
We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A).
Methods:We defined an incident case as the first detection of blaKPC or blaVIM from a patient’s clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing.
Results:From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates.
Conclusions:Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.
PP57 Collaborating In Times Of COVID: The Launch Of The National Wales COVID-19 Evidence Centre
- Lauren Elston, Thomas Winfield, Jenni Washington, David Jarrom, Susan Myles, Ruth Lewis, Alison Cooper, Micaela Gal, Adrian Edwards
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, p. S59
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Introduction
The COVID-19 pandemic has had a dramatic impact on the health and social care landscape, both in terms of service provision and citizen need. Responsive, evidence-based research is essential to develop and implement appropriate policies and practices that manage both the pandemic itself, and the impact COVID-19 has on other health and social care issues.
To address this, the Wales COVID-19 Evidence Centre (WCEC) was launched in 2021 with the aim of providing the best available, up-to-date, and relevant evidence to inform health and care decision making across Wales.
MethodsFunded by the Welsh Government, the WCEC comprises of a core team and several collaborating partner organizations, including Health Technology Wales, Wales Centre for Evidence-Based Care, Specialist Unit for Review Evidence Centre, SAIL Databank, Public Health Wales, Bangor Institute for Health & Medical Research in conjunction with Health and Care Economics Cymru, and the Public Health Wales Observatory. Over the last year, WCEC has developed its rapid review processes and methodology informed by best international practice and aims to provide around 50 reviews each year. WCEC works alongside various stakeholder groups from health and social care across Wales, and they form an integral part of the review process, from scoping to knowledge mobilization.
ResultsTo date, the WCEC has produced reviews on a diverse range of COVID-19 topics, including transmission, vaccination uptake (barriers, facilitators and interventions), mental health and wellbeing, as well as face coverings and other preventative interventions. The topics have also covered a wide range of populations, from general public, to healthcare workers, to children. These reviews have been used to inform policy and decision-making, including the Welsh Government’s Chief Medical Officer 21-day COVID-19 reviews.
ConclusionsThe WCEC has brought together multiple specialist centers with a diverse range of skills to produce timely reviews of the most up-to-date research to support decision makers across health and social care. These reviews have informed policy and decision-making across Wales.
A large outbreak of COVID-19 in a UK prison, October 2020 to April 2021
- James P. Adamson, Christopher Smith, Nicole Pacchiarini, Thomas Richard Connor, Janet Wallsgrove, Ian Coles, Clare Frost, Angharad Edwards, Jaisi Sinha, Catherine Moore, Steph Perrett, Christie Craddock, Clare Sawyer, Alison Waldram, Alicia Barrasa, Daniel Rh. Thomas, Philip Daniels, Heather Lewis
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- Journal:
- Epidemiology & Infection / Volume 150 / 2022
- Published online by Cambridge University Press:
- 30 May 2022, e134
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Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.
We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.
Of 453 cases, 53% (n = 242) were staff, most aged 25–34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26–64%) than in residents (12%, 95% CI 9–15%).
Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.
Whistle while you work: improving psychiatry training in a London NHS Trust and what we learned along the way
- Emily Duncan, Alex Bailey, Simon Edwards, Alison Butler, Layth Humsi
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S134
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Aims
The aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.
MethodCollected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.
Reassessed and fedback to the trainees throughout.
ResultOur baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.
We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.
From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.
Conclusion• Trainees must be central to the work in improving their training
• Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan
• Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses
• Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes
• Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central role
The Safety Conversation: developing a trustwide safety conference at CNWL during a pandemic
- Emily Duncan, Simon Edwards, Alison Butler, Cornelius Kelly
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S133-S134
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Aims
The COVID pandemic has had both a massive impact on clinical service delivery and the way that training and education is provided. CNWL is a large NHS provider and has approximately 7000 staff working across 150 locations, providing mental health and community health services. In response to the need to share learning across the organisation, a trustwide “Safety Conversation Day” took place to spotlight the work being done to promote safety and to act as a platform to share ideas and learning across the trust. This was the first ever virtual conference organised by the trust.
