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A daily prompt to offer vaccination to inpatients awaiting transfer to rehabilitation resulted in increased SARS-CoV-2 (OR 5.64, 95% CI 3.3–10.15; P < 0.001) and influenza (OR 3.80, 95% CI 2.45–6.06; P < 0.001) vaccination. Compared to baseline, this intervention was associated with reduced incidence of viral respiratory infection during subsequent admission to rehabilitation.
Leader exemplification involves implicit and explicit claims of high moral values made by a leader. We employed a 2 × 3 experimental design with samples of 265 students in Study 1 and 142 working adults in Study 2 to examine the effects of leader exemplification (exemplification versus no exemplification) and ethical conduct (self-serving, self-sacrificial, and self-other focus) on perceived leader authenticity, trust in leader, and organizational advocacy. In Study 1, we found that exemplification produced elevated levels of perceived authenticity, trust, and advocacy in the form of employment and investment recommendations. We also showed that leader ethical conduct moderated this effect, as ratings were highest following a leader’s self-sacrificial conduct, lowest for self-serving conduct, and moderate for conduct reflecting self-other concerns. In Study 2, we replicated these findings for perceived authenticity and trust, but not organizational advocacy, which yielded mixed results. The leadership implications and future research directions are discussed.
Many preoperative urine cultures are of low value and may even lead to patient harms. This study sought to understand practices around ordering preoperative urine cultures and prescribing antibiotic treatment.
We interviewed participants using a qualitative semi-structured interview guide. Collected data was coded inductively and with the Dual Process Model (DPM) using MAXQDA software. Data in the “Testing Decision-Making” code was further reviewed using the concept of perceived risk as a sensitizing concept.
Results:
We identified themes relating to surgeons’ concerns about de-implementing preoperative urine cultures to detect asymptomatic bacteriuria (ASB) in patients undergoing non-urological procedures: (1) anxiety and uncertainty surrounding missing infection signs spanned surgical specialties, (2) there were perceived risks of negative consequences associated with omitting urine cultures and treatment prior to specific procedure sites and types, and additionally, (3) participants suggested potential routes for adjusting these perceived risks to facilitate de-implementation acceptance. Notably, participants suggested that leadership support and peer engagement could help improve surgeon buy-in.
Conclusions:
Concerns about perceived risks sometimes outweigh the evidence against routine preoperative urine cultures to detect ASB. Evidence from trusted peers may improve openness to de-implementing preoperative urine cultures.
OBJECTIVES/GOALS: Antibiograms are used to guide empiric antibiotic selection. However, it is unclear if antibiotic profiles differ between symptomatic urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB). We aimed to compare antibiotic susceptibility profiles of urinary E. coli isolates from patients with a symptomatic UTI to those with ASB. METHODS/STUDY POPULATION: We conducted a cohort study of 1,140 urinary E. coli isolates from unique patients that received care through Vanderbilt University Medical Center (VUMC) from Nov 2020 – Jun 2021. We included any patient that was seen at VUMC as an inpatient, outpatient or at the emergency department with ≥ 105 colony forming units/mL E. coli detected from a clinical urine specimen. Chart abstractions were performed to capture reported UTI symptoms and demographic information. Descriptive statistics were conducted to compare antibiotic susceptibility profiles (i.e., susceptible, intermediate, resistant) between symptomatic and ASB groups. The risk of detection of a multidrug-resistant organism (MDRO) (intermediate, or resistant to at least one antibiotic in three or more classes) was assessed between groups. RESULTS/ANTICIPATED RESULTS: Among 1,140, 1,018 (89%) and 122 (11%) were symptomatic and ASB, respectively. When comparing symptomatic and ASB, the median ages were 50 and 46. Groups had similar proportions of no indwelling catheter (94% v. 95%) and without diabetes (87% v. 88%). The collection setting between inpatient, emergency department, and outpatient were similar with most being outpatient (79% v. 83%). The proportion of patients who were pregnant, immuno compromised, or had a structural/functional urinary tract abnormality were higher in the symptomatic group. The proportion of isolates resistant and susceptible to tested antibiotics were similar between groups, with only ciprofloxacin showing slightly higher resistance among ASB (16% v. 25%). The risk of MDRO detection was similar between groups (RR: 0.858, 95% CI: 0.64, 1.15). DISCUSSION/SIGNIFICANCE: Antibiotic susceptibility comparison demonstrated similar profiles, which suggests antibiogram use as appropriate to guide ASB treatment. Results offer insight on whether traditional methods for assessing antibiotic susceptibility on population-levels could benefit from further refinement by patient-specific clinical parameters.
This paper will study almost everywhere behaviors of functions on partition spaces of cardinals possessing suitable partition properties. Almost everywhere continuity and monotonicity properties for functions on partition spaces will be established. These results will be applied to distinguish the cardinality of certain subsets of the power set of partition cardinals.
The following summarizes the main results proved under suitable partition hypotheses.
• If $\kappa $ is a cardinal, $\epsilon < \kappa $, ${\mathrm {cof}}(\epsilon ) = \omega $, $\kappa \rightarrow _* (\kappa )^{\epsilon \cdot \epsilon }_2$ and $\Phi : [\kappa ]^\epsilon _* \rightarrow \mathrm {ON}$, then $\Phi $ satisfies the almost everywhere short length continuity property: There is a club $C \subseteq \kappa $ and a $\delta < \epsilon $ so that for all $f,g \in [C]^\epsilon _*$, if $f \upharpoonright \delta = g \upharpoonright \delta $ and $\sup (f) = \sup (g)$, then $\Phi (f) = \Phi (g)$.
• If $\kappa $ is a cardinal, $\epsilon $ is countable, $\kappa \rightarrow _* (\kappa )^{\epsilon \cdot \epsilon }_2$ holds and $\Phi : [\kappa ]^\epsilon _* \rightarrow \mathrm {ON}$, then $\Phi $ satisfies the strong almost everywhere short length continuity property: There is a club $C \subseteq \kappa $ and finitely many ordinals $\delta _0, ..., \delta _k \leq \epsilon $ so that for all $f,g \in [C]^\epsilon _*$, if for all $0 \leq i \leq k$, $\sup (f \upharpoonright \delta _i) = \sup (g \upharpoonright \delta _i)$, then $\Phi (f) = \Phi (g)$.
• If $\kappa $ satisfies $\kappa \rightarrow _* (\kappa )^\kappa _2$, $\epsilon \leq \kappa $ and $\Phi : [\kappa ]^\epsilon _* \rightarrow \mathrm {ON}$, then $\Phi $ satisfies the almost everywhere monotonicity property: There is a club $C \subseteq \kappa $ so that for all $f,g \in [C]^\epsilon _*$, if for all $\alpha < \epsilon $, $f(\alpha ) \leq g(\alpha )$, then $\Phi (f) \leq \Phi (g)$.
• Suppose dependent choice ($\mathsf {DC}$), ${\omega _1} \rightarrow _* ({\omega _1})^{\omega _1}_2$ and the almost everywhere short length club uniformization principle for ${\omega _1}$ hold. Then every function $\Phi : [{\omega _1}]^{\omega _1}_* \rightarrow {\omega _1}$ satisfies a finite continuity property with respect to closure points: Let $\mathfrak {C}_f$ be the club of $\alpha < {\omega _1}$ so that $\sup (f \upharpoonright \alpha ) = \alpha $. There is a club $C \subseteq {\omega _1}$ and finitely many functions $\Upsilon _0, ..., \Upsilon _{n - 1} : [C]^{\omega _1}_* \rightarrow {\omega _1}$ so that for all $f \in [C]^{\omega _1}_*$, for all $g \in [C]^{\omega _1}_*$, if $\mathfrak {C}_g = \mathfrak {C}_f$ and for all $i < n$, $\sup (g \upharpoonright \Upsilon _i(f)) = \sup (f \upharpoonright \Upsilon _i(f))$, then $\Phi (g) = \Phi (f)$.
• Suppose $\kappa $ satisfies $\kappa \rightarrow _* (\kappa )^\epsilon _2$ for all $\epsilon < \kappa $. For all $\chi < \kappa $, $[\kappa ]^{<\kappa }$ does not inject into ${}^\chi \mathrm {ON}$, the class of $\chi $-length sequences of ordinals, and therefore, $|[\kappa ]^\chi | < |[\kappa ]^{<\kappa }|$. As a consequence, under the axiom of determinacy $(\mathsf {AD})$, these two cardinality results hold when $\kappa $ is one of the following weak or strong partition cardinals of determinacy: ${\omega _1}$, $\omega _2$, $\boldsymbol {\delta }_n^1$ (for all $1 \leq n < \omega $) and $\boldsymbol {\delta }^2_1$ (assuming in addition $\mathsf {DC}_{\mathbb {R}}$).
This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses.
Methods
The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients’ characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded.
Results
In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10).
Conclusion
Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.
Bacterial superinfection and antibiotic prescribing in the setting of the current mpox outbreak are not well described in the literature. This retrospective observational study revealed low prevalence (11%) of outpatient antibiotic prescribing for bacterial superinfection of mpox lesions; at least 3 prescriptions (23%) were unnecessary.
Contemporary proof assistants such as Coq require that recursive functions be terminating and corecursive functions be productive to maintain logical consistency of their type theories, and some ensure these properties using syntactic checks. However, being syntactic, they are inherently delicate and restrictive, preventing users from easily writing obviously terminating or productive functions at their whim.
Meanwhile, there exist many sized type theories that perform type-based termination and productivity checking, including theories based on the Calculus of (Co)Inductive Constructions (CIC), the core calculus underlying Coq. These theories are more robust and compositional in comparison. So why haven’t they been adapted to Coq?
In this paper, we venture to answer this question with CIC
$\widehat{\ast}$
, a sized type theory based on CIC. It extends past work on sized types in CIC with additional Coq features such as global and local definitions. We also present a corresponding size inference algorithm and implement it within Coq’s kernel; for maximal backward compatibility with existing Coq developments, it requires no additional annotations from the user.
