22 results
Length of antibiotic therapy among adults hospitalized with uncomplicated community-acquired pneumonia, 2013–2020
- Natalie L. McCarthy, James Baggs, Hannah Wolford, Sophia V. Kazakova, Sarah Kabbani, Brandon K. Attell, Melinda M. Neuhauser, Lindsey Walker, Sarah H. Yi, Kelly M. Hatfield, Sujan Reddy, Lauri A. Hicks
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- Journal:
- Infection Control & Hospital Epidemiology , First View
- Published online by Cambridge University Press:
- 14 February 2024, pp. 1-7
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Objective:
The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual trends in length of therapy (LOT) in adults hospitalized with uncomplicated CAP from 2013 through 2020.
Methods:We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using International Classification of Diseases Ninth and Tenth Revision codes in MarketScan and the Centers for Medicare & Medicaid Services databases. We included patients with length of stay (LOS) of 2–10 days, discharged home with self-care, and not rehospitalized in the 3 days following discharge. We estimated inpatient LOT based on LOS from the PINC AI Healthcare Database. The total LOT was calculated by summing estimated inpatient LOT and actual postdischarge LOT. We examined trends from 2013 to 2020 in patients with total LOT >7 days, which was considered an indicator of likely excessive LOT.
Results:There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18–64 years and ≥65 years, respectively. From 2013 to 2020, the proportion of patients with total LOT >7 days decreased by 25% (68% to 51%) among patients aged 18–64 years and by 27% (68%–50%) among patients aged ≥65 years.
Conclusions:Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT >7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.
Validation of a culturally sensitive, Swahili-translated instrument to assess suicide risk among adults living with HIV in Tanzania
- Linda Minja, Brandon A. Knettel, Wei Pan, Kim Madundo, Ismail Amiri, Louise Joel, Elizabeth Knippler, Michael V. Relf, Joao Ricardo N. Vissoci, Catherine A. Staton, Elizabeth F. Msoka, Clotilda S. Tarimo, Victor Katiti, Blandina T. Mmbaga, David B. Goldston
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 05 October 2023, e67
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In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.
Spillover benefit of pre-exposure prophylaxis for HIV prevention: evaluating the importance of effect modification using an agent-based model
- Ashley L. Buchanan, Carolyn J. Park, Sam Bessey, William C. Goedel, Eleanor J. Murray, Samuel R. Friedman, M. Elizabeth Halloran, Natallia V. Katenka, Brandon D. L. Marshall
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- Journal:
- Epidemiology & Infection / Volume 150 / 2022
- Published online by Cambridge University Press:
- 28 October 2022, e192
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We developed an agent-based model using a trial emulation approach to quantify effect measure modification of spillover effects of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) in the Atlanta-Sandy Springs-Roswell metropolitan area, Georgia. PrEP may impact not only the individual prescribed, but also their partners and beyond, known as spillover. We simulated a two-stage randomised trial with eligible components (≥3 agents with ≥1 HIV+ agent) first randomised to intervention or control (no PrEP). Within intervention components, agents were randomised to PrEP with coverage of 70%, providing insight into a high PrEP coverage strategy. We evaluated effect modification by component-level characteristics and estimated spillover effects on HIV incidence using an extension of randomisation-based estimators. We observed an attenuation of the spillover effect when agents were in components with a higher prevalence of either drug use or bridging potential (if an agent acts as a mediator between ≥2 connected groups of agents). The estimated spillover effects were larger in magnitude among components with either higher HIV prevalence or greater density (number of existing partnerships compared to all possible partnerships). Consideration of effect modification is important when evaluating the spillover of PrEP among MSM.
Which pharmacists are performing antimicrobial stewardship: A national survey and a call for collaborative efforts
- Brandon Dionne, Jamie L. Wagner, Daniel B. Chastain, Meagen Rosenthal, Monica V. Mahoney, Christopher M. Bland
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 15 February 2022, e24
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Objectives:
To determine how pharmacists with formal antimicrobial stewardship program (ASP) responsibilities prioritize their time and pharmacists without formal antimicrobial stewardship program responsibilities contribute to ASP activities.
Design:A nationwide survey.
Respondents:Members of the American College of Clinical Pharmacy who subscribe to the following practice and research network e-mail listservs: infectious diseases, adult medicine, cardiology, critical care, hematology–oncology, immunology and transplantation, and pediatrics.
