Chlamydia test-of-cure in pregnancy

Includes correction issued in August 2020 issue, page 554.Clinical Inquiries question: What is the optimal interval between treatment and test-of-cure (TOC) in pregnant women with Chlamydia trachomatis (CT)? Evidence-based answer: The optimal interval between treatment and TOC in pregnant women with CT is 3 to 4 weeks (strength of recommendation C: several small prospective and retrospective cohort studies; a high-quality nonsystematic review; and a consensus guideline). Testing before 3 weeks might give false-positive results, while waiting longer than 4 weeks might delay detecting new infections or result in treatment failure.Jessie Pettit, MD; Carol Howe, MD, MLS; Joshua Freeman, MDDr Freeman is Clinical Professor and Dr Pettit is Associate Professor in the Department of Family and Community Medicine at the University of Arizona in Tucson. Dr Howe is a librarian in the Health Sciences Library at the University of Arizona.Includes bibliographical reference

Strong Solar Storms and their Effects on Middle and Lower Stratospheric Ozone Concentrations

Solar Storms are a well-known disruptor of the upper atmosphere. Radio communication as well as the safety of space travelers and equipment is at the mercy of these storms. Despite this, little work has been done in showing what these storms due to lower levels in the atmosphere. In this paper I look at strong solar storms and see how they affect the ozone concentration at 50mb, 20mb, and 10mb levels. Using daily ozone data and satellite instrumentation for solar events, I looked at how ozone changes during and after these events. I found that solar flares have the largest impact with concentration changes as high as 80%. Solar wind events seemed to only have modest impacts followed by coronal mass ejections which appear to have little impact at all

Space Weather Effects On The Middle and Upper Atmosphere

Impulsive solar events (ISEs) have a pronounced impact on the middle and upper atmosphere. Solar flares emit copious amounts of x-ray and EUV radiation that can ionize the D, E, and F regions of the ionosphere. Coronal mass ejections and geomagnetic storms can cause energetic particle precipitation. This creates nitrogen oxides and hydrogen oxides, which catalytically destroy ozone. Most global climate models exclude both radiation from solar flares and particles from geomagnetic storms and as a result, does not capture the atmospheric effects from these events. The work presented here improves modeling of ISEs by including high-energy photons from solar flares and energetic electrons from geomagnetic storms in the Whole Atmosphere Community Climate Model (WACCM). This is necessary in order to simulate accurately chemistry changes during and after ISEs. We found significant impacts on the D and lower E-regions of the ionosphere from WACCM simulations of the September 2005 solar flares. Effects from the flares were confined to the dayside of Earth but persisted a few days below the thermosphere. Large increases in electron densities were found from the lower D-region through the top of the model (~140 km). Moderate production of odd nitrogen in the mesosphere and lower thermosphere occurred during the larger flare events of the time period. We showed that differences in flare spectrum had a distinct impact on the intensity, length and location of the effects. This investigation also targeted the influence of electron precipitation during the 2003 SH polar winter. Two different energetic electron data sets were included in simulations using the WACCM model with D-region chemistry. Both electron data sets contained electrons &gt;30 keV using the Medium Energy Proton and Electron Detector (MEPED), however only one uses both telescopes onboard MEPED. Both simulations that included electrons &gt;30 keV compared better with observations than the baseline simulation. The simulation that included both telescopes agreed better with observations than the other simulations. The results confirm that including both telescopes during geomagnetically active time periods leads to better agreement with observations in the precipitation effects, particularly at sub-polar latitudes.</p

The Pervasive Impact of Moral Judgment

A series of recent studies have shown that people’s moral judgments can affect their intuitions as to whether or not a behavior was performed intentionally. Prior attempts to explain this effect can be divided into two broad families. Some researchers suggest that the effect is due to some peculiar feature of the concept of intentional action in particular, while others suggest that the effect is a reflection of a more general tendency whereby moral judgments exert a pervasive influence on folk psychology. The present paper argues in favor of the latter hypothesis by showing that the very same effect that has been observed for intentionally also arises for deciding, in favor of, opposed to, and advocating

Venous Thromboembolism and D-dimer In Patients with COVID-19

Background and Hypothesis: The potential association between venous thromboembolism (VTE) and COVID-19 is an area of growing research, and methods of effective prophylaxis, detection, and treatment continue to be sought. D-dimer assays have been previously established as a highly sensitive — albeit nonspecific — test to assess patient risk of VTE, but the full clinical utility of this test in COVID-19 patients is currently not well understood. We hypothesized that, in patients presenting to the emergency department (ED) and determined to be positive for COVID-19, an elevated D-dimer value is associated with an increased 30-day incidence of VTE.  Project Methods: Deidentified patient encounter data was collected and analyzed from a multicenter registry of ED patients tested for SARS-CoV-2. We measured the frequency of a positive SARS-CoV-2 test and compared the incidence of VTE between SARS-CoV-2 positive and negative patients. We also compared average D-dimer values in SARS-CoV-2 positive patients with and without VTE.  Results: Of 6,445 patient encounters queried, 2,051 tested positive for SARS-CoV-2 (32%).  SARS-CoV-2 positive patients had a significantly higher incidence of VTE in the 30-day follow-up period compared to SARS-CoV-2 negative patients (3.2 vs. 1.6%, p= 0.0002). D-dimer values were available for 537 of these SARS-CoV-2 patients, with an average D-dimer of 1813.83 ng/mL. The average D-dimer in SARS-CoV-2 positive patients who did develop VTE tended to be higher than those who did not develop VTE (2969 ng/mL vs. 1822 ng/mL), although this difference was not statistically significant (p=0.34). The fitted areas for binomial receiver operating characteristic curves of D-dimer for detection of VTE in patients with and without SARS-CoV-2 were 0.628 and 0.829, respectively. Conclusion and Potential Impact: We found a positive SARS-CoV-2 test to be associated with a higher incidence of VTE. However, an elevated D-dimer continues to be nonspecific for VTE in SARS-CoV-2 positive patients, and performs more poorly in SARS-CoV-2 positive patients than in negative patients. Additional clinical criteria should be identified to further guide the use of diagnostic imaging modalities and prophylactic anticoagulation in COVID-19 positive patients with suspicion of VTE.

Adoption of Health Information Technology Among US Nursing Facilities

Objectives: Nursing facilities have lagged behind in the adoption interoperable health information technology (i.e. technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. Design: Cross-sectional survey. Setting & participants: We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. Measurements: Using questions adopted from existing instruments, the survey measured nursing home’s EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for eight determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results: 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39; 95%CI = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/Implications: An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policymakers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities

Using MEPED observations to infer plasma density and chorus intensity in the radiation belts

Efforts to model and predict energetic electron fluxes in the radiation belts are highly sensitive to local wave-particle interactions. In this study, we use multi-point measurements of precipitating and trapped electron fluxes to investigate the dynamic variation of chorus wave-particle interactions during the 17 March 2013 storm. Quasilinear theory characterizes the chorus wave-particle interaction as a diffusive process, with the diffusion coefficients depending on the particle energy and pitch angle, as well as the background plasma parameters such as the wave intensity and plasma density. These plasma parameters in the radiation belts are spatially localized and time-varying, so we construct event-specific diffusion coefficients using MEPED (onboard POES/MetOp) measurements of electron fluxes at low Earth orbit. This new method provides realistic diffusion coefficients for chorus waves that account for changes in the wave intensity, the plasma density, and the magnetic field strength in the outer radiation belt. We show that the inferred chorus intensity is significantly lower than previous estimates that use MEPED observations since the same amount of increased precipitation by 30–300 keV electrons can be explained by a change in the plasma density. This technique therefore allows for us to create time varying, global maps of the plasma-gyrofrequency ratio (fpe/fce), and therefore plasma density, in the outer radiation belts using the MEPED measurements. The global density estimates compare reasonably well to in situ density measurements from RBSP-B

Eclipsing Binary Trojan Asteroid Patroclus: Thermal Inertia from Spitzer Observations

We present mid-infrared (8-33 micron) observations of the binary L5-Trojan system (617) Patroclus-Menoetius before, during, and after two shadowing events, using the Infrared Spectrograph (IRS) on board the Spitzer Space Telescope.F or the first time, we effectively observe changes in asteroid surface temperature in real time, allowing the thermal inertia to be determined very directly. A new detailed binary thermophysical model is presented which accounts for the system's known mutual orbit, arbitrary component shapes, and thermal conduction in the presence of eclipses. We obtain two local thermal-inertia values, representative of the respective shadowed areas: 21+/14 MKS and 6.4+/-1.6 MKS. The average thermal inertia is estimated to be 20+/-15 MKS, potentially with significant surface heterogeneity. This first thermal-inertia measurement for a Trojan asteroid indicates a surface covered in fine regolith. The diameters of Patroclus and Menoetius are 106 +/- 11 and 98+/-10 km, respectively, in agreement with previous findings. Taken together with the system's known total mass, this implies a bulk mass density of 1.08 +/-0.33 g/cm3, significantly below the mass density of L4-Trojan asteroid (624) Hektor and suggesting a bulk composition dominated by water ice.Comment: in press to Icarus, 48 pages, 6 tables, 5 figure