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To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.
Microorganism motility often takes place within complex, viscoelastic fluid environments, e.g. sperm in cervicovaginal mucus and bacteria in biofilms. In such complex fluids, strains and stresses generated by the microorganism are stored and relax across a spectrum of length and time scales and the complex fluid can be driven out of its linear response regime. Phenomena not possible in viscous media thereby arise from feedback between the swimmer and the complex fluid, making swimming efficiency co-dependent on the propulsion mechanism and fluid properties. Here, we parameterize a flagellar motor and filament properties together with elastic relaxation and nonlinear shear-thinning properties of the fluid in a computational immersed boundary model. We then explore swimming efficiency, defined as a particular flow rate divided by the torque required to spin the motor, over this parameter space. Our findings indicate that motor efficiency (measured by the volumetric flow rate) can be boosted or degraded by relatively moderate or strong shear thinning of the viscoelastic environment.
Chylothorax following paediatric cardiac surgery is associated with significant morbidity, particularly those that are refractory to conservative therapy. It is our impression that there is important variability in the medical, surgical, and interventional therapies used to manage refractory chylothorax between congenital heart programmes. We therefore conducted a survey study of current practices for managing refractory chylothorax.
Methods:
The Chylothorax Work Group, formed with the support of the Pediatric Cardiac Critical Care Consortium, designed this multi-centre survey study with a focus on the timing and indication for utilising known therapies for refractory chylothorax. The survey was sent to one chylothorax expert from each Work Group centre, and results were summarised and reported as the frequency of given responses.
Results:
Of the 20 centres invited to participate, 17 (85%) submitted complete responses. Octreotide (13/17, 76%) and sildenafil (8/17, 47%) were the most utilised medications. Presently, 9 (53%) centres perform pleurodesis, 15 (88%) perform surgical thoracic duct ligation, 8 (47%) perform percutaneous lymphatic interventions, 6 (35%) utilise thoracic duct decompression procedures, and 3 (18%) perform pleuroperitoneal shunts. Diagnostic lymphatic imaging is performed prior to surgical thoracic duct ligation in only 7 of the 15 (47%) centres that perform the procedure. Respondents identified barriers to referring and transporting patients to centres with expertise in lymphatic interventions.
Conclusions:
There is variability in the treatment of refractory post-operative chylothorax across a large group of academic heart centres. Few surveyed heart centres have replaced surgical thoracic duct ligation or pleurodesis with image-guided selective lymphatic interventions.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
The UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center (DISC) launched in 2020 to provide dissemination and implementation science (DIS) training, technical assistance, community engagement, and research advancement. DISC developed a program-wide logic model to inform a process evaluation of member engagement and impact related to DISC services. The DISC Logic Model (DLM) served as the framework for a process evaluation capturing quantitative and qualitative information about scientific activities, outputs, and outcomes. The evaluation involved a multimethod approach with surveys, attendance tracking, feedback forms, documentation of grant outcomes, and promotions metrics (e.g., Twitter engagement). There were 540 DISC Members at the end of year 2 of the DISC. Engagement in the DISC was high with nearly all members endorsing at least one scientific activity. Technical assistance offerings such as DISC Journal Club and consultation were most frequently used. The most common scientific outputs were grant submission (65, 39%), formal mentoring for career award (40, 24%), and paper submission (34, 21%). The DLM facilitated a comprehensive process evaluation of our center. Actionable steps include prioritizing technical assistance, strengthening networking opportunities, identifying streamlined approaches to facilitate DIS grant writing through writing workshops, as well as “office hours” or organized writing leagues.