MethodThe one-day conference included virtual posters and an all-day open access virtual conversation delivered via zoom. The day was divided into 6 safety themes: Safety tools; Safer Environments; Supporting and Involving Staff; Safer use of Medicines; See Think Act and Relational Security; and Prevention is Better than Cure. Frontline staff delivered 5-6 short presentations each hour highlighting new ways of working, quality improvement, local research etc.
Staff were also encouraged to submit posters for the event, with webinars held on how to write a poster held prior to the safety conversation to promote engagement. Prizes were awarded for best posters in the different categories.
A mentimeter survey was running throughout the day to get feedback from participants.
ResultThis was the largest event of this kind held by the trust. 430 unique viewers logged in during the day to watch the presentations.
Feedback was very positive on the mentimeter survey. 3 questions were asked on a likert scale of: Strongly Disagree – Strongly Agree (rated out of 5):
– ‘I found the posters really useful': 4.5/5
– ‘I found the presentations very useful': 4.6/5
– ‘I will share what I've learnt about safety': 4.6/5
174 posters were presented with good representation from all services and staff groups across the trust (18 on safer use of medicines, 15 on co-production, 52 on quality improvement, 50 on COVID and non-COVID safety, 16 on use of technology, 23 on supporting and involving staff). These posters have since been downloaded 4062 times.
ConclusionThe first CNWL safety conference proved an excellent opportunity to celebrate achievements in patient safety in a very difficult year. It was very well-received and well-attended by staff, promoting maximal learning across the organisation.
Improving venous thromboembolism risk assessments on an older age psychiatric ward – a complete audit cycle
- Syazana JD, Edward Hart, Ranjit Mahanta, Alison Marshall
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S86
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Aims
Venous thromboembolism (VTE) is a common disease amongst hospital patients. Within acute hospitals, there are well established protocols for risk assessment and prevention of VTE via mechanical and pharmacological prophylaxes.
In psychiatry, assessment of VTE risk is more commonly overlooked despite many inherent risk factors which are unique to acute psychiatric admissions; including antipsychotic medications, physical restraint, catatonic states, and poor nutritional and hydration status[1]. The risk is compounded in older adult psychiatric patients, in which both patient and admission-related risk factors can act synergistically.
Anecdotally, it was reported that VTE assessments were not being completed and documented on the electronic patient record system. Our aim was to introduce a physical VTE risk assessment to attach to paper drug charts, which would act as a prompt for junior doctors, and serve to increase rates of completion.
MethodA baseline retrospective audit of all patients admitted to the older adult inpatient ward over an 11-week period (05/08/2019~20/10/2019) was undertaken. The number of completed electronic VTE risk assessments at admission, and at 24 hours post-admission were calculated.
Subsequently, a new paper VTE risk assessment proforma was developed, combining the Department of Health VTE risk assessment tool[3] with several VTE risk factors associated with psychiatric patients (catatonia, antipsychotic medication, reduced oral intake, psychomotor retardation). Education was provided to the ward doctors, and regular assessments of VTE risk was incorporated into the weekly MDT meetings.
A re-audit was completed to assess the completion rates of the new paper VTE proforma. A snapshot style audit of all inpatients on the ward on Thursday 24th February 2020 was performed.
ResultThe baseline audit included 23 patients admitted during the 11-week period, consisting of 21 men and two women. The mean age was 74 years. Three patients (13% of total admissions) had their VTE and bleeding risk assessed on admission.
Following the implementation of a new VTE risk assessment proforma, the re-audit showed that all 19 inpatients (100% of total admissions) had a completed assessment. Although none of the patients required mechanical prophylaxis, one patient was receiving ongoing treatment for pulmonary embolism.
ConclusionVTE is a preventable disease, which historically has been under-recognised by psychiatric doctors. The introduction of a paper risk assessment proforma increased completion from 13% to 100%. It also prompted regular review of VTE risk during the weekly MDT meetings. This intervention may reduce the incidence of VTE-related pathology on the ward.
