Pulmonary Nocardiosisin an ImmunocompetentHost

Introduction: • Nocardia is known to cause severe pulmonary or disseminated infection in immunocompromised patients, but can cause infection in immunocompetent patients. Providers should consider Nocardiosis in immunocompetent patients with prolonged and unexplained respiratory failure. • The preferred therapy for pulmonary Nocardiosis is a sulfa antibiotic for 3-6 months. Toxicity from prolonged use of alternative agents presents a therapeutic challenge in those with sulfa allergy. Case Report: • An 85 year-old woman with a history of paroxysmal atrial fibrillation and heart failure with preserved EF presented to her primary care provider with 1 week of cough and progressive dyspnea. Chest x-ray (CXR) was normal, and echocardiogram demonstrated known HFpEFwithout new abnormalities. • Two months later, she presented to the hospital with progressive dyspnea, chest tightness, and was found to be hypoxic. CXR on admission showed bilateral consolidations as well as mediastinal and hilar adenopathy. She was treated with ceftriaxone & azithromycin for presumed community-acquired pneumonia (CAP). • Due to treatment failure, a CT Chest was obtained and showed a mass-like consolidation in the right middle lobe; she was discharged with a several-week prednisone taper for treatment of presumed cryptogenic organizing pneumonia. • Two weeks later, she returned for worsening dyspnea, chest pressure, malaise, and hypoxia. She was again treated for CAP and discharged. • One month later, she was admitted for similar symptoms, and a CT-guided lung biopsy showed several small clusters of long Gram-positive bacteria consistent with Nocardia spp. Tissue culture was positive for Nocardia cyriacigeorgicacomplex. • The patient was offered a challenge of her sulfa allergy (reported as a rash), but refused. She was started on linezolid in anticipation of a 6 month course of therapy. • Her hospitalization was complicated by cardiac & renal dysfunction. Due to severely impaired quality of life, the patient elected for hospice care and died approximately 2 weeks after discharge. Discussion: • Nocardiosis most commonly presents as a pulmonary infection as inhalation is the primary route of exposure. • More than half of all reported Nocardiosis cases are associated with preexisting immunocompromise such as organ transplantation, AIDS, diabetes, chronic granulomatous disease and alcoholism. More recently published case reports depict Nocardia infections in immunocompetent patients with a prior history of lung disease, such as chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis, and bronchiectasis. • Our patient was neither immunocompromised, nor had a prior history of lung disease, though was an elderly person. Immunosenescenceis associated with decline in innate as well as T-cell immunity, which may have imparted risk to our patient. • The mainstay for treatment of Nocardia infections is trimethoprim-sulfamethoxazole (TMP-SMX). Alternative oral agents include minocycline, amoxicillin-clavulanate, and linezolid. • Had our patient not chosen the route of hospice care, close monitoring for linezolid toxicity would have been necessary with possible TMP-SMX re-challenge for long term therapy.https://digitalcommons.psjhealth.org/psv_internal/1007/thumbnail.jp

Battling the Stigma: HIV Screening in Resident Primary Care Clinic

INTRODUCTION: HIV affects ~1.2 million in the US, with 25% unaware of their statusand annual incidence of 50,000. Early detection and treatment reduces risk of AIDS-related deaths and transmission. Both the CDC and the US Preventative Service Task Force recommend routine HIV screening. The Providence Medical Group at St Vincent (PMG-STV) resident clinic has no routine screening protocol. • 24% (757/3139) of all clinic patients have ever been screened. • Of active clinic patients seen quarterly, 5% are offered screening with only 3% completing screening. We implemented and measured a clinic-wide HIV screening protocol leveraging existing clinic workflows. We aimed to increase screening of active clinic patients from 3% to 25% at one year. METHODS: Using a time-series design we measured quarterly rates of HIV screening tests ordered and resulted in active clinic patients, ages 18-65 and seen in office, during the study period. We utilized a pre-existing preventative healthcare workflow for routine cancer screening, influenza vaccines, etc. We introduced this workflow to residents and staff prior to our go-live date. RESULTS / DISCUSSION: Our primary outcome was to increase quarterly HIV screening rate of active patients, with a secondary outcome to increase overall clinic HIV screening rate. We increased the quarterly screening rate of active patients from 3.34% to 9.19% (Phttps://digitalcommons.psjhealth.org/psv_internal/1011/thumbnail.jp

The Aesthetics and Perception of Documentary Film: A mixed methods approach and Its implications for Artistic Research

The ongoing research project Gadgets, Phones and Drones at the Zurich University of the Arts investigates how innovations in camera technology have affected the visual aesthetics of documentary films since the 1990s. With specially produced variants of short films, historical paradigm shifts are being subjected to contemporary comparative analyses. Major aspects of the aesthetic change, as for instance the tendency towards a shallow depth of field, are linked to the concept of authenticity or perceived realism. The project’s use of interdisciplinary research is oriented towards artistic research, or more precisely, towards a practice-based approach and is combined with empirical audience experiments. The dialogue between qualitative and quantitative research, also known as mixed methods, has enabled surprising new insights. However, the comparability of quantitative methods risks narrowing down the aesthetic potential of the filmic products that are used to conduct the research. In order to maintain a discriminating discourse within the practice-based approach, it is therefore advantageous to extend the study’s framework beyond a quantitative and comparative research set-up and provide specific fields for artistic investigations

Muses

Utah State University\u27s music therapy students present a concert on Muses.https://digitalcommons.usu.edu/music_programs/1138/thumbnail.jp

Muses

Utah State University\u27s music therapy students present a concert on Muses.https://digitalcommons.usu.edu/music_programs/1138/thumbnail.jp

A multimodal high-value curriculum affects drivers of utilization and performance on the high-value care component of the internal medicine in-training exam