In our evaluation of the implementation, we find a severe performance degradation when compiling parts of the Coq standard library, inherent to the algorithm itself. We conclude that if we wish to maintain backward compatibility, using size inference as a replacement for syntactic checking is impractical in terms of performance.
Recent research has shown that risk and reward are positively correlated in many environments, and that people have internalized this association as a “risk-reward heuristic”: when making choices based on incomplete information, people infer probabilities from payoffs and vice-versa, and these inferences shape their decisions. We extend this work by examining people’s expectations about another fundamental trade-off — that between monetary reward and delay. In 2 experiments (total N = 670), we adapted a paradigm previously used to demonstrate the risk-reward heuristic. We presented participants with intertemporal choice tasks in which either the delayed reward or the length of the delay was obscured. Participants inferred larger rewards for longer stated delays, and longer delays for larger stated rewards; these inferences also predicted people’s willingness to take the delayed option. In exploratory analyses, we found that older participants inferred longer delays and smaller rewards than did younger ones. All of these results replicated in 2 large-scale pre-registered studies with participants from a different population (total N = 2138). Our results suggest that people expect intertemporal choice tasks to offer a trade-off between delay and reward, and differ in their expectations about this trade-off. This “delay-reward heuristic” offers a new perspective on existing models of intertemporal choice and provides new insights into unexplained and systematic individual differences in the willingness to delay gratification.
In this prospective study, universal admission testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) averted transmission in shared patient rooms especially since the emergence of the SARS-CoV-2 omicron variant when the yield in identifying infectious asymptomatic cases more than doubled. This change may be due to the higher rate of asymptomatic infection with the omicron variant, the broader community prevalence during the omicron era, or both.
Assume $\mathsf {ZF} + \mathsf {AD}$ and all sets of reals are Suslin. Let $\Gamma $ be a pointclass closed under $\wedge $, $\vee $, $\forall ^{\mathbb {R}}$, continuous substitution, and has the scale property. Let $\kappa = \delta (\Gamma )$ be the supremum of the length of prewellorderings on $\mathbb {R}$ which belong to $\Delta = \Gamma \cap \check \Gamma $. Let $\mathsf {club}$ denote the collection of club subsets of $\kappa $. Then the countable length everywhere club uniformization holds for $\kappa $: For every relation $R \subseteq {}^{<{\omega _1}}\kappa \times \mathsf {club}$ with the property that for all $\ell \in {}^{<{\omega _1}}\kappa $ and clubs $C \subseteq D \subseteq \kappa $, $R(\ell ,D)$ implies $R(\ell ,C)$, there is a uniformization function $\Lambda : \mathrm {dom}(R) \rightarrow \mathsf {club}$ with the property that for all $\ell \in \mathrm {dom}(R)$, $R(\ell ,\Lambda (\ell ))$. In particular, under these assumptions, for all $n \in \omega $, $\boldsymbol {\delta }^1_{2n + 1}$ satisfies the countable length everywhere club uniformization.
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
Methods
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Results
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Conclusions
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Little is known about the effects of physical exercise on sleep-dependent consolidation of procedural memory in individuals with schizophrenia. We conducted a randomized controlled trial (RCT) to assess the effectiveness of physical exercise in improving this cognitive function in schizophrenia.
Methods
A three-arm parallel open-labeled RCT took place in a university hospital. Participants were randomized and allocated into either the high-intensity-interval-training group (HIIT), aerobic-endurance exercise group (AE), or psychoeducation group for 12 weeks, with three sessions per week. Seventy-nine individuals with schizophrenia spectrum disorder were contacted and screened for their eligibility. A total of 51 were successfully recruited in the study. The primary outcome was sleep-dependent procedural memory consolidation performance as measured by the finger-tapping motor sequence task (MST). Assessments were conducted during baseline and follow-up on week 12.
Results
The MST performance scored significantly higher in the HIIT (n = 17) compared to the psychoeducation group (n = 18) after the week 12 intervention (p < 0.001). The performance differences between the AE (n = 16) and the psychoeducation (p = 0.057), and between the AE and the HIIT (p = 0.999) were not significant. Yet, both HIIT (p < 0.0001) and AE (p < 0.05) showed significant within-group post-intervention improvement.
Conclusions
Our results show that HIIT and AE were effective at reverting the defective sleep-dependent procedural memory consolidation in individuals with schizophrenia. Moreover, HIIT had a more distinctive effect compared to the control group. These findings suggest that HIIT may be a more effective treatment to improve sleep-dependent memory functions in individuals with schizophrenia than AE alone.
Sponges and swabs were evaluated for their ability to recover Candida auris dried 1 hour on steel and plastic surfaces. Culture recovery ranged from <0.1% (sponges) to 8.4% (swabs), and cells detected with an esterase activity assay revealed >50% recovery (swabs), indicating that cells may enter a viable but nonculturable state.