OBJECTIVES/GOALS: We aim to discover safer and more effective therapeutics for CNS disorders. Current therapeutic development is hindered by dosing out drugs for safe consumption. By identifying proteins with narrow functional roles in the brain (i.e., behavioral control), we can develop drugs targeting these proteins for improved treatment safety and efficacy. METHODS/STUDY POPULATION: We focused on an evolutionarily new, non-neuronal, non-synaptic glutamate signaling mechanism, system xc- (Sxc). Sxc activity was eliminated by mutating the gene Slc7a11 through pronuclear injection of zinc-finger nucleases into Sprague Dawley rat embryos to create a line of rats lacking Sxc (MSxc). To confirm Sxc mutation, we verified that tissue from MSxc rats had a complete lack of xCT, which is the regulatory subunit of Sxc that is encoded by Slc7a11. We also verified that astrocyte cultures generated from MSxc tissue lacked cystine-evoked glutamate release. Next, we measured development (body weight), CNS regulation of metabolism, and other indicators of generalized, non-specific brain function as well as behaviors that are reliant on behavioral control, such as impulse control and response inhibition. RESULTS/ANTICIPATED RESULTS: Eliminating Sxc was not lethal and did not impair development or produce widespread changes in brain function as is commonly observed when deleting other glutamate mechanisms. MSxc rats did not differ from wildtype in growth rate, central regulation of metabolism as reflected by absolute or diurnal changes in core body temperature, locomotor activity in a familiar or novel environment, or simple forms of cognition such as novel object recognition, or operant responding (food and cocaine-reinforced). In contrast, behaviors that rely on behavioral control were impaired. MSxc rats displayed deficits in impulse control and behavioral flexibility. We hypothesize that MSxc rats will also show deficits in response inhibition using the stop signal reaction time task, a common metric used in clinical populations. DISCUSSION/SIGNIFICANCE: Eliminating Sxc activity in rats produced deficits in behaviors reliant on impulse control, without impacting development or simple brain function. These results show the potential of targeting Sxc to restore behavioral control without generating therapeutically limiting adverse effects resulting from non-specific changes in brain function.
The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program’s implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.
To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks.
Design:
HOB preventability rating guide was compared against a reference standard expert panel.
Participants:
A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison.
Methods:
The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.
Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic.
Results:
Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.
After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64–0.88]) and 87% (κ, 0.79; 95% CI, 0.65–0.94) for the 52 scenarios with expert consensus.
Conclusions:
Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.
Background: Hospital-onset bacteremia and fungemia (HOB) may be a preventable hospital-acquired condition and a potential healthcare quality measure. We developed and evaluated a tool to assess the preventability of HOB and compared it to a more traditional consensus panel approach. Methods: A 10-member healthcare epidemiology expert panel independently rated the preventability of 82 hypothetical HOB case scenarios using a 6-point Likert scale (range, 1= “Definitively or Almost Certainly Preventable” to 6= “Definitely or Almost Certainly Not Preventable”). Ratings on the 6-point scale were collapsed into 3 categories: Preventable (1–2), Uncertain (3–4), or Not preventable (5–6). Consensus was defined as concurrence on the same category among ≥70% expert raters. Cases without consensus were deliberated via teleconference, web-based discussion, and a second round of rating. The proportion meeting consensus, overall and by predefined HOB source attribution, was calculated. A structured HOB preventability rating tool was developed to explicitly account for patient intrinsic and extrinsic healthcare-related risks (Fig. 1). Two additional physician reviewers independently applied this tool to adjudicate the same 82 case scenarios. The tool was iteratively revised based on reviewer feedback followed by repeat independent tool-based adjudication. Interrater reliability was evaluated using the Kappa statistic. Proportion of cases where tool-based preventability category matched expert consensus was calculated. Results: After expert panel round 1, consensus criteria were met for 29 cases (35%), which increased to 52 (63%) after round 2. Expert consensus was achieved more frequently for respiratory or surgical site infections than urinary tract and central-line–associated bloodstream infections (Fig. 2a). Most likely to be rated preventable were vascular catheter infections (64%) and contaminants (100%). For tool-based adjudication, following 2 rounds of rating with interim tool revisions, agreement between the 2 reviewers was 84% for cases overall (κ, 0.76; 95% CI, 0.64–0.88]), and 87% for the 52 cases with expert consensus (κ, 0.79; 95% CI, 0.65–0.94). Among cases with expert consensus, tool-based rating matched expert consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewer 1 and reviewer 2, respectively. The proportion of cases rated “uncertain“ was lower among tool-based adjudicated cases with reviewer agreement (15 of 69) than among cases with expert consensus (23 of 52) (Fig. 2b). Conclusions: Healthcare epidemiology experts hold varying perspectives on HOB preventability. Structured tool-based preventability rating had high interreviewer reliability, matched expert consensus in most cases, and rated fewer cases with uncertain preventability compared to expert consensus. This tool is a step toward standardized assessment of preventability in future HOB evaluations.
Continued reliance on chemical methods for controlling annual bluegrass has resulted in many populations evolving resistance to PRE and POST herbicides, particularly in warm-season turfgrass species such as zoysiagrass. Soil seedbank management is critically important when managing herbicide-resistant weeds. Fraise mowing (also spelled fraze, frase, and fraize) is a new turfgrass cultivation practice designed to remove aboveground biomass while allowing turf to regrow vegetatively. We hypothesized that this process would remove annual bluegrass seed and therefore be a mechanical means of controlling annual bluegrass in turfgrass. Zoysiagrass field plots were fraise-mowed in June 2015 only, June 2016 only, June 2015 and June 2016, or left untreated. The fraise mower was configured to remove the uppermost 25 mm of plot surface (i.e., 15-mm verdure and 10-mm soil). Annual bluegrass infestation was quantified in April following fraise mowing via grid count. Soil cores (10.8 cm diameter) were extracted from each plot after grid count data were collected to assess effects of fraise mowing on the soil seedbank. Moreover, replicated subsamples (7.6 L) of debris generated during fraise mowing were collected to better understand weed seed content removed during the fraise mowing process. Fraise mowing in June offered a slight reduction (24%) in annual bluegrass cover the following April. Whereas 28% of the seed in fraise-mowing debris consisted of annual bluegrass, there was no difference in the quantity of annual bluegrass seed remaining in the soil seedbank among fraise-mowed and non–fraise-mowed plots. Although fraise mowing may help to temporarily reduce existing annual bluegrass infestations via mechanical removal, the frequency and depth we studied did not effectively reduce the seedbank. Fraise mowing is a useful tool for providing mechanical suppression of annual bluegrass but it is not a replacement for properly timed herbicide applications.
The lower leg venous system consists of the superficial (greater saphenous vein) and deep (femoral vein) systems. Duplicated saphenous systems exist in the calf and thigh in approximately 25% of patients.
Distally, the greater saphenous vein can be found anterior to the medial malleolus. It crosses the tibia, runs medial to the knee, and ascends into the medial and posterior segment of the thigh as it descends medially into the common femoral vein in the groin (saphenofemoral junction).
In the thigh, the greater saphenous vein lies deep to the fascia (unlike accessory veins or tributaries). This may help discriminate the veins of the thigh during dissection.
In the proximal aspect of the thigh, the greater saphenous vein runs into the confluence of the superficial circumflex iliac vein, superficial inferior epigastric vein, and external pudendal veins to create the saphenofemoral junction. A useful anatomic landmark for the saphenofemoral junction is two fingerbreadths inferior and medial to the pubic tubercle.
Scientific endeavors are increasingly carried out by teams of scientists. While there is growing literature on factors associated with effective science teams, little is known about processes that facilitate the success of dissemination and implementation (D&I) teams studying the uptake of healthcare innovations. This study aimed to identify strategies used by D&I scientists to promote team science.
Methods:
Using a nominal group technique, a sample of 27 D&I scholars responded to the question, “What strategies have you or others used to promote team science?” Participants were asked to individually respond and then discuss within a small group to determine the group’s top three strategies. Through a facilitated consensus discussion with the full sample, a rank-ordered list of three strategies was determined.
Results:
A total of 126 individual responses (M = 9; SD = 4.88) were submitted. Through small group discussion, six groups ranked their top three strategies to promote team science. The final ranked list of strategies determined by the full sample included: (1) developing and maintaining clear expectations, (2) promoting and modeling effective communication, and (3) establishing shared goals and a mission of the work to be accomplished.
Conclusions:
Because of its goal of translating knowledge to practice, D&I research necessitates the use of team science. The top strategies are in line with those found to be effective for teams in other fields and hold promise for improving D&I team cohesion and innovation, which may ultimately accelerate the translation of health innovations and the improvement of care quality and outcomes.
Mesotrione, a 4-hydroxyphenylpyruvate dioxygenase-inhibiting herbicide, is labeled for PRE and POST crabgrass control. It has enhanced efficacy on smooth and large crabgrass when applied in conjunction with soil-applied nitrogen (N). The objectives of this study, using crabgrass as the weed species, were to (1) determine the influence of N rate and tissue N concentration on mesotrione activity, (2) determine the influence of N source on mesotrione activity, and (3) determine the influence of N application timing on mesotrione activity. Large crabgrass plants that received 12 kg N ha−1 or more before mesotrione application had more bleached and necrotic leaves compared with plants that received 0 kg N ha−1 7 d after treatment (DAT) in the greenhouse. Although N application rates as high as 98 kg N ha−1 were tested, 90% leaf bleaching and necrosis were observed with rates of 8.9 or 10.1 kg N ha−1 in Tennessee and Indiana, respectively. Nitrogen concentration in large crabgrass leaf and stem tissue on the day of the mesotrione application was closely related to the bleaching and necrosis symptoms observed 7 DAT. Although N rate influenced mesotrione activity, N source did not. Nitrogen application timing was also important, with N applications 3, 1, and 0 d before a mesotrione application having the highest percentage of bleached and necrotic leaves in greenhouse experiments. Both greenhouse and field trials support the finding that N applications in proximity to the mesotrione application enhance herbicide activity. Thus, practitioners can pair N and POST mesotrione applications together or in proximity to enhance crabgrass control.