Background: Teaching the practice of high-value care (HVC) is an increasingly important function of graduate medical education but best practices and long-term outcomes remain unknown. Objective: Whether a multimodal curriculum designed to address specific drivers of low-value care would affect resident attitudes, skills, and performance of HVC as tested by the Internal Medicine In-Training Exam (ITE). Methods: In 2012, we performed a baseline needs assessment among internal medicine residents at a community program regarding drivers of healthcare utilization. We then created a multimodal curriculum with online interactive worksheets, lectures, and faculty buy-in to target specific skills, knowledge, and culture deficiencies. Perceived drivers of care and performance on the Internal Medicine ITE were assessed yearly through 2016. Results: Fourteen of 27 (52%) residents completed the initial needs assessment while the curriculum was eventually seen by at least 24 of 27 (89%). The ITE was taken by every resident every year. Long-term, 3-year follow-up demonstrated persistent improvement in many drivers of utilization (patient requests, reliance on subspecialists, defensive medicine, and academic curiosity) and improvement with sustained high performance on the high-value component of the ITE. Conclusion: A multimodal curriculum targeting specific drivers of low-value care can change culture and lead to sustained improvement in the practice of HVC

Digitized Reality: 4K & HFR

In der Diskussion über die technische Weiterentwicklung von Kino und Fernsehen kommt der Erhöhung der räumlichen und zeitlichen Auflösung ein wichtiger Stellenwert zu. Während 4K für’s Kino oder Ultra High Definition (UHD) für’s Fernsehen detailreichere Bilderlebnisse versprechen, garantieren höhere Bildraten (HFR) flüssigere Bewegungen und mehr Schärfe in der Bewegung. Die damit einhergehende neue Ästhetik der hyperscharfen Bilder stellt für Filmschaffende indes eine Herausforderung dar, denn das narrative Kino entfaltet seine Wirkung in vielen Fällen gerade nicht dadurch, dass es alles klar und deutlich zeigt. Die erhöhte Informationsdichte kann etwa dann zum Nachteil gereichen, wenn das Publikum von zu vielen Bilddetails abgelenkt wird und sich durch gesteigerte Wirklichkeitsnähe eine desillusionierende Wirkung einstellt. Im Forschungsprojekt 'Digitized Reality: 4K & HFR' wurden die neuen technischen Trends anhand von Kurzfilmen einem Praxistest unterzogen. Dabei wurden die Auswirkungen auf die Bildästhetik und den erzählerischen Kontext diskutiert. Die künstlerischen Fragen wurden teilweise durch empirische Methoden (Zuschauerexperimente mit Eyetracking) ergänzt. Die Präsentation umfasst die Projektion von 4K- und HFR-Kurzfilmen sowie Direktvergleiche von unterschiedlichen Bildraten. Zudem werden die Ergebnisse der Eyetracking-Studie und ein Experiment mit variabler Bildrate vorgestellt

The Cinematic Look and the Paradox of High Frame Rates

The onset of Hollywood films produced with high frame rates has raised many questions and controversial discussions among filmmakers and critics about the cinematic look and the potential of digital innovations. Cinema audiences all over the world are used to the standard frame rate of 24 frames per second (fps) and only few cinemas are able to project higher frame rates than 96 fps. An artistic research project was conducted to test the effects of high frame rates (HFR) on film perception. A short movie was shot in HFR (96 fps) and produced in three frame rates (24* / 48* / 96 fps, *frame rate conversions in postproduction) for a cinema experiment. 49 participants watched the film in all three frame rates while being measured with an eye tracking device (counterbalanced within subjects design). They filled out a questionnaire after each film version. The analysis of the results will give new insights about the perception of high frame rates compared to the standard frame rate. Open questions for future research projects on HFR will be discussed

Digitized reality: Effects of high frame rate on visual perception

The digital revolution changed film production and its aesthetics in many ways. Although motion is a defining feature of moving images, it is also one of their most problematic aspects because of blurred images or other signal processing artifacts. An artistic research project was conducted to test the effects of high frame rates (HFR) on visual perception. Typical camera movements were recorded in different frame rates (24 / 48 / 96 fps) to generate test sequences for a cinema experiment. 69 participants were measured with an SMI eye tracking device and a questionnaire in a within subjects design. The results show that the participants valued the higher image quality of HFR, but rated the standard frame rate as more realistic and indicated more presence. Moreover, HFR produced a higher number of fixations than the standard frame rate. Open questions for future research projects on HFR will be discussed

Digitized Reality: The Trouble with Motion

Although motion is a defining feature of moving images, it is also one of their most problematic aspects due to blurred or partially stuttering images (strobe effect) at the standard frame rate of 24 frames per second (fps). This research was conducted to test the aesthetic and perceptual consequences of higher frame rates in narrative films. In a first step, typical camera movements were recorded at different frame rates and shutter angles to compare assumptions about production aesthetics. Film sequences were then tested using questionnaires and eye-tracking measurements in a cinema experiment involving 69 participants. The results showed that while participants valued the enhanced image quality of higher frame rates, they rated the standard frame rate as more realistic. Movements recorded with higher frame rates seem slower. In general, high frame rates produced more perceptual exploration (e.g. higher number of fixations). Second, a complete short film was shot at 96 fps and finished in different versions (96 fps, 48 fps, 24 fps, and a variable frame rate). All frame rate conversions were carried out in postproduction. The version with a variable frame rate was produced to assess its aesthetic potential. Several presentations and subsequent discussions with film professionals, experts, and students revealed an initial preference for the “cinematic look” of the standard frame rate of 24 fps. Some film professionals believe that both staging and editing need to be adapted to higher frame rates. This paper discusses the aesthetic, perceptual, and artistic consequences of higher frame rates