We investigated the impact of rapid diagnostic testing with real-time stewardship intervention on patients with Streptococcal bacteremia. Compared to pre-intervention, patients in the post-intervention group received more rapid antibiotic de-escalation (42 vs 88 h), and were more commonly de-escalated to narrow-spectrum (86% vs 52%) and oral antibiotics (30% vs 14%).

During the coronavirus disease 2019 (COVID-19) pandemic, navigating the implementation of public health measures in a politically charged environment for a large state entity was challenging. However, Louisiana State University (LSU) leadership developed and deployed an effective, multi-layered mitigation plan and successfully opened in-person learning while managing cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the fourth surge. We describe the plan to provide a framework for other institutions during this and future responses. The goals were 3-fold: maintain a quality learning environment, mitigate risk to the campus community, and ensure that LSU operations did not contribute to health-care stress. As of September 2022, LSU has achieved high compliance with interventions and relatively low virus activity on campus compared with peer institutions. This university model can serve as a template for similar implementation plans in the context of complex socio-political and economic considerations.

Introduction: Introduction: Transitions in care (TiC) interventions have been proposed to improve the management and outcomes of patients in emergency departments (ED). The objective of this review was to examine the effectiveness of ED-based TiC interventions to improve outcomes for adult patients presenting to an ED with acute atrial fibrillation or flutter (AFF). Methods: Methods: A comprehensive search of eight electronic databases and various grey literature sources was conducted. Comparative studies assessing the effectiveness of interventions to improve TiC for patients presenting to the ED with acute AFF were eligible. Two independent reviewers completed study selection, quality assessment, and data extraction. When applicable, relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity was reported among studies using I-square (I2) statistics. Results: Results: From 744 citations, seven studies were included, consisting of three randomized controlled trials (RCT), three before-after (B/A) studies, and one cohort study. Study quality ranged from unclear to low for the RCTs according to the risk of bias tool, moderate in the BA trials according to the BA quality assessment tool, and high quality of the cohort study according to the Newcastle Ottawa scale. The majority of interventions were set within-ED (n=5), including three clinical pathways/management guidelines and two within-ED observation units. Post-ED interventions (n=2) included patient education and general practitioner referral. Four studies reported a decreased overall hospital length of stay (LoS) for AFF patients undergoing TiC interventions compared to control, ranging from 26.4 to 53 hours; however, incomplete and non-standardized outcome reporting precluded meta-analysis. An increase in conversion to normal sinus rhythm among TiC intervention patients was noted, which may be related to increased utilization of electrical cardioversion among the RCTs (RR=2.16; 95% CI: 1.42, 3.30; I2=%), B/A studies (RR=2.69, 95% CI: 2.17, 3.33), and cohort study (RR=1.39; 95% CI: 1.24, 1.56). Conclusion: Conclusions: Within-ED TiC interventions may reduce hospital LoS and increase use of electrical cardioversion. However, no clear recommendations to implement such interventions in EDs can be generated from this systematic review and more efforts are required to improve TiC for patients with AFF.

The paucity of modern pollen-rain data from Amazonia constitutes a significant barrier to understanding the Late Quaternary vegetation history of this globally important tropical forest region. Here, we present the first modern pollen-rain data for tall terra firme moist evergreen Amazon forest, collected between 1999 and 2001 from artificial pollen traps within a 500 × 20 m permanent study plot (14°34′50″S, 60°49′48″W) in Noel Kempff Mercado National Park (NE Bolivia). Spearman's rank correlations were performed to assess the extent of spatial and inter-annual variability in the pollen rain, whilst statistically distinctive taxa were identified using Principal Components Analysis (PCA). Comparisons with the floristic and basal area data of the plot (stems ≥10 cm d.b.h.) enabled the degree to which taxa are over/under-represented in the pollen rain to be assessed (using R-rel values). Moraceae/Urticaceae dominates the pollen rain (64% median abundance) and is also an important constituent of the vegetation, accounting for 16% of stems ≥10 cm d.b.h. and ca. 11% of the total basal area. Other important pollen taxa are Arecaceae (cf. Euterpe), Melastomataceae/Combretaceae, Cecropia, Didymopanax, Celtis, and Alchornea. However, 75% of stems and 67% of the total basal area of the plot ≥10 cm d.b.h. belong to species which are unidentified in the pollen rain, the most important of which are Phenakospermum guianensis (a banana-like herb) and the key canopy-emergent trees, Erisma uncinatum and Qualea paraensis.