128 Factors Associated with Cost Savings Following Use of a Pharmacogenetic Assay in Individuals with Mood and Anxiety Disorders
- Alison M Edwards, Roy H Perlis, David S Krause
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- Journal:
- CNS Spectrums / Volume 25 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 281-282
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Background:
In a study conducted in the database of a large commercial healthcare insurer, we previously demonstrated that use of a commercial pharmacogenetic assay for individuals with mood disorders was associated with decreased resource utilization and cost in the 6 month period following use compared to propensity-score matched controls. We conducted a post hoc analysis to understand variables associated with high cost savings.
Methods:The results and methods of the initial study have previously been described. Cases were individuals with mood and anxiety disorders who received a commercial pharmacogenetic assay (Genomind, King of Prussia PA) to inform pharmacotherapy. 817 tested individuals (cases) with mood and/or anxiety disorders were matched to 2745 controls. Overall costs were estimated to be $1,948 lower in the tested group. The differences were largely the result of lesser emergency room and inpatient utilization for cases. In the present analysis, cost difference for cases compared to their matched controls was rank ordered by decile. High cost savers were arbitrarily defined a priori as the top 20% of savers. Using multivariable modeling techniques, an ordinal logistic regression model was generated in which baseline or follow-up variables were statistically tested for independent associations with high, low, and no cost savings.
Results:606 (74%) of cases were net cost savers compared to their controls (cost difference <0). High cost savers (n=121) saved on average $10,690 compared to their matched controls. They were statistically more likely to have been diagnosed with bipolar disorder (n=33/121) than low cost savers (n=57/485) or non-savers (n=31/211), and had a lower Charlson Comorbidity index. High cost savers had fewer mean number of antidepressants in the baseline period (mean=3.16) compared to non-savers (3.73) but more than low cost savers (2.72) (p<0.05 across groups). In a multivariable model, bipolar, count of antidepressants, outpatient visits, and inpatient visits were statistically associated with being a high cost saver; antidepressant count and all-cause inpatient and outpatient visits in the baseline period were inversely associated with cost savings.
Conclusions:Use of a pharmacogenetic assay was associated with cost-savings in the database of a large commercial insurer. Patients with bipolar disorder were more likely to be high cost savers than individuals with other mood and anxiety disorders.
Funding Acknowledgements:Genomind
15 - Beyond English as a Second or Foreign Language: Local Uses and the Cultural Politics of Identification
- from Part III - Linguistics and World Englishes
- Edited by Daniel Schreier, Universität Zürich, Marianne Hundt, Universität Zürich, Edgar W. Schneider, Universität Regensburg, Germany
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- The Cambridge Handbook of World Englishes
- Published online:
- 16 December 2019
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- 02 January 2020, pp 339-359
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Summary
We explore how English is implicated in local language practices in the Netherlands, where English has limited official status, and in Japan, where it has no significant role in transactional communication at all. English in these contexts has typically been constructed as a “foreign” or “international” language, precluding consideration of the increasingly complex and multifarious ways it is mobilized for local interpersonal functions and the performance of identity. We present two specific analytic examples from the mediascapes of the two countries. Sociolinguistic and discourse-analytic analyses of our data show how English is tied up with the construction of the self and the other in different, profound, and sometimes unexpected ways. Although the prevailing English-language ideologies are almost polar opposites – the Japanese are typically constructed in the Japanese national imagination as “English-incompetent,” in contrast with the broad “English-knowing” identity in the Netherlands – in both contexts the use of English as a global linguistic resource creates new semiotic opportunities for social actors to negotiate and revise their identities and strategically construct the local.
