Undergraduate Adult Learners’ Acquisition of Credit Through Multiple Means

Using available institutional data, the authors determined the extent to which Penn State’s undergraduate adult learners acquired credit through means in addition to enrolling in other higher education institutions, the frequency with which several means are used, and offered suggestions for improvements to increase adults’ use of these options

Etiologicalagents of hospital-acquired infections in premature babies with gestationalage less than 32 weeks

Spital Clinic de Obstetrică-Ginecologie „Polizu” secţia neonatologie, Bucureşti, Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu”, Universitatea de Medicină şi Farmacie „Carol Davila”, Bucureşti, Facultatea de Medicină, Disciplina Obstetrică-Ginecologie, Facultatea de Moaşe şi Asistenţă medicală, Disciplina Pediatrie centrată pe nou-născutIntroducere. Morbiditatea prin infecţii nozocomiale, dificil de evaluat datorită tendinţelor de supraevaluare (colonizarea des interpretată ca infecţie) sau de subevaluare (infecţii nozocomiale nedeclarate) este o preocupare permanentă în neonatologie. Scop. Diminuarea morbidităţii şi mortalităţii neonatale. Obiective. Identificarea agenţilor etiologici ai infecţiilor nozocomiale survenite la prematuri cu vârsta de gestaţie <32 săptămâni. Material şi metodă. Studiu retrospectiv al prematurilor îngrijiţi în anul 2015 în Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu” - spitalul de Obstetrică Ginecologie – departamentul de neonatologie „Polizu”. Rezultate. Prematurii cu vârsta de gestaţie <32 săptămâni, reprezintă mai mult de 1/3 din totalul prematurilor îngrijiţi. Majoritatea infecţiilor nozocomiale au fost determinate de bacterii Gram negative (Enterobacter, Escherichia coli, Serratia) sau Gram pozitive (Staphylococcus aureus). Concluzii. Diminuarea morbidităţii şi a mortalităţii neonatale, a duratei de spitalizare şi implicit a costurilor deteminate de infecţiile nozocomiale, impun măsuri de prevenţie riguros aplicate, prima dintre acestea fiind igiena mâinilor.Introduction (Background). Nosocomial infections are a constant concern in neonatology, seeing the difficulty to evaluate the real incidence – either amplified (colonization falsely interpreted as infection) or underestimated (hospital-acquired infection remained unreported) Purpose. To diminish the neonatal morbidity and mortality Objectives. To identify the infectious agents in hospital-acquired infections of premature babies with GA under 32 weeks of gestation. Material and methods. The retrospective study realized in „The National Institute for the Health of the Mother and Child Alessandrescu-Rusescu, Polizu Hospital of Gynecology” regarding premature babies cared in the neonatology department during the year 2015. Results. Premature babies with GA under 32 weeks of gestation represent more than 1/3 of the number of premature babies born in our hospital. Most of the nosocomial infections have been caused by either Gram-negative (Enterobacter spp, E.Coli, Serratia) or Gram-positive (Staphylococcus aureus) bacteria. Conclusions. Lowering the neonatal morbidity and mortality, reducing the length of hospital stay and by that the costs associated with nosocomial infections do demand strict preventive measures, first of which should be hand hygiene

Taxonomic classification of asteroids based on MOVIS near-infrared colors

We aim to provide a taxonomic classification for asteroids observed by VISTA-VHS survey. We derive a method for assigning a compositional type to an object based on its (Y-J), (J-Ks), and (H-Ks) colors. We present a taxonomic classification for 18\,265 asteroids from the MOVIS catalog, using a probabilistic method and the k-nearest neighbors algorithm. Because our taxonomy is based only on NIR colors, several classes from Bus-DeMeo were clustered into groups and a slightly different notation was used (i.e. the superscript indicates that the classification was obtained based on the NIR colors and the subscript indicates possible miss-identifications with other types). Our results are compared with the information provided by the Sloan Digital Sky Survey (SDSS) and Wide-field Infrared Survey Explorer (WISE). The two algorithms used in this study give a taxonomic type for all objects having at least (Y-J) and (J-Ks) observed colors. A final classification is reported for a set of 6\,496 asteroids based on the criteria that KNN and probabilistic algorithms gave the same result, (Y-J)$_{err}\leq$ 0.118 and (J-Ks)$_{err}\leq$0.136. This set includes 144 bodies classified as $B_k^{ni}$, 613 as $C^{ni}$, 197 as $C_{gx}^{ni}$, 91 as $X_t^{ni}$, 440 as $D_s^{ni}$, 665 as $K_l^{ni}$, 233 as $A_d^{ni}$, 3\,315 as $S^{ni}$, and 798 as $V^{ni}$. We report the albedo distribution for each taxonomic group and we compute new median values for the main types. We found that V-type and A-type candidates have identical size frequency distributions, but the V-types are five times more common than the A-types. Several particular cases, such as the A-type asteroid (11616) 1996 BQ2 and the S-type (3675) Kematsch, both in the Cybele population, are discussed. Files and codes available at: https://github.com/marcelpopescu/MOVIS-TaxonomyComment: 18 pages, 10 figures, accepted for publication in Astronomy & Astrophysics (A&A

Qualitative Analysis of the Factors Associated with Whistleblowing Intentions among Athletes from Six European Countries

Although whistleblowing is thought to represent an effective mechanism for detecting and uncovering doping in sport, it has yet to become a widely adopted practice. Understanding the factors that encourage or discourage whistleblowing is of vital importance for the promotion of this practice and the development of pedagogical material to enhance the likelihood of whistleblowing. The current study employed a qualitative methodology to explore the personal and organisational factors that underpin intentions to blow the whistle or that may lead to engagement in whistleblowing behaviours in sport. Thirty-three competitive athletes across a range of sports took part in a semi-structured interview which sought to explore what they would do should they encounter a doping scenario. Content analysis revealed that whistleblowing is a dynamic process characterised by the interaction of a range of personal and organisational factors in determining the intention to report PED use. These factors included moral reasoning, a desire to keep the matter "in-house", perceived personal costs, institutional attitudes to doping, and social support. Analysis revealed a number of 'intervening events' (Ajzen, 1991), including a perceived lack of organisational protection (e.g., ethical leadership) within some sporting sub-cultures, which present an important obstacle to whistleblowing. The intention to report doping was underpinned by a "fairness loyalty trade-off" which involved athletes choosing to adhere to either fairness norms (which relate to a sense that all people and groups are treated equally) or loyalty norms (which reflect preferential treatment towards an in-group) when deciding whether they would blow the whistle. The promotion of fairness norms that emphasise a group's collective interests might encourage athletes to view whistleblowing as a means of increasing group cohesiveness and effectiveness and thereby increase the likelihood of this practice

Toxocariasis: a silent threat with a progressive public health impact

Background: Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide, especially in impoverished communities. This disease is caused by infection with the larvae of Toxocara canis and T. cati, the most ubiquitous intestinal nematode parasite in dogs and cats, respectively. In this article, recent advances in the epidemiology, clinical presentation, diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed. Main text: Over the past two decades, we have come far in our understanding of the biology and epidemiology of toxocariasis. However, lack of laboratory infrastructure in some countries, lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden. Toxocariasis encompasses four clinical forms: visceral, ocular, covert and neural. Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending. Fortunately, multiple diagnostic modalities are available, which if effectively used together with the administration of appropriate pharmacologic therapies, can minimize any unnecessary patient morbidity. Conclusions: Although progress has been made in the management of toxocariasis patients, there remains much work to be done. Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers, which may help in increasing diagnostic accuracy. Also, further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p&nbsp;&lt;.001. Over 24&nbsp;months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes