Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study.

Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P \u3c .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P \u3c .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs

Analysis of Caesarean section rate in a government teaching institute based on Robson’s ten group classification

Background: Caesarean section rate is a qualitative health care indicator in India. With increasing rates of caesarean sections and no defined method to audit present institutes it is the need of the hour to use tools like Robson’s classification to understand present system. The aim of this study was to determine the rate and analyse Caesarean sections in a tertiary care institute using Robson’s ten group classification system.Methods: This is a retrospective analytical study in which all Caesarean section done over a period of 3 years (July 2014-June 2017) were included which were performed in single unit (out of 6) of Department of Obstetrics and Gynecology of Sassoon General Hospital. Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, authors calculated its relative size and its contribution to the overall caesarean rate.Results: Total deliveries were 4750 out of which 985 were Caesarean section, incidence was calculated as 20.7%. The main contributors to the overall Caesarean rate were primiparous women in spontaneous labour (group 1- {18.3%}) and women with previous caesarean section (group 5- {34.9%}).Conclusions: The Robson’s classification is an easy tool to use and identify the current changing dynamics in any hospital setup. Its implementation as an obstetric audit can help lower the Caesarean rates and improve the standards based on WHO criteria

Background-Limited Imaging in the Near-Infrared with Warm InGaAs Sensors: Applications for Time-Domain Astronomy

We describe test observations made with a customized 640 x 512 pixel Indium Gallium Arsenide (InGaAs) prototype astronomical camera on the 100" DuPont telescope. This is the first test of InGaAs as a cost-effective alternative to HgCdTe for research-grade astronomical observations. The camera exhibits an instrument background of 113 e-/sec/pixel (dark + thermal) at an operating temperature of -40C for the sensor, maintained by a simple thermo-electric cooler. The optical train and mechanical structure float at ambient temperature with no cold stop, in contrast to most IR instruments which must be cooled to mitigate thermal backgrounds. Measurements of the night sky using a reimager with plate scale of 0.4 arc seconds / pixel show that the sky flux in Y is comparable to the dark current. At J the sky brightness exceeds dark current by a factor of four, and hence dominates the noise budget. The sensor read noise of ~43e- falls below sky+dark noise for exposures of t>7 seconds in Y and 3.5 seconds in J. We present test observations of several selected science targets, including high-significance detections of a lensed Type Ia supernova, a type IIb supernova, and a z=6.3 quasar. Deeper images are obtained for two local galaxies monitored for IR transients, and a galaxy cluster at z=0.87. Finally, we observe a partial transit of the hot JupiterHATS34b, demonstrating the photometric stability required over several hours to detect a 1.2% transit depth at high significance. A tiling of available larger-format sensors would produce an IR survey instrument with significant cost savings relative to HgCdTe-based cameras, if one is willing to forego the K band. Such a camera would be sensitive for a week or more to isotropic emission from r-process kilonova ejecta similar to that observed in GW170817, over the full 190 Mpc horizon of Advanced LIGO's design sensitivity for neutron star mergers.Comment: 13 pages, 12 figures, submitted to A

From γ to Radio: The Electromagnetic Counterpart of GW170817

The gravitational waves from the first binary neutron star merger, GW170817, were accompanied by a multiwavelength electromagnetic counterpart, from γ-rays to radio. The accompanying γ-rays seem at first to confirm the association of mergers with short gamma-ray bursts (sGRBs). The common interpretation was that we see an emission from an sGRB jet seen off-axis. However, a closer examination of the subluminous γ-rays and the peculiar radio afterglow was inconsistent with this simple interpretation. Here we present results of 3D and 2D numerical simulations that follow the hydrodynamics and emission of the outflow from a neutron star merger, form its ejection and up to its deceleration by the circum-merger medium. Our results show that the current set of γ-rays, X-rays, and radio observations can be explained by the emission from a mildly relativistic cocoon material (Lorentz factor ~2–5) that was formed while a jet propagated through the material ejected during the merger. The γ-rays are generated when the cocoon breaks out from the engulfing ejecta, while the afterglow is produced by interaction of the cocoon matter with the interstellar medium. The strong early UV/optical signal may be a Lorentz-boosted macronova/kilonova. The fate of the jet itself is currently unknown, but our full-electromagnetic (EM) models define a path to resolving between successful and choked jet scenarios, outputting coupled predictions for the image size, morphology, observed time-dependent polarization, and light-curve behavior from radio to X-ray. The predictive power of these models will prove key in interpreting the ongoing multifaceted observations of this unprecedented event

Advanced cognitive impairment among older nursing home residents

BACKGROUND: Though work has been done studying nursing home (NH) residents with either advanced Alzheimer\u27s disease (AD) or Alzheimer\u27s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. METHODS: This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011-2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. RESULTS: Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p \u3c 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). CONCLUSIONS: There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care

Consideraciones taxonómicas sobre algunos taxones egipcios de Capparis y géneros relacionados (Capparaceae) a partir de RAPDs