Chapter 14 - Varieties of English in the Netherlands and Germany
- from IV - Beyond Germany
- Edited by Raymond Hickey, Universität Duisburg–Essen
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- English in the German-Speaking World
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- 11 November 2019
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- 05 December 2019, pp 267-293
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Summary
As English becomes ever more entrenched as an additional language in mainland Europe, research suggests it is no longer used purely instrumentally, for the purposes of international communication, but is becoming an integral part of the sociocultural identity of many continental Europeans (e.g. Berns, De Bot and Hasebrink 2007; Berns 1995, 2005; Edwards 2016; Leppänen et al. 2011; Preisler 1999; Proshina 2005). An increasing number of studies have focused on mainland Europeans’ attitudes to different non-native (NNS) varieties of English. Attitudes to the notion of a pan-continental ‘Euro-English’ have been found to be largely negative (Van den Doel and Quené 2013; Forche 2012; Gnutzmann, Jakisch and Rabe 2015; Groom 2012; Mollin 2006; Murray 2004; Sing 2004). However, there are indications that more localised (regional or national) varieties of English may be viewed as more acceptable.
Parasites in Antarctic krill guts inferred from DNA sequences
- Alison C. Cleary, Maria C. Casas, Edward G. Durbin, Jaime Gómez-Gutiérrez
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- Antarctic Science / Volume 31 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 10 January 2019, pp. 16-22
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The keystone role of Antarctic krill, Euphausia superba Dana, in Southern Ocean ecosystems, means it is essential to understand the factors controlling their abundance and secondary production. One such factor that remains poorly known is the role of parasites. A recent study of krill diet using DNA analysis of gut contents provided a snapshot of the parasites present within 170 E. superba guts in a small area along the West Antarctic Peninsula. These parasites included Metschnikowia spp. fungi, Haptoglossa sp. peronosporomycetes, Lankesteria and Paralecudina spp. apicomplexa, Stegophorus sp. nematodes, and Pseudocollinia spp. ciliates. Of these parasites, Metschnikowia spp. fungi and Pseudocollinia spp. ciliates had previously been observed in E. superba, as had other genera of apicomplexans, though not Lankesteria and Paralecudina. In contrast, nematodes had previously only been observed in eggs of E. superba, and there are no literature reports of peronosporomycetes in euphausiids. Pseudocollinia spp., parasitoids which obligately kill their host, were the most frequently observed infection, with a prevalence of 12%. The wide range of observed parasites and the relatively high frequency of infections suggest parasites may play a more important role than previously acknowledged in E. superba ecology and population dynamics.
WHICH DATABASES SHOULD BE USED TO IDENTIFY STUDIES FOR SYSTEMATIC REVIEWS OF ECONOMIC EVALUATIONS?
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- Mick Arber, Julie Glanville, Jaana Isojarvi, Erin Baragula, Mary Edwards, Alison Shaw, Hannah Wood
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue 6 / 2018
- Published online by Cambridge University Press:
- 16 November 2018, pp. 547-554
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Objectives:
This study investigated which databases and which combinations of databases should be used to identify economic evaluations (EEs) to inform systematic reviews. It also investigated the characteristics of studies not identified in database searches and evaluated the success of MEDLINE search strategies used within typical reviews in retrieving EEs in MEDLINE.
Methods:A quasi-gold standard (QGS) set of EEs was collected from reviews of EEs. The number of QGS records found in nine databases was calculated and the most efficient combination of databases was determined. The number and characteristics of QGS records not retrieved from the databases were collected. Reproducible MEDLINE strategies from the reviews were rerun to calculate the sensitivity and precision for each strategy in finding QGS records.
Results:The QGS comprised 351 records. Across all databases, 337/351 (96 percent) QGS records were identified. Embase yielded the most records (314; 89 percent). Four databases were needed to retrieve all 337 references: Embase + Health Technology Assessment database + (MEDLINE or PubMed) + Scopus. Four percent (14/351) of records could not be found in any database. Twenty-nine of forty-one (71 percent) reviews reported a reproducible MEDLINE strategy. Ten of twenty-nine (34.5 percent) of the strategies missed at least one QGS record in MEDLINE. Across all twenty-nine MEDLINE searches, 25/143 records were missed (17.5 percent). Mean sensitivity was 89 percent and mean precision was 1.6 percent.
Conclusions:Searching beyond key databases for published EEs may be inefficient, providing the search strategies in those key databases are adequately sensitive. Additional search approaches should be used to identify unpublished evidence (grey literature).