Methods:A survey was distributed via listservs. Respondents were asked about their personal and institutional demographics and ASP activities.
Results:In total, 245 pharmacists responded: 135 pharmacists with formal antimicrobial stewardship program responsibilities; 110 pharmacists without formal antimicrobial stewardship program responsibilities. Although most respondents had completed a general pharmacy residency (85%), only 20% had completed an infectious diseases (ID) specialty residency. Among pharmacists with formal antimicrobial stewardship program responsibilities, one-third had no formal training or certification in ID or ASP. Pharmacists without formal antimicrobial stewardship program responsibilities spent ∼12.5% of their time per week on ASP activities, whereas pharmacists with formal antimicrobial stewardship program responsibilities spent 28% of their time performing non-ASP activities. Pharmacists with formal antimicrobial stewardship program responsibilities were more likely than pharmacists without formal antimicrobial stewardship program responsibilities to perform antibiotic guideline development (P < .001), antibiotic-related education (P = .002), and direct notification of rapid diagnostic results (P = .018). Pharmacists with formal antimicrobial stewardship program responsibilities without formal ID training or certification spent less time on ASP activities and were more likely to perform lower-level interventions.
Conclusions:Many ASP activities are being performed by pharmacists without formal ID training. To ensure the future success of ASPs, pharmacists with formal antimicrobial stewardship program responsibilities should have adequate training to meet more advanced metrics, and more pharmacists without formal antimicrobial stewardship program responsibilities should be included in basic interventions.
SERRE WEIGHTS AND BREUIL’S LATTICE CONJECTURE IN DIMENSION THREE
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- DANIEL LE, BAO V. LE HUNG, BRANDON LEVIN, STEFANO MORRA
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- Journal:
- Forum of Mathematics, Pi / Volume 8 / 2020
- Published online by Cambridge University Press:
- 25 March 2020, e5
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We prove in generic situations that the lattice in a tame type induced by the completed cohomology of a $U(3)$-arithmetic manifold is purely local, that is, only depends on the Galois representation at places above $p$. This is a generalization to $\text{GL}_{3}$ of the lattice conjecture of Breuil. In the process, we also prove the geometric Breuil–Mézard conjecture for (tamely) potentially crystalline deformation rings with Hodge–Tate weights $(2,1,0)$ as well as the Serre weight conjectures of Herzig [‘The weight in a Serre-type conjecture for tame $n$-dimensional Galois representations’, Duke Math. J. 149(1) (2009), 37–116] over an unramified field extending the results of Le et al. [‘Potentially crystalline deformation 3985 rings and Serre weight conjectures: shapes and shadows’, Invent. Math. 212(1) (2018), 1–107]. We also prove results in modular representation theory about lattices in Deligne–Lusztig representations for the group $\text{GL}_{3}(\mathbb{F}_{q})$.
Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda
- Byamah B. Mutamba, Jeremy C. Kane, Joop T. V. M. de Jong, James Okello, Seggane Musisi, Brandon A. Kohrt
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- Journal:
- Psychological Medicine / Volume 48 / Issue 15 / November 2018
- Published online by Cambridge University Press:
- 15 February 2018, pp. 2573-2583
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Background
Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.
MethodsA non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.
ResultsCaregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.
ConclusionIPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.
Pharmacists’ Familiarity with and Institutional Utilization of Rapid Diagnostic Technologies for Antimicrobial Stewardship
- Rachel A. Foster, Kristi Kuper, Z. Kevin Lu, P. Brandon Bookstaver, Christopher M. Bland, Monica V. Mahoney
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 38 / Issue 7 / July 2017
- Published online by Cambridge University Press:
- 11 May 2017, pp. 863-866
- Print publication:
- July 2017
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Rapid diagnostic technologies (RDTs) significantly reduce organism identification time and can augment antimicrobial stewardship program (ASP) activities. An electronic survey quantified familiarity with and utilization of RDTs by clinical pharmacists participating in ASPs. Familiarity was highest with polymerase chain reaction (PCR). Formal infectious diseases training was the only significant factor influencing RDT familiarity.