The South Sandwich Islands and associated seamounts constitute the volcanic arc of an active subduction system situated in the South Atlantic. We introduce a map of the bathymetry and geological setting of the South Sandwich Islands and the associated East Scotia Ridge back-arc spreading centre that consists of two sides: side 1, a regional overview of the volcanic arc, trench and back-arc, and side 2, detailed maps of the individual islands. Side 1 displays the bathymetry at scale 1:750 000 of the intra-oceanic, largely submarine South Sandwich arc, the back-arc system and other tectonic boundaries of the subduction system. Satellite images of the islands on side 2 are at scales of 1:50 000 and 1:25 000 with contours and main volcanological features indicated. These maps are the first detailed topological and bathymetric maps of the area. The islands are entirely volcanic in origin, and most have been volcanically or fumarolically active in historic times. Many of the islands are ice-covered, and the map forms a baseline for future glaciological changes caused by volcanic activities and climate change. The back-arc spreading centre consists of nine segments, most of which have rift-like morphologies.

A challenge to the development of foodborne illness prevention measures is determining the sources of enteric illness. Microbial subtyping source-attribution models attribute illnesses to various sources, requiring data characterizing bacterial isolate subtypes collected from human and food sources. We evaluated the use of antimicrobial resistance data on isolates of Salmonella enterica serotype Hadar, collected from ill humans, food animals, and from retail meats, in two microbial subtyping attribution models. We also compared model results when either antimicrobial resistance or pulsed-field gel electrophoresis (PFGE) patterns were used to subtype isolates. Depending on the subtyping model used, 68–96% of the human infections were attributed to meat and poultry food products. All models yielded similar outcomes, with 86% [95% confidence interval (CI) 80–91] to 91% (95% CI 88–96) of the attributable infections attributed to turkey, and 6% (95% CI 2–10) to 14% (95% CI 8–20) to chicken. Few illnesses (<3%) were attributed to cattle or swine. Results were similar whether the isolates were obtained from food animals during processing or from retail meat products. Our results support the view that microbial subtyping models are a flexible and robust approach for attributing Salmonella Hadar.

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006–May 2011) were compared with the intervention period (June 2011–December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

This article presents a systematic review identifying variables and their prognostic value for return to work (RTW) after traumatic brain injury (TBI). RTW has been identified as being a key goal following TBI, with estimates ranging from 10% to 70%. Prediction of postinjury employment is important for planning rehabilitation and structuring individualised vocational services. Studies examining prognostic factors were identified by searching four electronic databases, until June 2006. Searches yielded 1948 studies of which 55 met inclusion criteria and were subsequently rated for methodological quality. Mean methodological score for included studies was 3.9/6 (SD 0.9, range 1–6). Analysis focused on a subset of 27 studies which provided sampling from all three domains of preinjury, injury and early postinjury variables. Few studies considered preinjury variables, apart from simple demographics. Only five studies considered preinjury employment, which was a significant predictor in each case. Severity of injury variables were invariably examined, but were significant predictors in only 8/27 studies (30%). For early postinjury variables, 14/27 studies entered cognitive variables with 12/14 (86%) identifying them as significant predictors; 3/27 studies examined neurophysical variables, with 2/3 (67%) studies finding them significant; and 12/27 studies examined multidimensional/participation variables which were statistically significant individual predictors in 8/12 (67%) cases. The results are discussed in the context of methodological issues encountered during the course of the review that require addressing in future studies.

This study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n = 19), 2 to 4 weeks (n = 44) and more than 4 weeks (n = 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative data, including all individuals aged 65 years and older living in a British Columbia NH facility between April 1996 and March 1999. Hospitalization rates of NH residents were compared to estimated rates for community-dwelling seniors, using age- and sex-adjusted standardized incidence ratios (SIRs): SIR = 2.81 (95%CI: 2.71, 2.91) for femoral fractures, 1.96 (1.88, 2.04) for pneumonia, 0.73 (0.70, 0.76) for other heart disease, and 1.01 (0.99, 1.02) for all causes. NH residents have disproportionately higher rates of hospitalization for femoral fractures and pneumonia, with NH residents accounting for approximately one quarter of all femoral fracture hospitalizations of BC seniors.

In the absence of a universally agreed-upon definition of successful aging, researchers increasingly look to older adults for layperson views of aging and definitions of successful aging. To use lay definitions in studies of aging, however, researchers must address the definitions’ consistency. In 2004, surviving members of the Manitoba Follow-up Study male cohort (mean age: 83 years) were asked twice for their definition of successful aging. A consistency category was assigned based on the similarity of themes in each of 654 pairs of definitions. At least half of the main themes were similar in 70 per cent of the definition pairs; 80 per cent of respondents repeated at least one theme. Positive or negative health events in the four-week interval between definitions and specific respondents’ characteristics did not vary across consistency categories. This evidence for consistency supports our continued reliance on lay definitions of successful aging.