Small Sets of Novel Words Are Fully Retained After 1-Week in Typically Developing Children and Down Syndrome: A Fast Mapping Study
- Stella Sakhon, Kelly Edwards, Alison Luongo, Melanie Murphy, Jamie Edgin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 24 / Issue 9 / October 2018
- Published online by Cambridge University Press:
- 30 October 2018, pp. 955-965
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Objectives: Down syndrome (DS) is a population with known hippocampal impairment, with studies showing that individuals with DS display difficulties in spatial navigation and remembering arbitrary bindings. Recent research has also demonstrated the importance of the hippocampus for novel word-learning. Based on these data, we aimed to determine whether individuals with DS show deficits in learning new labels and if they may benefit from encoding conditions thought to be less reliant on hippocampal function (i.e., through fast mapping). Methods: In the current study, we examined immediate, 5-min, and 1-week delayed word-learning across two learning conditions (e.g., explicit encoding vs. fast mapping). These conditions were examined across groups (twenty-six 3- to 5-year-old typically developing children and twenty-six 11- to 28-year-old individuals with DS with comparable verbal and nonverbal scores on the Kaufman Brief Intelligence Test – second edition) and in reference to sleep quality. Results: Both individuals with and without DS showed retention after a 1-week delay, and the current study found no benefit of the fast mapping condition in either group contrary to our expectations. Eye tracking data showed that preferential eye movements to target words were not present immediately but emerged after 1-week in both groups. Furthermore, sleep measures collected via actigraphy did not relate to retention in either group. Conclusions: This study presents novel data on long-term knowledge retention in reference to sleep patterns in DS and adds to a body of knowledge helping us to understand the processes of word-learning in typical and atypically developing populations. (JINS, 2018, 24, 955–965)
The Neotoma Paleoecology Database, a multiproxy, international, community-curated data resource
- John W. Williams, Eric C. Grimm, Jessica L. Blois, Donald F. Charles, Edward B. Davis, Simon J. Goring, Russell W. Graham, Alison J. Smith, Michael Anderson, Joaquin Arroyo-Cabrales, Allan C. Ashworth, Julio L. Betancourt, Brian W. Bills, Robert K. Booth, Philip I. Buckland, B. Brandon Curry, Thomas Giesecke, Stephen T. Jackson, Claudio Latorre, Jonathan Nichols, Timshel Purdum, Robert E. Roth, Michael Stryker, Hikaru Takahara
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- Journal:
- Quaternary Research / Volume 89 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 17 January 2018, pp. 156-177
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The Neotoma Paleoecology Database is a community-curated data resource that supports interdisciplinary global change research by enabling broad-scale studies of taxon and community diversity, distributions, and dynamics during the large environmental changes of the past. By consolidating many kinds of data into a common repository, Neotoma lowers costs of paleodata management, makes paleoecological data openly available, and offers a high-quality, curated resource. Neotoma’s distributed scientific governance model is flexible and scalable, with many open pathways for participation by new members, data contributors, stewards, and research communities. The Neotoma data model supports, or can be extended to support, any kind of paleoecological or paleoenvironmental data from sedimentary archives. Data additions to Neotoma are growing and now include >3.8 million observations, >17,000 datasets, and >9200 sites. Dataset types currently include fossil pollen, vertebrates, diatoms, ostracodes, macroinvertebrates, plant macrofossils, insects, testate amoebae, geochronological data, and the recently added organic biomarkers, stable isotopes, and specimen-level data. Multiple avenues exist to obtain Neotoma data, including the Explorer map-based interface, an application programming interface, the neotoma R package, and digital object identifiers. As the volume and variety of scientific data grow, community-curated data resources such as Neotoma have become foundational infrastructure for big data science.
