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In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply.
Setting:
VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA. It also includes a free-standing Emergency Department in New Kent, VA.
Patients:
Blood cultures from both pediatric and adult patients were included in this study.
Interventions:
VCUHS intervened to decrease blood culture utilization across the entire health system. Interventions included communication of blood culture guidance as well as an electronic health record order designed to guide providers and discourage wasteful ordering.
Results:
Post-implementation analyses showed that interventions reduced overall usage by 35.6% (P < .0001) and by greater than 40% in the Emergency Departments. The impact of these changes in utilization on positivity were analyzed, and it was found that the overall positivity rate increased post-intervention from 8.8% to 12.1% (P = .0115) and in the ED specifically from 10.2% to 19.5% (P < .0001).
Conclusions:
These findings strongly suggest that some basic stewardship interventions can significantly change blood culture practice in a manner that minimizes the impact on patient care.
Prior research finds that women earn fewer citations than men for their publications, and it offers various reasons why this is the case. This study provides new evidence on these citation differences from two datasets on career citations earned by male and female political scientists. Our findings extend and elaborate on those in earlier research. Most notably, we find that older cohorts of women demonstrate substantial progress toward citation equity with their male peers.
Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.
We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window.
Methods:
Individual patients’ data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed. Mixed-effects logistic regression was used to estimate the likelihood of functional independence at 90 days (modified Rankin Scale 0–2). Mixed-effects negative binomial regression was used to evaluate the relationship between patient characteristics and workflow time intervals.
Results:
608 patients were included. The median age was 70 years (IQR: 58–71), 307 (50.5%) were female, and 310 (53.2%) had wake-up strokes. Successful reperfusion was achieved in 493 (81.2%) patients, and 262 (44.9%) achieved 90-day mRS 0–2. The estimated odds of functional independence decreased by 13% for every 30 minute delay from emergency department (ED) arrival to imaging time and by 7% from ED arrival to the end of EVT in the entire cohort. Also, the estimated odds of functional independence decreased by 33% for every 30 minute delay in the interval from arterial puncture to end of EVT, 16% in the interval from arrival in ED to end of EVT and 6% in the interval from stroke onset to end of EVT among patients who had a wake-up stroke.
Conclusion:
Faster workflow from ED arrival to end of EVT is associated with improved functional independence among stroke patients treated in the late window.
Purposeful training and ongoing career support are necessary to meet the evolving and expanding roles of clinical research professionals (CRP). To address the training and employment needs of clinical research coordinators (CRCs), one of the largest sectors of the CRP workforce, we designed, developed, and implemented an online career navigation system, eMPACTTM (eMpowering Purposeful Advancement of Careers and Training).
Methods:
A design-based research method was employed as an overarching approach that frames iterative design, development, and implementation of educational interventions. The five major phases of this project – conceptualization, task analysis for measurement development, algorithms development, algorithms validation, and system evaluation – presented specific goals and relevant methods.
Results:
The results reported how the eMPACTTM system was conceptualized, developed, and validated. The system allowed CRCs to navigate tailored training and job opportunities by completing their task competencies and career goals. The data sets could, in turn, support employees’ and training coordinators’ informed decisions about organizational training needs and recruitment. The early dissemination results showed steady growth in registered CRCs and diversity in users’ ethnicity and job levels.
Conclusions:
The eMPACTTM service showed the possibility of supporting CRCs’ individual career advancement and organizational workforce enhancement and diversity. Long-term research is needed to evaluate its impact on CRC workforce development, explore key factors influencing workforce sustainability, and expand eMPACTTM service to other CRP sectors.
Background: Sex differences in treatment response to intravenous thrombolysis (IVT) are poorly characterized. We compared sex-disaggregated outcomes in patients receiving IVT for acute ischemic stroke in the Alteplase compared to Tenecteplase (AcT) trial, a Canadian multicentre, randomised trial. Methods: In this post-hoc analysis, the primary outcome was excellent functional outcome (modified Rankin Score [mRS] 0-1) at 90 days. Secondary and safety outcomes included return to baseline function, successful reperfusion (eTICI≥2b), death and symptomatic intracerebral hemorrhage. Results: Of 1577 patients, there were 755 women and 822 men (median age 77 [68-86]; 70 [59-79]). There were no differences in rates of mRS 0-1 (aRR 0.95 [0.86-1.06]), return to baseline function (aRR 0.94 [0.84-1.06]), reperfusion (aRR 0.98 [0.80-1.19]) and death (aRR 0.91 [0.79-1.18]). There was no effect modification by treatment type on the association between sex and outcomes. The probability of excellent functional outcome decreased with increasing onset-to-needle time. This relation did not vary by sex (pinteraction 0.42). Conclusions: The AcT trial demonstrated comparable functional, safety and angiographic outcomes by sex. This effect did not differ between alteplase and tenecteplase. The pragmatic enrolment and broad national participation in AcT provide reassurance that there do not appear to be sex differences in outcomes amongst Canadians receiving IVT.
