Turn-Around-Time Improvements for Positive Blood Cultures from Incorporation of Workflow Modifications

Background: Emergence of direct from positive blood culture bottle identification (ID) methods reveal opportunities for improving bacterial ID and select resistance marker detection turn-around-times. Each system has various advantages and disadvantages; each institution must select the method/s that best fit the laboratory and patient needs. Here we elucidate improvements in 24 hour workflow through incorporating multiple rapid technologies for positive blood culture ID into a 24 hour algorithm. Methods: MALDI-TOF (Bruker) analysis with sepsityper extraction (aerobic Gram-positive and anaerobic bacteria); MALDI-TOF analysis with serum separator tube concentration (Gram-negative bacteria); and a FilmArray Blood Culture Panel (Biofire) were utilized. MALDI was utilized on 1st shift for single bacterium positives. FilmArray was performed on 2nd and 3rd shift for aerobic bottles and on 1st shift for gram-positive cocci in clusters and Candida. We examined all events during our pre-modification (September-November 2013) and post-modification (late-December 2014-March 2015) time periods and defined an event as the first positive blood culture for a patient within the examined data period. The Antimicrobial Stewardship Pharmacist (ASP) was notified with identifications and also KPC carbapenemase positives, to implement a carbapenem-resistant Enterobacteriaceae (CRE) empiric treatment algorithm. For KPC positives (CRE) a custom minimum inhibitory concentration (MIC) panel was utilized, replacing a standard susceptibility panel and Etests. Finally, 2nd shift began susceptibility setup on subcultured bloods that had turned positive from 11 p.m.-6 a.m. Results: Pre- and post- workflow modification average turn-around times (TAT) and p-values are shown in the Table. Detection of either the KPC or the mecA marker significantly improved the TAT needed for phenotypic detection of carbapenem or methicillin resistance. KPC was detected in 3 Enterobactericeae. Conclusions: Improvements to patient care are to be determined, but strong collaboration with ASP is anticipated to make a significant impact on patient outcomes. Of note, while having a universal Staphylococcus species target is useful, it can lead to complications with multi-species positive bottles. With the universal Staphylococcus species target, it is not possible to differentiate between a mixed coagulase negative Staphylococcus species (CNSS) versus Staphylococcus aureus when both are present as the CNSS may harbor the mecA target, preventing adequate treatment. Furthermore, a Staphylococcus lugdunensis specific marker would be clinically useful

Characterizing user requirements for future land observing satellites

The objective procedure was developed for identifying probable sensor and mission characteristics for an operational satellite land observing system. Requirements were systematically compiled, quantified and scored by type of use, from surveys of federal, state, local and private communities. Incremental percent increases in expected value of data were estimated for critical system improvements. Comparisons with costs permitted selection of a probable sensor system, from a set of 11 options, with the following characteristics: 30 meter spatial resolution in 5 bands and 15 meters in 1 band, spectral bands nominally at Thematic Mapper (TM) bands 1 through 6 positions, and 2 day data turn around for receipt of imagery. Improvements are suggested for both the form of questions and the procedures for analysis of future surveys in order to provide a more quantitatively precise definition of sensor and mission requirements

Turning around at-risk school: What effective principals do

At-risk schools are defined by the Department of Education in the state of Selangor, Malaysia as schools with serious disciplinary problems and low academic achievement. In 2003, the Selangor Department of Education identified 22 schools in this category (Selangor State Department of Education, 2003). Some have shown remarkable improvements and have turned around the situation from being "at-risk" to "excellent." This paper is based on a qualitative study of two selected turn-around at-risk schools, one in the State of Selangor and the other in the Federal Territory of Kuala Lumpur, Malaysia. Both had been listed as at-risk by the education department, but are now considered as exemplary due to their accomplishments in various endeavors. In this paper, the authors describe and discuss what principals in these schools did to change the climate of their schools into a positive one that enabled them to turn around their at-risk schools to schools deemed as excellent

A new internal combustion engine configuration: opposed pistons with crank offset

[Abstract]: Theoretical and experimental performance results for a new internal combustion engine configuration are presented in this paper. The engine is a piston ported, spark ignition petrol engine which consists of two opposed pistons in a single cylinder controlled by two synchronously timed crankshafts at opposite ends of the cylinder. It makes use of crank offset to create the required piston motion aimed at engine efficiency improvements through thermodynamic performance gains. In particular, the engine employs full expansion in which the power stroke displaces a larger volume than the compression stroke, thereby allowing the expanding gas to reach near atmospheric pressure before the exhaust port opens. This allows more work to be done by each thermodynamic cycle. It also features a greater rate of volume change after combustion than a convention 4-stroke engine for the same crank speed. This reduces the time that the temperature difference between the gas and the cylinder is high relative to a conventional engine which in turn, should reduce the heat lost from the combustion products. Thermodynamic and friction modelling of the engine indicated that efficiencies around 38% might be achieved. However, experiments with a prototype engine demonstrated that friction losses in the engine exceeded that predicted in the original modelling

What not to write:an intervention in written communication skills for accounting students

Abstract: This study considers the evidence that many accounting students struggle to write accurately and appropriately, which in turn has negative implications on their wider employability. Using an intervention approach, initiatives were taken to address this problem for first year accounting undergraduates at the University of Portsmouth. The results indicate that some improvements are possible and students' self-awareness of the issue was raised, but that in order to sustain any improvements an increased focus on the teaching of writing skills would be required. This may have resource implications but the potential benefits to students in the wider realm could be significant. The initiative is targeted specifically at the enhancement of employability and, although based around extracts from the accounting literature, could readily be transferred to other subject areas. 126 word

How and why deliberative democracy enables co-intelligence and brings wisdom to governance