PERFORMANCE OF OVID MEDLINE SEARCH FILTERS TO IDENTIFY HEALTH STATE UTILITY STUDIES
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- Mick Arber, Sonia Garcia, Thomas Veale, Mary Edwards, Alison Shaw, Julie M. Glanville
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue 4 / 2017
- Published online by Cambridge University Press:
- 25 October 2017, pp. 472-480
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Objectives: This study was designed to assess the sensitivity of three Ovid MEDLINE search filters developed to identify studies reporting health state utility values (HSUVs), to improve the performance of the best performing filter, and to validate resulting search filters.
Methods: Three quasi-gold standard sets (QGS1, QGS2, QGS3) of relevant studies were harvested from reviews of studies reporting HSUVs. The performance of three initial filters was assessed by measuring their relative recall of studies in QGS1. The best performing filter was then developed further using QGS2. This resulted in three final search filters (FSF1, FSF2, and FSF3), which were validated using QGS3.
Results: FSF1 (sensitivity maximizing) retrieved 132/139 records (sensitivity: 95 percent) in the QGS3 validation set. FSF1 had a number needed to read (NNR) of 842. FSF2 (balancing sensitivity and precision) retrieved 128/139 records (sensitivity: 92 percent) with a NNR of 502. FSF3 (precision maximizing) retrieved 123/139 records (sensitivity: 88 percent) with a NNR of 383.
Conclusions: We have developed and validated a search filter (FSF1) to identify studies reporting HSUVs with high sensitivity (95 percent) and two other search filters (FSF2 and FSF3) with reasonably high sensitivity (92 percent and 88 percent) but greater precision, resulting in a lower NNR. These seem to be the first validated filters available for HSUVs. The availability of filters with a range of sensitivity and precision options enables researchers to choose the filter which is most appropriate to the resources available for their specific research.
Computing the volume response of the Antarctic Peninsula ice sheet to warming scenarios to 2200
- Nicholas E. Barrand, Richard C.A. Hindmarsh, Robert J. Arthern, C. Rosie Williams, Jérémie Mouginot, Bernd Scheuchl, Eric Rignot, Stefan R.M. Ligtenberg, Michiel R. Van Den Broeke, Tamsin L. Edwards, Alison J. Cook, Sebastian B. Simonsen
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- Journal:
- Journal of Glaciology / Volume 59 / Issue 215 / 2013
- Published online by Cambridge University Press:
- 10 July 2017, pp. 397-409
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The contribution to sea level to 2200 from the grounded, mainland Antarctic Peninsula ice sheet (APIS) was calculated using an ice-sheet model initialized with a new technique computing ice fluxes based on observed surface velocities, altimetry and surface mass balance, and computing volume response using a linearized method. Volume change estimates of the APIS resulting from surface mass-balance anomalies calculated by the regional model RACMO2, forced by A1B and E1 scenarios of the global models ECHAM5 and HadCM3, predicted net negative sea-level contributions between −0.5 and −12 mm sea-level equivalent (SLE) by 2200. Increased glacier flow due to ice thickening returned ∼15% of the increased accumulation to the sea by 2100 and ∼30% by 2200. The likely change in volume of the APIS by 2200 in response to imposed 10 and 20 km retreats of the grounding line at individual large outlet glaciers in Palmer Land, southern Antarctic Peninsula, ranged between 0.5 and 3.5 mm SLE per drainage basin. Ensemble calculations of APIS volume change resulting from imposed grounding-line retreat due to ice-shelf break-up scenarios applied to all 20 of the largest drainage basins in Palmer Land (covering ∼40% of the total area of APIS) resulted in net sea-level contributions of 7–16 mm SLE by 2100, and 10–25 mm SLE by 2200. Inclusion of basins in the northern peninsula and realistic simulation of grounding-line movement for AP outlet glaciers will improve future projections.