Freedom of the press has long been considered a critical requirement for the maintenance of democratic government. Most previous writings on the position of the press around the world, however, have argued that restrictions on the press have become generally more numerous in recent years and, hence, press freedom levels have been declining over time. Merrill et al., in their survey of national press systems, note that “recent surveys and studies tend to indicate that in many ways freedom of the press is eroding slowly in a worldwide context. Press laws are proliferating, sanctions of many kinds are growing up to thwart the free workings of the press, and press councils and other groups are moving in to restrict activities of the press.” Survey articles on the state of the press in Africa and in Asia reach the same conclusion for those regions, and a recent report of the prestigious Inter-American Press Association argued that press freedom in the western hemisphere is under greater threat than ever before. Even in some advanced western nations the press has come under attack by governmental officials, as is evident in the United States with both the Nixon administration's antipress activities as well as recent court rulings that limit press coverage of legal proceedings and the secrecy of newsmen's sources and working materials.
The building of online atomic and molecular databases for astrophysics and for other research fields started with the beginning of the internet. These databases have encompassed different forms: databases of individual research groups exposing their own data, databases providing collected data from the refereed literature, databases providing evaluated compilations, databases providing repositories for individuals to deposit their data, and so on. They were, and are, the replacement for literature compilations with the goal of providing more complete and in particular easily accessible data services to the users communities. Such initiatives involve not only scientific work on the data, but also the characterization of data, which comes with the “standardization” of metadata and of the relations between metadata, as recently developed in different communities. This contribution aims at providing a representative overview of the atomic and molecular databases ecosystem, which is available to the astrophysical community and addresses different issues linked to the use and management of data and databases. The information provided in this paper is related to the keynote lecture “Atomic and Molecular Databases: Open Science for better science and a sustainable world” whose slides can be found at DOI : doi.org/10.5281/zenodo.6979352 on the Zenodo repository connected to the “cb5-labastro” Zenodo Community (https://zenodo.org/communities/cb5-labastro).
Considerable research finds that male political scientists publish more research on average than do female political scientists. Yet the reasons for this difference are not entirely clear. Those findings may also overestimate the relative productivity of men because they do not account for the longer time that more men have been in the profession and thus have been publishing longer than women. For a prominent survey dataset of political scientists, we demonstrate notable cohort differences in the research productivity of both men and women across time. Our results also indicate that the overall greater productivity of men results in part from senior women scholars not generally enjoying the same benefits of long tenure on their research output as men do.
We demonstrate how men and women political scientists in PhD-granting departments perceive the professional climates there. We find remarkable differences in how men and women perceive the “cultural” climates of their departments, such as the degree to which it is sexist, but not in how they perceive strictly collegial aspects of climate. We also demonstrate that these patterns characterize the perceptions of men and women at both junior and senior ranks. Contrary to some past research, we also find that climate perceptions do not have a general effect on faculty research productivity. Further, perceptions of high departmental sexism by women scholars does not degrade their research productivity.
Due to continuing pressures on the UK National Health Service’s mental health services, there has been increased interest in the development of brief psychological interventions (BPIs). These interventions are usually defined as including selected components of established psychological interventions, delivered over fewer sessions, and by staff with less specialised training (paraprofessionals). Cognitive behavioural therapy (CBT)-based BPIs for anxiety and depression have been found to be helpful for clients with mild to moderate mental health problems. This project evaluates the introduction of BPIs for anxiety and depression in a secondary care adult mental health service, with clients experiencing moderate to severe mental health difficulties. The service developed CBT-based manuals for anxiety (anxiety management) and depression (behavioural activation) BPIs. The BPIs were delivered by mental health workers without core therapeutic training, who were offered training and group supervision by psychologists in the team. Measures of anxiety (GAD-7), depression (PHQ-9), wellbeing (SWEMWBS) and functioning (WSAS) were completed at the start and end of treatment. The data reported from a 2-year period suggest that BPIs are associated with reductions in symptoms of anxiety and low mood, and improvements in wellbeing and functioning. Whilst this is a small-scale initial evaluation, the results are promising for the potential benefit of BPIs for clients in secondary care settings. Given that this new way of working has possible additional benefits such as improving access to psychological treatment and cost-effectiveness, further research in the area is warranted and encouraged.
Key learning aims
(1) To overview the current evidence for BPIs.
(2) To outline a possible model for offering BPIs in secondary care.
(3) To illustrate the potential positive effects of BPIs within a secondary care population.
(4) To consider the need for future research and development of BPIs.
Considerable work assesses research productivity in political science. Yet, the latter work has not explicated how research careers can differ across time and individuals and neither has it considered such careers in teaching institutions. This article presents an empirically validated typology for research career paths for political scientists who began their career in a teaching institution. The typology demonstrates that many scholars follow paths different from the most conventional expectations, and research “success” by measures of publications and citations is associated with only some of those paths. Thus, existing research on aggregate publications and citations likely addresses only a subset of the career paths described here. Understanding research activities in our profession requires accounting for various career paths, their motivations, and their place in our research community.