Infect Control Hosp Epidemiol 2017;38:863–866
Reply to Iannicelli's (2012) Letter to the Editor
- B. Brandon Curry, Michael E. Konen, Timothy H. Larson, Catherine H. Yansa, Keith C. Hackley, Thomas V. Lowell, Justine Petras
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- Journal:
- Quaternary Research / Volume 77 / Issue 2 / March 2012
- Published online by Cambridge University Press:
- 20 January 2017, pp. 332-334
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Climate change in southern Illinois, USA, based on the age and δ13C of organic matter in cave sediments
- Samuel V. Panno, B. Brandon Curry, Hong Wang, Keith C. Hackley, Chao-Li Liu, Craig Lundstrom, Juanzuo Zhou
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- Quaternary Research / Volume 61 / Issue 3 / May 2004
- Published online by Cambridge University Press:
- 20 January 2017, pp. 301-313
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Matrix-supported diamicton and uniform to laminated, silty, fine-grained sediment deposited from about 42,500 to 27,600 cal yr B.P. under slackwater conditions nearly filled two caves in southwestern Illinois. At some point, most of the sediment was flushed from the caves and from about 22,700 to 4000 cal yr B.P. floods deposited a drape of sandy and silty sediment on remnant slackwater successions, cobbly alluvium, and bedrock (especially from 7700 to 4000 cal yr B.P.). Clay mineral analyses of the slackwater cave sediment reveal a provenance of chiefly Petersburg Silt, a smectite- and illite-rich proglacial lacustrine unit present in the overlying Illinois Episode glacial succession. Today, remnants of the ancient subterranean slackwater deposits nearly fill several secondary passages and in at least two locations, cover a cobble-mantled strath terrace 1.3 to 1.5 m above active stream channels. Slumping and sinkhole formation appear to have been important mechanisms for deposition of the ancient subterranean deposits. Slumping of these surficial deposits and associated vegetation can occur along the flanks of sinkholes (in addition to sinkhole formation) and enter caves; however, the finer organics, some of them comminuted during transport into the caves, become part of the cave alluvium. This finer organic fraction is the modern analog of the humified organic matter disseminated in slackwater sediment dated in this investigation by radiocarbon methods. Twenty-four 14C ages on humified organic matter provide chronologic control. The δ13C values of the organic matter reflect the proportion of C4-type to C3-type vegetation growing in and around swallets and sinkholes at the time of redeposition. Drought-tolerant C4-type vegetation was more prevalent relative to C3-type vegetation from 42,500 to 31,200 cal yr B.P. compared to conditions from 28,800 cal yr B.P. to the present. The δ13C values are consistent with the results from other investigations of speleothems and organic matter from loessial paleosols.
The DeKalb mounds of northeastern Illinois as archives of deglacial history and postglacial environments
- B. Brandon Curry, Michael E. Konen, Timothy H. Larson, Catherine H. Yansa, Keith C. Hackley, Helena Alexanderson, Thomas V. Lowell
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- Quaternary Research / Volume 74 / Issue 1 / July 2010
- Published online by Cambridge University Press:
- 20 January 2017, pp. 82-90
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The “type” DeKalb mounds of northeastern Illinois, USA (42.0°N, −88.7°W), are formed of basal sand and gravel overlain by rhythmically bedded fines, and weathered sand and gravel. Generally from 2 to 7 m thick, the fines include abundant fossils of ostracodes and uncommon leaves and stems of tundra plants. Rare chironomid head capsules, pillclam shells, and aquatic plant macrofossils also have been observed.
Radiocarbon ages on the tundra plant fossils from the “type” region range from 20,420 to 18,560 cal yr BP. Comparison of radiocarbon ages of terrestrial plants from type area ice-walled lake plains and adjacent kettle basins indicate that the topographic inversion to ice-free conditions occurred from 18,560 and 16,650 cal yr BP. Outside the “type” area, the oldest reliable age of tundra plant fossils in DeKalb mound sediment is 21,680 cal yr BP; the mound occurs on the northern arm of the Ransom Moraine (−88.5436°W, 41.5028°N). The youngest age, 16,250 cal yr BP, is associated with a mound on the Deerfield Moraine (−87.9102°W, 42.4260°N) located about 9 km east of Lake Michigan. The chronology of individual successions indicates the lakes persisted on the periglacial landscape for about 300 to 1500 yr.
Thermodynamic properties of thermonuclear fuel in inertial confinement fusion
- V. Brandon, B. Canaud, M. Temporal, R. Ramis
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- Laser and Particle Beams / Volume 34 / Issue 3 / September 2016
- Published online by Cambridge University Press:
- 31 August 2016, pp. 539-544
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Hot-spot path in the thermodynamic space $({\rm \rho} R,T_{\rm i} )_{{\rm hs}} $ is investigated for direct-drive scaled-target family covering a huge interval of kinetic energy on both sides of kinetic threshold for ignition. Different peak implosion velocities and two initial aspect ratios have been considered. It is shown that hot spot follows almost the same path during deceleration up to stagnation whatever the target is. As attended, after stagnation, a clear distinction is done between non-, marginally-, or fully igniting targets. For the last, ionic temperature can reach very high values when the thermonuclear energy becomes very high.
Contributors
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- By Magdalena Anitescu, Charles E. Argoff, Arash Asher, Nyla Azam, Nomen Azeem, Sachin K. Bansal, Jose E. Barreto, Rodrigo A Benavides, Niteesh Bharara, Justin B. Boge, Robert B. Bolash, Thomas K. Bond, Christopher Centeno, Zachariah W. Chambers, Jonathan Chang, Grace Chen, Hamilton Chen, Jeffry Chen, Jianguo Cheng, Natalia Covarrubias, Claire J. Creutzfeldt, Gulshan Doulatram, Amirpasha Ehsan, Ike Eriator, Jeff Ericksen, Mark Etscheidt, Frank J. E. Falco, Jack Fu, Timothy Furnish, Annemarie E. Gallagher, Kingsuk Ganguly, Eugene Garvin, Cliff Gevirtz, Scott E. Glaser, Brandon J. Goff, Harry J. Gould, Christine Greco, Jay S. Grider, Maged Guirguis, Qiao Guo, Justin Hata, John Hau, Garett J. Helber, Eric R. Helm, Lori Hill Marshall, Dean Hommer, Jeffrey Hopcian, Eric S. Hsu, Jakun Ing, Tracy P. Jackson, Gaurav Jain, Chrystina Jeter, Alan David Kaye, James Kelly, Soorena Khojasteh, Ankur Khosla, Daniel Krashin, Monika A. Krzyzek, Prasad Lakshminarasimhiah, Steven Michael Lampert, Garrett LaSalle, Quan D. Le, Ankit Maheshwari, Edward R. Mariano, Joaquin Maury, John P. McCallin, John Michels, Natalia Murinova, Narendren Narayanasamy, Rebekah L. Nilson, Elliot Palmer, Vikram B. Patel, Devin Peck, Donald B. Penzien, Danielle Perret Karimi, Tilak Raj, Michael R. Rasmussen, Mohit Rastogi, Rahul Rastogi, Nashaat N. Rizk, Rinoo V. Shah, Paul A. Sloan, Julian Sosner, A. Raj Swain, Minyi Tan, Natacha Telusca, Santhosh A. Thomas, Andrea Trescot, Michael Truong, Jason Tucker, Richard D. Urman, Brandon A. Van Noord, Nihir Waghela, Irene Wu, Jiang Wu, Jijun Xu, Jinghui Xie, William Yancey
- Edited by Alan David Kaye, Louisiana State University, Rinoo V. Shah
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- Case Studies in Pain Management
- Published online:
- 05 October 2014
- Print publication:
- 16 October 2014, pp xi-xv
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Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-β-Lactamase at an Acute Care Hospital, Colorado, 2012
- Erin E. Epson, Larissa M. Pisney, Joyanna M. Wendt, Duncan R. MacCannell, Sarah J. Janelle, Brandon Kitchel, J. Kamile Rasheed, Brandi M. Limbago, Carolyn V. Gould, Alexander J. Kallen, Michelle A. Barron, Wendy M. Bamberg
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 4 / April 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 390-397
- Print publication:
- April 2014
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Objective.
To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission.
Design, Setting, and Patients.Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital.
Methods.Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations.
Results.Two patients were initially identified with NDM-producing CRE during July–August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission.
Conclusions.A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.
