Prevalence and predictors of postdischarge antibiotic use following mastectomy

OBJECTIVESurvey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.DESIGNRetrospective cohort.PATIENTSCommercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.METHODSPredictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.RESULTSOverall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P&lt;.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (bothP&gt;.05).CONCLUSIONSProphylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.Infect Control Hosp Epidemiol2017;38:1048–1054</jats:sec

Peer Instruction observed in the wild

\u27Flipped\u27 or \u27inverted classroom\u27 approaches have been shown to enhance the effectiveness of teaching contact time. We have adopted this pedagogy in our introductory physics classes, in which we teach a mixed cohort of around 300 major and non-major students at a large, research-intensive university. A crucial element of class activity is the Peer Instruction methodology, in which students discuss and defend their conceptions of topics, with levels of student understanding gauged using clicker questions. We have studied student behavior during these Peer Instruction sessions using \u27smart pen\u27 technology, which allows us to match audio-recorded student conversations and pen strokes with their clicker votes in an unobtrusive way. We find that the large majority of student conversations result in students settling on the correct answer to the post-discussion clicker questions, and that the success of these conversations does not depend on the technical fluency of the students\u27 vocabulary. The smart pen recordings also allow us to assess any problems or ambiguities in the clicker questions themselves, thus affording the opportunity for informed revision of pathological clicker questions. Over two iterations of the class we have successfully modified a number of clicker questions in light of this feedback and find them to have correspondingly increased learning gains. Thus, this authentically-situated \u27in the wild\u27 study of student behavior has benefits both in terms of increased theoretical understanding of the instructional approach and also in direct refinement of the classroom resources, i.e. more learning with less confusion

Fast track children's hearing pilot: final report of the evaluation of the pilot

This report presents key findings of the evaluation of the Fast Track children’s hearings pilot in Scotland1. The research was undertaken by staff at the Universities of Glasgow, Stirling and Strathclyde between February 2003 and January 2005

Chandra Observations of the Crab-like Supernova Remnant G21.5-0.9

Chandra observations of the Crab-like supernova remnant G21.5-0.9 reveal a compact central core and spectral variations indicative of synchrotron burn-off of higher energy electrons in the inner nebula. The central core is slightly extended, perhaps indicating the presence of an inner wind-shock nebula surrounding the pulsar. No pulsations are observed from the central region, yielding an upper limit of ~40% for the pulsed fraction. A faint outer shell may be the first evidence of the expanding ejecta and blast wave formed in the initial explosion, indicating a composite nature for G21.5-0.9.Comment: 4 pages, 2 figures, formatted with emulateapj, submitted to ApJ

Electron-deuteron scattering in the equal-time formalism: beyond the impulse approximation

Using a three-dimensional formalism that includes relativistic kinematics, the effects of negative-energy states, approximate boosts of the two-body system, and current conservation, we calculate the electromagnetic form factors of the deuteron up to Q^2 of 4 GeV^2. This is done using a dynamical boost for two-body systems with spin. We first compute form factors in impulse approxmation, but then also add an isoscalar meson-exchange current of pion range that involves the gamma-pi contact operator associated with pseudovector pi-N coupling. We also consider effects of the rho-pi-gamma meson-exchange current. The experimentally measured quantities A, B, and t20 are calculated over the kinematic range probed in recent Jefferson Laboratory experiments. The rho-pi-gamma meson-exchange current provides significant strength in A at large Q^2 and the gamma-pi contact-term exchange current shifts t20, providing good agreement with the JLab data. Relativistic effects and the gamma-pi meson-exchange current do not provide an explanation of the B observable, but the rho-pi-gamma current could help to provide agreement if a nonstandard value is used for the tensor rho-N coupling that enters this contribution.Comment: 15 pages, 10 figures. (v2) Added references on rho-pi-gamma current as well as comparison to recent Novosibirsk data on T20. Implemented \includegraphics in place of \BoxedEPSF. (v3) Modified in order to clarify the nature of the boost we implemented for particles with spin. Other minor changes. Version to be published in Physical Review

Technologies for Future High Capability Micro-Milsatcom Systems

Satellite communications systems are a vitally important component of our Defense infrastructure for both tactical and strategic missions. In particular, satellite communications (whether military or commercial) have become increasingly important to support tactical operations, as was clearly demonstrated during Operations Desert Shield and Desert Storm. In the emerging doctrinal shift to a CONUS-based force structure with capabilities for rapidly responsive lethal power projection to meet global crises, the vital necessity for SATCOM to provide an omnipresent communications infrastructure for immediate support of the developing theater will become a key element in the successful realization of our new warfighting strategy. This infrastructure must provide RF bandwidth on demand and access to ATM switches and B-ISDN or SONET services as required from any worldwide location for any type of terminal. DARPA is developing the enabling technologies to give future systems the ability to realize their potential for becoming more affordable, more capable and more accessible by a theater commander. Advanced technologies are facilitating microminiaturization of key subsystems for communications satellite payloads, their host satellite buses, terminals and interfaces with terrestrial systems. These technologies can enhance the capability density of large spacecraft, as well as facilitate small, highly capable space and terrestrial assets, which can be labeled microMILSATCOM systems

Coarse-graining microscopic strains in a harmonic, two-dimensional solid and its implications for elasticity: non-local susceptibilities and non-affine noise

In soft matter systems the local displacement field can be accessed directly by video microscopy enabling one to compute local strain fields and hence the elastic moduli using a coarse-graining procedure. We study this process for a simple triangular lattice of particles connected by harmonic springs in two-dimensions. Coarse-graining local strains obtained from particle configurations in a Monte Carlo simulation generates non-trivial, non-local strain correlations (susceptibilities), which may be understood within a generalized, Landau type elastic Hamiltonian containing up to quartic terms in strain gradients (K. Franzrahe et al., Phys. Rev. E 78, 026106 (2008)). In order to demonstrate the versatility of the analysis of these correlations and to make our calculations directly relevant for experiments on colloidal solids, we systematically study various parameters such as the choice of statistical ensemble, presence of external pressure and boundary conditions. We show that special care needs to be taken for an accurate application of our results to actual experiments, where the analyzed area is embedded within a larger system, to which it is mechanically coupled. Apart from the smooth, affine strain fields, the coarse-graining procedure also gives rise to a noise field made up of non-affine displacements. Several properties of this noise field may be rationalized for the harmonic solid using a simple "cell model" calculation. Furthermore the scaling behavior of the probability distribution of the noise field is studied and a master curve is obtained.Comment: 16 pages, 12 figure