Considerable research assesses research success in political science. Yet this work has not considered widespread findings that scholars can follow various career research paths that complicate how we envision scholarly success. Further, we have no systematic information on these career paths in any scientific discipline. I present an empirically validated research career-path typology for political scientists who began their career in a research institution. The typology demonstrates that many scholars follow paths different from the most conventional expectations, and research success by measures of publications and citations is associated with only some of these paths. Thus, existing research on aggregate publications and citations likely addresses only a subset of the career paths revealed in this article. Understanding research activities in our profession requires consideration of the various career paths, their motivation, and their place in our research community.
This study examined the perceived competence of Clinical Research Coordinators (CRCs) using several conceptual frameworks. Accurate self-assessment of one’s professional competence is a critical component in the career navigation process and contributes to (a) identifying and securing professional development (training), (b) leveraging professional strengths, and (c) integrating self-knowledge into a comprehensive career plan.
Method:
A survey design gathered responses from a sample of 119 CRCs in a southeastern region of the USA Two conceptual frameworks were used to represent aspects of CRC professional competence: the eight Joint Task Force (JTF) competence domains, and perceptions of strengths and training needs from a list of 12 task categories.
Results:
The JTF domain with the lowest competence level was Development and Regulations, while the highest was Communication. Perceived competence increased incrementally with years of experience. Top strengths involved direct patient interaction and data management. Tasks in need of training included project management and reporting issues. Variations in responses were based on years of experience as a CRC.
Conclusion:
Our results demonstrate an association between the self-reported strengths and training needs of CRCs and experience. This information can contribute to the self-directed career navigation of CRCs.
Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation.
Key learning aims
(1) To enhance practitioners’ awareness of distress intolerance as a potential maintaining factor and therefore treatment target.
(2) To outline a transdiagnostic distress tolerance brief psychological intervention.
(3) To illustrate the potential of this distress tolerance brief psychological intervention to produce positive reliable change with real-world clients when delivered by non-psychologists.
Major depressive disorder and neuroticism (Neu) share a large genetic basis. We sought to determine whether this shared basis could be decomposed to identify genetic factors that are specific to depression.
Methods
We analysed summary statistics from genome-wide association studies (GWAS) of depression (from the Psychiatric Genomics Consortium, 23andMe and UK Biobank) and compared them with GWAS of Neu (from UK Biobank). First, we used a pairwise GWAS analysis to classify variants as associated with only depression, with only Neu or with both. Second, we estimated partial genetic correlations to test whether the depression's genetic link with other phenotypes was explained by shared overlap with Neu.
Results
We found evidence that most genomic regions (25/37) associated with depression are likely to be shared with Neu. The overlapping common genetic variance of depression and Neu was genetically correlated primarily with psychiatric disorders. We found that the genetic contributions to depression, that were not shared with Neu, were positively correlated with metabolic phenotypes and cardiovascular disease, and negatively correlated with the personality trait conscientiousness. After removing shared genetic overlap with Neu, depression still had a specific association with schizophrenia, bipolar disorder, coronary artery disease and age of first birth. Independent of depression, Neu had specific genetic correlates in ulcerative colitis, pubertal growth, anorexia and education.
Conclusion
Our findings demonstrate that, while genetic risk factors for depression are largely shared with Neu, there are also non-Neu-related features of depression that may be useful for further patient or phenotypic stratification.
A growing body of research investigates the factors that enhance the research productivity and creativity of political scientists. This work provides a foundation for future research, but it has not addressed some of the most promising causal hypotheses in the general scientific literature on this topic. This article explicates the latter hypotheses, a typology of scientific career paths that distinguishes how scientific careers vary over time with respect to creative ambitions and achievements, and a research agenda based on the preceding components for investigation of the publication success of political scientists.
In this brief report, computed tomography perfusion (CTP) thresholds predicting follow-up infarction in patients presenting <3 hours from stroke onset and achieving ultra-early reperfusion (<45 minutes from CTP) are reported. CTP thresholds that predict follow-up infarction vary based on time to reperfusion: Tmax >20 to 23 seconds and cerebral blood flow <5 to 7 ml/min−1/(100 g)−1 or relative cerebral blood flow <0.14 to 0.20 optimally predicted the final infarct. These thresholds are stricter than published thresholds.
The giant reed, Arundo donax is one of the worst invasive alien species globally, including South Africa, where it invades riparian areas across the country. Biological control is being considered to address the invasive potential and negative impacts of the weed. This study investigated the phylogeography of A. donax to guide the biological control program. To determine plant haplotype and genetic diversity, three regions of the chloroplast were sequenced and three microsatellite markers were analyzed in 40 samples from across the plant’s distribution in South Africa. It was determined that all populations of A. donax in South Africa were haplotype M1, which is the most widely distributed haplotype worldwide, believed to originate from the Indus Valley, Asia. In addition, no genetic diversity was found, indicating that all the A. donax populations in South Africa are essentially one clone. The results indicate that suitable biological control agents are likely to be found in the ancient native range of haplotype M1. This research has contributed to the global understanding of the phylogeography of A. donax and will guide the biological control program in South Africa.