Inpatient urine cultures are frequently performed without urinalysis or microscopy: Findings from a large academic medical center

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; &gt;7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460</jats:sec

Coiled phononic crystal with periodic rotational locking: subwavelength bragg band gaps

Phononic crystals (PnC) are spatially periodic materials with band gaps that form by Bragg scattering of elastic waves. Within the frequency range of a band gap, wave propagation is not admitted. A long-standing limitation of this class of materials is that the wavelength for band-gap formation must be on the order of the unit-cell size. This restricts the presence of band gaps to relatively high frequencies for a given lattice spacing. Locally resonant metamaterials, on the other hand, enable the opening of low-frequency, subwavelength band gaps through resonance hybridization. However, their band gaps are characteristically narrow and require large or massive local resonators to form. Here, we break both limitations using beam-based PnCs by (1) locking the rotation degree of freedom at the edges of the primitive unit cell, and (2) coiling the PnC by applying full beam-axis rotations at the locked locations. These respective kinematic and geometric transformations convert a conventional beam PnC from its extended form with a nominal lattice constant to an extremely compact coiled configuration with a greatly reduced lattice constant. With the periodic rotational locking, the band gaps remain intact and are still large, and in fact increase noticeably in size. With the subsequent coiling, the band gaps remain based on Bragg scattering and are quantitatively conserved except now appearing at lower frequencies as dictated by the ratio of the extended-to-coiled lattice constants. This ratio defines a coiling factor, which is a measure of the reduction in the PnC unit-cell length in the direction of wave transmission while maintaining the band structure of its original extended form except for the favorable changes induced by the periodic rotational locking. A coiling factor of ß lowers, by construction, the location of the normalized central frequency of any given band gap by a factor of ß . The only limitation is the need for lateral space to accommodate the coiling of the beam segments. The vibration behavior of a finite version of the coiled structure is experimentally tested demonstrating a matching band-gap response, despite the reduction in length, to that obtained by finite-element analysis of the extended rotationally locked version. This concept creates effectively subwavelength Bragg band gaps. It clears the path for PnCs to serve in applications that are orders-of-magnitude smaller in scale than are currently possible, while featuring band gaps that are significantly larger than those generated by locally resonant metamaterials.This research is funded by the Air Force Office of Scientific Research under grant number 20RXCOR058.Peer ReviewedPostprint (author's final draft

Traffic related noise and air quality valuations: evidence from stated preference residential choice models

This paper reports on research which has estimated valuations of changes in traffic related noise levels and air quality and which contributes to the body of knowledge and to methodology in this area. There are several novel aspects of this research. Firstly, there have been relatively few stated preference studies of the monetary valuations of traffic related noise and air quality. A feature of this analysis is the examination of variations in values according to the size and sign of the environmental change, the currently experienced level of the attribute and various socio-economic factors. Secondly, the important issue of presentation is addressed, with two different methods used in the valuation of air quality and links made between valuations and physical measures. Thirdly, the results from stated preference and the contingent valuation method are compared. Finally, we bring together evidence from other studies and compare them with the findings obtained here

International meta-analysis of stated preference studies of transportation noise nuisance

The final publication is available at Springer via http://dx.doi.org/10.1007/s11116-014-9527-4This paper reports the first meta-analysis and most extensive review of stated preference studies of transportation noise nuisance. The meta-analysis is based on a newly compiled data set of 258 values from 49 studies and 23 countries and spanning more than 40 years. Contrast this with the most extensive meta-analysis of the more conventional hedonic pricing approach which includes 53 noise valuations. Moreover, the sample compares favourably with the 444 observations from the very first meta-analysis of the value of travel time savings which is by far the most widely examined parameter in transport planning. A particularly significant finding of the study is that the intertemporal income elasticity is close to one, somewhat larger than the cross-sectional income elasticity typically obtained from individual studies. This demonstrates the importance of distinguishing the effects of 2 income variations that occur over time, which tend to drive policy, from variations across individuals at one point in time, and such findings are typical of those observed in other markets. Importantly, the values derived are transferable across countries and may be used to benchmark existing evidence and provide values in contexts where none exist. Other key results are that values for aircraft noise exceed those for other modes, whilst those exposed to higher noise levels and those who are highly annoyed also have higher values in line with expectations. A wide range of design effects were tested but few were significant and these included the consumer surplus measure, the representation of noise and the context

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Saliva microbiome in relation to SARS-CoV-2 infection in a prospective cohort of healthy US adultsResearch in context

Summary: Background: The clinical outcomes of SARS-CoV-2 infection vary in severity, potentially influenced by the resident human microbiota. There is limited consensus on conserved microbiome changes in response to SARS-CoV-2 infection, with many studies focusing on severely ill individuals. This study aimed to assess the variation in the upper respiratory tract microbiome using saliva specimens in a cohort of individuals with primarily mild to moderate disease. Methods: In early 2020, a cohort of 831 adults without known SARS-CoV-2 infection was followed over a six-month period to assess the occurrence and natural history of SARS-CoV-2 infection. From this cohort, 81 participants with a SARS-CoV-2 infection, along with 57 unexposed counterparts were selected with a total of 748 serial saliva samples were collected for analysis. Total bacterial abundance, composition, population structure, and gene function of the salivary microbiome were measured using 16S rRNA gene and shotgun metagenomic sequencing. Findings: The salivary microbiome remained stable in unexposed individuals over the six-month study period, as evidenced by all measured metrics. Similarly, participants with mild to moderate SARS-CoV-2 infection showed microbiome stability throughout and after their infection. However, there were significant reductions in microbiome diversity among SARS-CoV-2-positive participants with severe symptoms early after infection. Over time, the microbiome diversity in these participants showed signs of recovery. Interpretation: These findings demonstrate the resilience of the salivary microbiome in relation to SARS-CoV-2 infection. Mild to moderate infections did not significantly disrupt the stability of the salivary microbiome, suggesting its ability to maintain its composition and function. However, severe SARS-CoV-2 infection was associated with temporary reductions in microbiome diversity, indicating the limits of microbiome resilience in the face of severe infection. Funding: This project was supported in part by Danone North America and grants from the National Institutes of Health, United States

Nature-based tourism, resource dependence, and resilience of Arctic communities: framing complex issues in a changing environment

This is an original manuscript / preprint of an article published by Taylor & Francis in Journal of Sustainable Tourism on 16 May 2019, available online: http://www.tandfonline.com/ https://doi.org/10.1080/09669582.2019.1612905.Current research on tourism in the Arctic has focused largely on the extent, location, and type of tourism activities that occur in the region. Recently, challenges have been identified that the tourism industry is likely to face in the wake of global changes, including climate change. Related research, conducted within and outside of the Arctic, suggests that rural communities can become economically dependent on natural resource extraction (e.g. oil, gas, timber harvesting, and mining of minerals) and non-extractive resources (e.g. nature-based recreation and tourism), limiting diversification and potentially threatening resilience of rural communities. In the western USA, communities have become dependent on both extractive and non-extractive natural resource activities including nature-based tourism; however, it is less clear whether a similar situation is occurring in Arctic communities. In this article, we propose a framework and indicators to analyze the potential dependence of Arctic communities on nature-based tourism and the resilience of Arctic communities to potential boom–bust cycles of nature-based tourism. To do so, we examine the current state-of-knowledge about tourism and nature-based tourism in the Arctic through the lens of boom–bust dynamics and social-ecological systems