The effect of a nudge intervention on procalcitonin-guided antibiotic de-escalation in patients with respiratory infections 

Background: Evidence based procalcitonin algorithms recommend discontinuation of antibiotics at values < 0.25 ng/mL for lower respiratory tract infections. A retrospective study conducted at our academic center in 2021 demonstrated that treatment was continued despite a low PCT value in 80.4% of patients on antibiotics. We examined the impact of a nudge intervention on clinicians' decision to de-escalate antibiotics in patients with a low procalcitonin value. Methods: We conducted a pre-post intervention study on adult inpatients with a procalcitonin result < 0.25 ng/mL receiving antibiotics for LRTIs. We excluded patients on antibiotics for non-LRTIs, COPD exacerbation, or VAP/HAP, as well as immunosuppressed and ICU patients. In the intervention stage, we used a dynamic EPIC procalcitonin report to identify eligible patients and contacted 1st call providers via EPIC Secure Chat with a standardized message suggesting antibiotic de-escalation if clinically appropriate. Our primary endpoint was antibiotic duration and time from procalcitonin result to antibiotic de-escalation. Differences in mean times were compared using paired t-testing. Results: We conducted a nudge intervention on 48 patients between August-December 2023, and identified 48 patients between June-July 2023 to serve as a baseline comparison group. The mean antibiotic duration was 105.84 hours and 123.24 hours for the pre-intervention and intervention groups respectively (p=0.29). The time from procalcitonin result to antibiotic de-escalation was 105.85 hours and 108.15 hours for the pre-intervention and intervention groups respectively (p=0.87). In the intervention group, 25% of providers de-escalated antibiotics within 24 hours after nudge intervention. Conclusions: Nudge interventions did not influence clinician decision making regarding procalcitonin-guided antibiotic de-escalation, when evaluating mean antibiotic duration or time from procalcitonin result to antibiotic de-escalation. Despite high utilization of the procalcitonin assay at our institution, results rarely impact clinical decision-making. The utility of procalcitonin as a tool for antibiotic stewardship, absent more effective decision support, is questionable. Recommendations/Next Steps: Lack of improvement following a nudge implies that knowledge gaps do not explain discordance between testing and antibiotic prescribing. Future interventions could focus on guidance at the point-of-care through indication-based ordering protocols or other forms of restricted usage.&nbsp

Exploiting Image Collections for Recovering Photometric Properties

Abstract. We address the problem of jointly estimating the scene illumination, the radiometric camera calibration and the reflectance properties of an object using a set of images from a community photo collection. The highly ill-posed nature of this problem is circumvented by using appropriate representations of illumination, an empirical model for the nonlinear function that relates image irradiance with intensity values and additional assumptions on the surface reflectance properties. Using a 3D model recovered from an unstructured set of images, we estimate the coefficients that represent the illumination for each image using a frequency framework. For each image, we also compute the corresponding camera response function. Additionally, we calculate a simple model for the reflectance properties of the 3D model. A robust non-linear optimization is proposed exploiting the high sparsity present in the problem

A new co-learning method in spatial complex fuzzy inference systems for change detection from satellite images

The detection of spatial and temporal changes (or change detection) in remote sensing images is essential in any decision support system about natural phenomena such as extreme weather conditions, climate change, and floods. In this paper, a new method is proposed to determine the inference process parameters of boundary point, rule coefficient, defuzzification coefficient, and dependency coefficient and present a new FWADAM+ method to train that set of parameters simultaneously. The initial data are clustered simultaneously according to each data group. This result will be the basis for determining a suitable set of parameters by using the FWADAM+ concurrent training algorithm. Eventually, these results will be inherited in the following data groups to build other complex fuzzy rule systems in a shorter time while still ensuring the model’s efficiency. The weather imagery database of the United States Navy (US Navy) is used to evaluate and compare with some related methods using the root-mean-squared error (RMSE), R-squared (R2) measures, and the analysis of variance (ANOVA) model. The experimental results show that the proposed method is up to 30% better than the SeriesNet method, and the processing time is 10% less than that of the SeriesNet method. © 2022, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature

Unexpected synthesis and crystal structure of N-{2-[2-(2-acetylethenyl)phenoxy]ethyl}-N-ethenyl-4-methylbenzenesulfonamide

The title compound, C21H23NO4S, obtained by alkaline treatment of 1,5-bis(1-phenoxy)-3-azapentane at moderate heating, is a N-tosylated secondary vinylamine. An intramolecular S=O⋯H - C hydrogen bond generates a 13-membered ring. The benzalacetone moiety adopts a trans conformation with respect to the C=C double bond, which is slightly longer than usual due to the conjugation with a neighbouring acetyl group. Theoretical predictions of potential biological activities were performed, suggesting that the title compound can inhibit gluconate 2-dehydrogenase (85% probability), as well as to act as a mucomembranous protector (73%). © 2020

Applications of a 6.5T Superconducting Solenoidal Separator

A 6.5 Tesla superconducting gas-filled solenoid (SOLITAIRE) has been developed at the Heavy Ion Accelerator Facility at the ANU as a reaction product separator. Key features of the device allowing its application for precise measurement of heavy ion fusion cross sections are described. The physical separation of beam particles and the high efficiency (~80%) transport of heavy ion fusion products open up applications in nuclear structure physics, and in materials science. Finally, the developments to allow its application to providing beams of light radioactive isotopes (SOLEROO) are described

Applications of a 6.5T Superconducting Solenoidal Separator

A 6.5 Tesla superconducting gas-filled solenoid (SOLITAIRE) has been developed at the Heavy Ion Accelerator Facility at the ANU as a reaction product separator. Key features of the device allowing its application for precise measurement of heavy ion fusion cross sections are described. The physical separation of beam particles and the high efficiency (~80%) transport of heavy ion fusion products open up applications in nuclear structure physics, and in materials science. Finally, the developments to allow its application to providing beams of light radioactive isotopes (SOLEROO) are described