Residual Effect of Herbicides Used in Pastures on Clover Establishment and Productivity
- Angela S. Laird, Donnie K. Miller, James L. Griffin, Edward K. Twidwell, Montgomery W. Alison, David C. Blouin
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- Journal:
- Weed Technology / Volume 30 / Issue 4 / December 2016
- Published online by Cambridge University Press:
- 23 February 2017, pp. 929-936
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A major hindrance to establishment of successful complementary forage systems that include warm-season perennial grasses and clovers is tolerance of the latter to herbicides available for weed control. Field experiments were conducted in 2013 at two locations in northeast Louisiana to evaluate simulated residual rate effects of fluroxypyr plus triclopyr and 2,4-D plus picloram applied at 0, 0.25, 0.38, and 0.5× use rates immediately after fall planting of ball, white, crimson, and red clover. For all clovers, when averaged across herbicide rates, plant population 161/171 d after planting (DAP), ground cover, and height 184/196 DAP were equivalent for fluroxypyr plus triclopyr and the nontreated control and greater than 2,4-D plus picloram. Averaged across clovers, plant height after all rates of fluroxypyr plus triclopyr was equivalent to the nontreated control (14.2 to 14.3 vs. 15.3 cm) and greater than 2,4-D plus picloram. Compared with the nontreated control, 2,4-D plus picloram at 25, 38, and 50% of the normal use rates reduced height 58, 76, and 85%, respectively. When averaged across clover species, yield for fluroxypyr plus triclopyr at all rates was equivalent to the nontreated control (2,624 to 2,840 vs. 2,812 kg ha−1). Compared with the nontreated control, 2,4-D plus picloram at the 0.25, 0.38, and 0.50× use rates reduced yield 65, 89, and 99%, respectively.
Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?
- Andrew G. Edwards, Mark Teoh, Ryan J Hodges, Ricardo Palma-Dias, Stephen A. Cole, Alison M. Fung, Susan P. Walker
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- Journal:
- Twin Research and Human Genetics / Volume 19 / Issue 3 / June 2016
- Published online by Cambridge University Press:
- 18 April 2016, pp. 276-284
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The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of ‘competence based’ assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.
Evaluation of a Novel Intervention to Reduce Unnecessary Urine Cultures in Intensive Care Units at a Tertiary Care Hospital in Maryland, 2011–2014
- Lauren Epstein, Jonathan R. Edwards, Alison Laufer Halpin, Michael Anne Preas, David Blythe, Anthony D. Harris, David Hunt, J. Kristie Johnson, Mala Filippell, Carolyn V. Gould, Surbhi Leekha
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 37 / Issue 5 / May 2016
- Published online by Cambridge University Press:
- 02 February 2016, pp. 606-609
- Print publication:
- May 2016
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We assessed the impact of a reflex urine culture protocol, an intervention aimed to reduce unnecessary urine culturing, in intensive care units at a tertiary care hospital. Significant decreases in urine culturing rates and reported rates of catheter-associated urinary tract infection followed implementation of the protocol.
Infect Control Hosp Epidemiol 2016;37:606–609
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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The Differential Diagnosis of Pseudobulbar Affect (PBA): Distinguishing PBA Among Disorders of Mood and Affect
- David B. Arciniegas, Edward C. Lauterbach, David L. Ginsberg, Karen E. Anderson, Tiffany W. Chow, Laura A. Flashman, Robin A. Hurley, Daniel I. Kaufer, Thomas W. McAllister, Alison Reeve, Randolph B. Schiffer, Jonathan M. Silver
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- Journal:
- CNS Spectrums / Volume 10 / Issue S5 / 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-16
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This monograph summarizes the proceedings of a roundtable meeting convened to discuss pseudobulbar affect (PBA). Two didactic lectures were presented, followed by a moderated discussion among 11 participants. Post-meeting manuscript development synthesized didactic- and discussion-based content and incorporated additional material from the neuroscience literature. A conceptual framework with which to distinguish between disorders of mood and affect is presented first, and disorders of affect regulation are then reviewed briefly. A detailed description of the most common of these disorders, PBA, is the focus of the remainder of the monograph. The prevalence, putative neuranatomic and neurochemical bases of PBA are reviewed, and current and emerging methods of evaluation and treatment of persons with PBA are discussed. The material presented in this monograph will help clinicians better recognize, diagnose, and treat PBA, and will form a foundation for understanding and interpreting future studies of this condition.