Selective annual bluegrass (ABG) control with mesotrione is often inconsistent, and sequential applications might be required for complete control. The complementary nature of p-hydroxyphenylpyruvate dioxygenase (HPPD)- and photosystem II (PSII)-inhibiting herbicides is well documented. The HPPD-inhibiting herbicide mesotrione and the PSII-inhibiting herbicide amicarbazone both have efficacy against annual bluegrass and safety on certain cool-season turfgrasses. Topramezone is a HPPD-inhibiting herbicide being investigated for use in turfgrass. Field and greenhouse experiments were conducted to examine single applications of topramezone and mesotrione alone or in combination with amicarbazone for POST ABG control in spring. In greenhouse experiments, the combination of mesotrione (280 g ai ha−1) and amicarbazone (75 g ai ha−1) controlled ABG 70% by 21 d after treatment, > 29% more than either herbicide applied alone; these combinations were determined to be synergistic. Amicarbazone combined with topramezone (14.5 g ai ha−1) provided < 10% ABG control and was not synergistic. When combined with mesotrione, increasing amicarbazone rate to 150 or 255 g ha−1 did not increase ABG control compared to 75 g ha−1in field experiments. Combining mesotrione with amicarbazone resulted in a synergistic increase in POST ABG control at 1 and 2 wk after treatment (WAT). When applied alone or in combination with amicarbazone, increasing the mesotrione rate from 90 to 280 g ha−1 increased efficacy on ABG in field experiments. The combination of mesotrione at 280 g ha−1 and amicarbazone at 75 g ha−1 provided > 90% ABG control in field experiments. Future research should focus on sequential applications of mesotrione–amicarbazone combinations for ABG control in locations where ABG is historically more difficult to control.
The stellar radial profiles of disk galaxies are often observed to be truncated, or anti-truncated in the galaxies’ outskirts. As of now, the literature about galaxy formation lacks a model for the formation of observed anti-truncated stellar disks which is based on secular processes. We present an attempt to fill this gap. We were able to model anti-truncated disks in numerical SPH simulations of the formation of isolated galaxies. We will show that the stars in the outskirts of the simulated galactic disk are on very eccentric orbits but were formed on circular orbits at much smaller radii. We argue that a strong central bar is the main driver of the formation of such a disk configuration. The model predicts that such outer stellar disks should show very slow rotation, but high radial dispersion. If confirmed, their existence would constitute galaxy disks of qualitatively very new kinematic properties.
Background: Clinical research is required to develop and evaluate suicide prevention interventions in the elderly. However, there is insufficient information available about how to best recruit suicidal older adults for such research. This study evaluated the success and efficiency of five recruitment strategies for a clinical trial on the efficacy of cognitive therapy for suicidal older men.
Methods: For each strategy, the numbers of individuals approached, screened, and enrolled were calculated, and the expenses and time associated with each enrollment estimated. Men who were 60 years or older and who had a desire for suicide over the past month were eligible for the trial.
Results: Of 955 individuals considered for trial, 33 were enrolled. Most enrollments were sourced from the Veterans Affairs Behavioral Health Laboratory. Recruiting form this source was also the most time and cost efficient recruitment strategy in the study.
Conclusions: Recruitment strategies are effective when they are based on collaborative relationships between researchers and providers, and utilize an existing infrastructure for involving patients in ongoing research opportunities.
This chapter considers the role of experiments in regard to evaluation and action research in determining whether change in educational contexts can be attributed to the introduction of an intervention approach or programme. It explains the three classes of experimental design: 'true' experimental designs, such as randomised, controlled trials (RCTs), 'quasi-experimental' designs, and also 'small-n' experimental designs. True' and 'quasi-experiments' are 'studies of deliberate intervention. In the case of a 'true' experimental design such as an RCT, allocation to groups must be random. 'Small- n' experimental designs involve the manipulation of an independent (treatment) variable across a pre-intervention baseline phase, an intervention phase, and commonly a post-intervention phase. Most published studies of the effectiveness of school-based interventions use quasi-experimental designs. It is important for educational researchers to be aware of the beliefs and values of participants and stakeholders and indeed of underlying policy contexts and political realities.