Thickness Variations and Absence of Lateral Compositional Fluctuations in Aberration-Corrected STEM Images of InGaN LED Active Regions at Low Dose
- Andrew B. Yankovich, Alexander V. Kvit, Xing Li, Fan Zhang, Vitaliy Avrutin, Huiyong Liu, Natalia Izyumskaya, Ümit Özgür, Brandon Van Leer, Hadis Morkoç, Paul M. Voyles
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- Journal:
- Microscopy and Microanalysis / Volume 20 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 26 March 2014, pp. 864-868
- Print publication:
- June 2014
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Aberration-corrected scanning transmission electron microscopy images of the In0.15Ga0.85N active region of a blue light-emitting diode, acquired at ~0.1% of the electron dose known to cause electron beam damage, show no lateral compositional fluctuations, but do exhibit one to four atomic plane steps in the active layer’s upper boundary. The area imaged was measured to be 2.9 nm thick using position averaged convergent beam electron diffraction, ensuring the sample was thin enough to capture compositional variation if it was present. A focused ion beam prepared sample with a very large thin area provides the possibility to directly observe large fluctuations in the active layer thickness that constrict the active layer at an average lateral length scale of 430 nm.
Contributors
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- By Ioannis P. Androulakis, Djillali Annane, Gérard Audibert, Lisa L. Barnes, Paolo Bartolomeo, Walter S. Bartynski, David A. Bennett, Nicolas Bruder, Nathan E. Brummel, Steve E. Calvano, Alain Cariou, F. Chretien, Jan Claassen, Colm Cunningham, Souhayl Dahmani, Robert Dantzer, Dimitry S. Davydow, Sanjay V. Desai, E. Wesley Ely, Frédéric Faugeras, Karen J. Ferguson, Brandon Foreman, Sadanand M. Gaikwad, Rebecca F. Gottesman, Maura A. Grega, Richard D. Griffiths, Marion Griton, Stefan D. Gurney, Hebah M. Hefzy, Michael T. Heneka, Dustin M. Hipp, Ramona O. Hopkins, Christopher G. Hughes, James C. Jackson, Christina Jones, Peter W. Kaplan, Keith W. Kelley, Raymond C. Koehler, Matthew A. Koenig, Jan Pieter Konsman, Felix Kork, John P. Kress, Stephen F. Lowry, Alawi Luetz, David Luis, Alasdair M. J. MacLullich, Guy M. McKhann, Jean Mantz, Panteleimon D. Mavroudis, Mervyn Maze, Bruno Mégarbane, Lionel Naccache, Dale M. Needham, Pratik P. Pandharipande, Jean-Francois Payen, V. Hugh Perry, Margaret Pisani, C. Rauturier, Benjamin Rohaut, Jennifer Ryan, Robert D. Sanders, Jeremy D. Scheff, Frederic Sedel, Ola A. Selnes, Tarek Sharshar, Martin Siegemund, Yoanna Skrobik, Jamie W. Sleigh, Romain Sonneville, Claudia D. Spies, Luzius A. Steiner, Robert D. Stevens, Raoul Sutter, Fabio Silvio Taccone, Richard E. Temes, Willem A. van Gool, Christel C. Vanbesien, F. Verdonk, Odile Viltart, Julia Wendon, Catherine N. Widmann, Robert S. Wilson
- Edited by Robert D. Stevens, Tarek Sharshar, E. Wesley Ely, Vanderbilt University, Tennessee
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- Book:
- Brain Disorders in Critical Illness
- Published online:
- 05 October 2013
- Print publication:
- 19 September 2013, pp viii-xii
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Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans
- Brian V. Cashin, Jr., Aaron G. Matlock, Chris Kang, Penny S. Reynolds, Brandon K. Wills
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 4 / August 2013
- Published online by Cambridge University Press:
- 01 May 2013, pp. 367-369
- Print publication:
- August 2013
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Introduction
The newer cyanide antidote, hydroxocobalamin, due to its pigmentation, has been found to cause interferences in some laboratory assays. Co-oximetry may also be affected by hydroxocobalamin, leading to false elevations in hemoglobin concentration, methemoglobin, carboxyhemoglobin, and false decreases in oxyhemoglobin. The Masimo Radical-7 is a medical device that performs noninvasive oximetry and estimates hemoglobin (Hb) concentration and percent carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin saturation (O2Hb).
Study ObjectivesThe study sought to determine the effect of hydroxocobalamin on noninvasive measurement of hemoglobin indices using the Masimo Radical-7 monitor.
MethodsSeven asymptomatic volunteers who were unexposed to cyanide had baseline heart rate (HR), blood pressure (BP), and oximeter measurements recorded followed by an infusion of five grams of hydroxocobalamin over 15 minutes. The above parameters were subsequently recorded at: 5, 10, 15, 30 and 60 minutes post infusion. Data were analyzed by calculating the area under the curve (AUC) for each variable and comparing the results to expected values by paired t tests. Expected AUC values were calculated by extrapolating baseline values across the entire time period.