Over the past decade, state and local governments throughout Australia have focused on how to improve community consultation. Government consultation processes, regulated with the best of intentions to involve the public, have come under heavy criticism as being DEAD (Decide, Educate, Announce and Defend). It has become apparent that the problem community consultation was supposed to fix – including the voice of the community in developing policy and plans – has remained problematic. Worse, the fix has often backfired. Rather than achieving community engagement, consultation has frequently resulted in the unintended consequence of community frustration and anger at tokenism and increased citizen disaffection. Traditional community consultation has become a “fix that failed”, resulting in a “vicious cycle” of ever-decreasing social capital1 (Hartz-Karp 2002). Ordinary citizens are less and less interested in participating, evidenced by the generally low turn-out at government community consultation initiatives. When the community does attend in larger numbers, it is most often because the issue has already sparked community outrage, inspiring those with local interests to attend and protest. In their endeavour to change this situation, government agencies have created and disseminated ‘how to’ community consultation manuals, conducted conferences and run training sessions for staff. Issues of focus have included project planning, risk analysis, stakeholder mapping, economic analysis, value assurance, standardisation and so forth. Implementation models have illustrated a desired shift from informing, educating and gaining input from citizens, to collaboration, empowerment and delegated decision-making. Although new engagement techniques have been outlined, it has not been clarified how agencies can achieve such a radical change from eliciting community input to collaborative decision-making. Regardless, to reassure the public that improvements have been made, community consultation has been ‘re-badged’ to ‘community engagement’. A new vocabulary has developed around this nomenclature. However, the community has remained unconvinced that anything much has changed. The question is: Why hasn’t the community accepted these efforts with enthusiasm? The most optimistic response is that there will be a lag time between the announcement of improvements and actual improvements, and an even longer time lag between seeing the results and a resumption of the community’s trust in government. The more pessimistic response (one that also has resonance with many public sector staff) is that in essence, not a lot has changed. The ‘re-badging’ and management improvements have not resulted in the public feeling more engaged or empowered

Assessing Africa's food and nutrition security situation

"...in more than a dozen African countries the rate of undernourishment is more than 40 percent, exceeding 50 percent in those countries experiencing or emerging from armed conflict. As a result, more than a third of African children suffer stunted growth and face a range of physical and cognitive challenges not faced by their better fed peers. Ultimately, undernutrition underlies around 2.9 million deaths in Africa annually — more than a quarter of all the deaths occurring on the continent each year. The economic costs of such widespread undernutrition are enormous. This is because the economic growth of each nation — which requires enhanced economic productivity — depends upon broad improvements being made in the intellectual and technical capacity of its population. But, this in turn depends upon people receiving adequate nutrition, particularly women in their childbearing years and young children. So, only once African countries have secured the basic food and nutritional needs of their populations will they be able to achieve the broad-based economic growth necessary to reduce." from TextNutrition ,

Don't Look Back: Robustifying Place Categorization for Viewpoint- and Condition-Invariant Place Recognition

When a human drives a car along a road for the first time, they later recognize where they are on the return journey typically without needing to look in their rear-view mirror or turn around to look back, despite significant viewpoint and appearance change. Such navigation capabilities are typically attributed to our semantic visual understanding of the environment [1] beyond geometry to recognizing the types of places we are passing through such as "passing a shop on the left" or "moving through a forested area". Humans are in effect using place categorization [2] to perform specific place recognition even when the viewpoint is 180 degrees reversed. Recent advances in deep neural networks have enabled high-performance semantic understanding of visual places and scenes, opening up the possibility of emulating what humans do. In this work, we develop a novel methodology for using the semantics-aware higher-order layers of deep neural networks for recognizing specific places from within a reference database. To further improve the robustness to appearance change, we develop a descriptor normalization scheme that builds on the success of normalization schemes for pure appearance-based techniques such as SeqSLAM [3]. Using two different datasets - one road-based, one pedestrian-based, we evaluate the performance of the system in performing place recognition on reverse traversals of a route with a limited field of view camera and no turn-back-and-look behaviours, and compare to existing state-of-the-art techniques and vanilla off-the-shelf features. The results demonstrate significant improvements over the existing state of the art, especially for extreme perceptual challenges that involve both great viewpoint change and environmental appearance change. We also provide experimental analyses of the contributions of the various system components.Comment: 9 pages, 11 figures, ICRA 201

The Halo Boundary of Galaxy Clusters in the SDSS

Mass around dark matter halos can be divided into "infalling" material and "collapsed" material that has passed through at least one pericenter. Analytical models and simulations predict a rapid drop in the halo density profile associated with the transition between these two regimes. Using data from SDSS, we explore the evidence for such a feature in the density profiles of galaxy clusters and investigate the connection between this feature and a possible phase space boundary. We first estimate the steepening of the outer galaxy density profile around clusters: the profiles show an abrupt steepening, providing evidence for truncation of the halo profile. Next, we measure the galaxy density profile around clusters using two sets of galaxies selected based on color. We find evidence of an abrupt change in the galaxy colors that coincides with the location of the steepening of the density profile. Since galaxies are likely to be quenched of star formation and turn red inside of clusters, this change in the galaxy color distribution can be interpreted as the transition from an infalling regime to a collapsed regime. We also measure this transition using a model comparison approach which has been used recently in studies of the "splashback" phenomenon, but find that this approach is not a robust way to quantify the significance of detecting a splashback-like feature. Finally, we perform measurements using an independent cluster catalog to test for potential systematic errors associated with cluster selection. We identify several avenues for future work: improved understanding of the small-scale galaxy profile, lensing measurements, identification of proxies for the halo accretion rate, and other tests. With upcoming data from the DES, KiDS and HSC surveys, we can expect significant improvements in the study of halo boundaries.Comment: 17 pages, 8 figure