Taxonomic considerations among and within some Egyptian taxa of Capparis and related genera (Capparaceae) as revealed by RAPD fingerprinting.- This investigation was carried out to assess the taxonomic relationships among eight taxa of the Egyptian members of Capparaceae based on random amplified polymorphic DNA markers, and to compare the results with those obtained from morphological studies. A total of 46 bands were scored for three RAPD primers corresponding to an average of 15.3 bands per primer. The three primers (A03, A07 and A09) revealed eight polymorphic RAPD markers among the studied taxa ranging in size from 200 bp to 1000 bp. Jaccard’s coefficient of similarity varied from 0.28 to 0.84, indicative of high level of genetic variation among the genotypes studied. UPGMA cluster analysis indicated three distinct clusters, one comprised Cleome amblyocarpa and Gynandropsis gynandra, while another included two clusters at 0.74 phenon line; one for Capparis decidua, and the other for Capparis sinaica and all varieties of Capparis spinosa. The four varieties of Capparis spinosa were segregated at 0.84 phenon line. However, one of these varieties was more closely related to Capparis sinaica than to the other three varieties of C. spinosa. The RAPD analysis reported here confirms previous studies based on morphological markers.Consideraciones taxonómicas sobre algunos taxones egipcios de Capparis y géneros relacionados (Capparaceae) a partir de RAPDs.- El objetivo de este trabajo es investigar las relaciones taxonómicas entre ocho taxones pertenecientes a las Capparaceae en base a marcadores de tipo RAPD, y comparar los resultados con los obtenidos previamente en estudios morfológicos. Se han contabilizado un total de 46 bandas para tres pares de cebadores, con una media de 15,3 bandas por cebador. Los tres pares de cebadores (A03, A07 y A09) revelan ocho marcadores polimórficos entre los taxones estudiados, de entre 200 y 1000 pares de bases. El coeficiente de similaridad de Jaccard varía entre 0,28 y 0,84, indicativo de un alto nivel de variación genética entre los genotipos estudiados. El análisis UPGMA muestra tres grupos distintos, el primero comprende Cleome amblyocarpa y Gynandropsis gynandra, mientras que el segundo incluye dos grupos a la altura del valor 0,74 del dendrograma: uno se corresponde con Capparis decidua, y el otro comprende Capparis sinaica y todas las variedades de Capparis spinosa. Las cuatro variedades de C. spinosa se segregan a la altura del valor 0,84 del dendrograma. Sin embargo, una de estas variedades está más relacionada con C. sinaica que con las otras variedades de C. spinosa. El análisis de RAPD confirma los resultados de estudios anteriores basados en caracteres morfológicos

Factors Associated with Diabetes Risk in South Texas College Students

South Texas has a high prevalence of diabetes and college students may be particularly at risk for developing diabetes. Early detection and prevention are crucial to reducing the prevalence of this disease. While increased BMI, sedentary activity and depression have been associated with diabetes progression in the general population, it has not been established whether these factors contribute to increased risk for developing diabetes in college students. PURPOSE: To assess diabetes risk and to determine whether depressive symptoms or physical activity patterns are associated with increased diabetes risk in college students. METHODS: 69 college students were assessed for diabetes risk using the Finnish Diabetes Risk Score (FINDRISC) questionnaire. Each subject also completed the International Physical Activity Questionnaire (IPAQ) long form which includes a sitting subscale, the Zung Self-Rated Depression Scale and had anthropometric measures taken. Relationships were determined using Pearson Product Movement correlation, α=0.05. RESULTS: 21.7% of students reported an elevated risk (FINDRISC score 7-11), and 4.3% of subjects had a moderate to high risk of developing diabetes (FINDRISC \u3e12). On average, the sample of students were overweight (BMI = 26.81±0.75 kg . m-2), and BMI was associated with diabetes risk (r = 0.626, p = 0.001). While diabetes risk was not correlated with the IPAQ total physical activity score (r = 0.019, p = 0.874), it had a modest correlation with time spent sitting (r = 0.295, p = 0.015). There was no association between self-reported depressive symptoms and diabetes risk (r =0.078, p = 0.525). CONCLUSION: A substantial number of college students in South Texas are at risk for developing diabetes. Although diabetes risk was not associated with total physical activity and depressive symptoms, it was associated with time spent sitting and BMI. This suggests that in this college-age population, sitting less and reducing weight may help lower the risk of developing diabetes

COVID‐19 Preparedness in Nursing Homes in the Midst of the Pandemic

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155887/1/jgs16520.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155887/2/jgs16520_am.pd

Behavioral mechanisms that mediate mental and physical health improvements in people with chronic pain who receive a digital health intervention: Prospective cohort pilot study

BACKGROUND: Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood. OBJECTIVE: The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health. METHODS: In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants\u27 engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale-Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P\u3c.20 was considered significant for this pilot study. RESULTS: Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect -0.4, 80% CI -0.7 to -0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well. CONCLUSIONS: In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722