ResultsThe mean differences from baseline values with 95% confidence intervals and t tests of mean difference were: SBP: 11 mm Hg (95% CI, 0-22; P = .051); HR: -9 (95% CI, -15 to -3; P = .01); Hb: -0.1 (95% CI, -0.7 to 0.4; P = .57); O2Hb: 0 g/dL (95% CI, -1 to 1; P = .41); COHb: -1 (95% CI, -3 to 1; P = .25); MetHb: -0.2 (95% CI, -0.3 to 0; P = .03).
DiscussionAfter infusion of hydroxocobalamin there was a significant elevation of systolic blood pressure and decrease in heart rate. There were no significant differences in Hb, O2Hb, and COHb. Although percent methemoglobin concentrations were statistically lower, the authors feel this difference is of trivial clinical significance.
ConclusionThe administration of hydroxocobalamin does not significantly impact noninvasive oximetry.
. ,Cashin B ,Matlock A ,Kang C ,Reynolds P .Wills B Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans . Prehosp Disaster Med.2013 ;28 (4 ):1 -3
Marginally igniting direct-drive target designs for the laser megajoule
- V. Brandon, B. Canaud, M. Primout, S. Laffite, M. Temporal
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- Journal:
- Laser and Particle Beams / Volume 31 / Issue 1 / March 2013
- Published online by Cambridge University Press:
- 22 February 2013, pp. 141-148
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Direct-drive target designs below self-ignition threshold are proposed for the laser megajoule in the context of shock-ignition. Two distinct initial aspect ratios are considered and laser pulses are shaped following a classical Kidder's law in order to achieve an implosion velocity of 300 km/s, an in-fight adiabat close to unity and to maximize the peak areal density. The pulse shapes are adjusted to arrange shock timing at the inner side of the DT fuel. The robustness of the laser pulse is addressed by the means of random variations around the initial Kidder's laws. Correlation matrices show no significant correlations between laser parameters. An admissible envelope of laser pulse is given for both designs in order to warrant more than 80% of the best peak areal density. Variations of laser drive power produce variations of implosion velocities in the range 250–370 km/s. Self-ignition threshold is achieved and thermonuclear energy are produced in the range 3 kJ–27 MJ. Finally, the random procedure shows that it is possible to improve the first deterministic optimization and the laser pulses are given.
Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions
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- Amit S. Chitnis, Pam S. Caruthers, Agam K. Rao, JoAnne Lamb, Robert Lurvey, Valery Beau De Rochars, Brandon Kitchel, Margarita Cancio, Thomas J. Török, Alice Y. Guh, Carolyn V. Gould, Matthew E. Wise
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 10 / October 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 984-992
- Print publication:
- October 2012
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Objective.
To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.
Design, Setting, and Patients.Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).
Methods.Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.
Results.Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.
Conclusion.CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.
Infect Control Hosp Epidemiol 2012;33(10):984-992
2D analysis of direct-drive shock-ignited HiPER-like target implosions with the full laser megajoule
- B. Canaud, S. Laffite, V. Brandon, M. Temporal
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- Journal:
- Laser and Particle Beams / Volume 30 / Issue 2 / June 2012
- Published online by Cambridge University Press:
- 09 March 2012, pp. 183-188
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We present a 2D analysis of direct-drive shock ignition for the laser Megajoule. First, a target design is chosen in the HiPER-like target family generated by scale up and down of the original HiPER target. A first analysis is done considering the 1D fuel assembly and 2D shock ignition by means of the ring at polar angle of 33°2. The intensity profile is top-hat and calculations are done for several different radii. It is shown that larger the radius, lower the minimum spike power is. In addition, the intensity in each quad can stay below 4 × 1014 W/cm2 and is considered non crucial for parametric instabilities such as two plasmons. A 2D analysis of the fuel assembly is done in a second step by considering the two rings located at 49° and 59°5 and their symmetric by the equatorial plane symmetry. It is shown that low mode asymmetries are important at the stagnation and can significantly affect the areal density obtained. Finally, full 2D calculations of shock ignition is done, using all the beams of the LMJ and show that the spike power needed for ignition and gain is increased by a factor greater than 3 regarding the power needed in perfectly isotropic fuel assembly. This increase is mainly due to high level low mode asymmetries generated during fuel assembly.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
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- The Cambridge Dictionary of Christianity
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