Campus & alumni news

Boston University Medicine was published by the Boston University Medical Campus, and presented stories on events and topics of interest to members of the BU Medical Campus community. It followed the discontinued publication Centerscope as Boston University Medicine from 1991-2005, then continued as Campus and Alumni News from 2006-2013 before returning to the title Boston University Medicine from 2014-present

Observations of the influence of diurnal convection on upper ocean dissolved gas measurements

An important example of the interaction between biological productivity and near-surface oceanography is the role of nocturnal convection and diurnal restratification in modifying the environment in which photosynthetic activity takes place. In situ time series measurements of dissolved oxygen reveal the effects of photosynthetic activity, respiration and redistribution by mixing. Moored thermistor time series and frequent CTD casts show that restratification during the day is confined to a warmer shallow surface layer where most of the biological production is expected to occur. The depth and rate of mixing is measured with neutrally buoyant floats which track the vertical excursions of convecting water parcels. Early in the evening, at the onset of night time convection, this warm oxygenated water is mixed down and diluted by deeper less oxygenated water. The interpretation of oxygen time series at specified depths (here 21 m and 30 m) requires knowledge of this mixing process. Use is made of in situ dissolved nitrogen time series to infer that gas transfer at the surface is of secondary importance in determining the diurnal dissolved oxygen budget. A qualitative coupled biological/oceanographic model of the data is presented and discussed. It is concluded that a serious overestimate of daily oxygen production can result from excluding diurnal convection from the interpretation of oxygen time series

Oxygen variability in the near-surface waters of the northern North Atlantic: Observations and a model

As part of the World Ocean Circulation Experiment a major study was undertaken to determine the absolute circulation of the Subpolar North Atlantic using a large number of acoustically tracked isopycnal floats deployed on the 27.5 σ surface. Fifty floats were equipped with sensors to study dissolved oxygen from a Lagrangian perspective. In this paper we comment on very large variations in oxygen along trajectories of fluid parcels that outcrop in winter and resubduct the following spring. We employ a one-dimensional model to interpret these in terms of biophysical processes at and near the surface. In an attempt to understand the observed variability, we find that a modified form of the Price-Weller-Pinkel mixed layer model using NCEP-derived surface forcing accurately reproduces both the float-observed temperature and the meteorological-based sea-surface temperatures to within 1°C for an entire year, including the timing of the ventilation and restratification observed by the float. The model also employs satellite-derived observations to represent three processes of oxygen exchange: an air-sea gas flux dependent upon wind-driven turbulence, oxygen production in the mixed layer as a result from primary productivity, and oxygen consumption at depth as a result of net community respiration. The model accurately reproduces the observed ~3% supersaturation in the wintertime mixed layer, a level which is supported by the air-sea gas flux. We also find that later in the year, during springtime restratification, the model reproduces the observed decline from 105% to 92% oxygen saturation. The good agreement between observation and model depends upon a one-dimensional balance in the vertical, i.e.the absence of horizontal advective effects. For floats outcropping in an area of horizontal thermal contrast, conspicuous errors in the predicted vertical structure arise, most likely due to horizontal advection or displacement of the float by surface winds, effects which cannot be assessed without additional information. This limitation notwithstanding, the agreement between model and observation indicates the power of Lagrangian techniques for understanding how the properties of surface waters are set and later modified as they subduct into the interior of the ocean

Dean\u27s Panel: Coping with the Limited and Declining States’ Support for Higher Education and the Need to Maintain Quality and Accreditations

Panel\u27s goals are to provide a forum to discuss: •The necessary levels of funding for colleges to maintain quality to achieve and keep accreditation • The ways that colleges may be able to use available resources to increase productivity while maintaining quality in the face of declining public financial support for higher education • The ways student financial support can be increased given the annual increase in the levels of tuition and fees students are facin

Identifying barriers to healthcare as reported by rural and medically underserved patients in Oklahoma

OBJECTIVE: The Rural Patient Experience survey seeks to identify barriers to healthcare faced by patients in rural Oklahoma. Through the administration of a survey directly to patients, this study will analyze the current status of healthcare access, availability, and usage among rural Oklahoma populations. Results can be used to implement effective improvements in healthcare access tailored to specific patient-identified barriers.METHODS: Surveys will be distributed to individuals residing in rural communities and Health Professional Shortage Areas in the state of Oklahoma. The study involves patients of healthcare facilities in partnerships with Oklahoma State University's Center for Health System Innovation, and the facilities that agree to participate in the study will allow access to their patient panel. Patients residing in rural zip codes will be pooled into a randomly sampled population for survey distribution. Two-thirds (67%) of qualifying patients from each patient panel will be randomly selected to receive a survey in order to achieve a sample of adequate size.Responses will be analyzed using summary statistics, descriptive statistics, and significance testing.RESULTS & CONCLUSIONS: The development of the survey is being conducted and results are pending the distribution of the survey

Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women:A Cross-Sectional Study

Background: Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults. Methods: Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism. Results: Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women. Conclusions: Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing

Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study

OBJECTIVE: Optimism is modifiable and may be associated with healthy ageing. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults aged 70 years and older. METHODS: Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians, and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test – Revised (LOT-R). The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox Proportional Hazard models. RESULTS: 11,701 participants (mean age: 75.1 years, SD 4.24; 46.6% men) returned the ALSOP Social questionnaire and completed the LOT-R. During the median 4.7 years follow-up, 469 deaths occurred. The fully adjusted model was not significant (HR 0.78, 95% CI 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years) (HR 0.61, 95% CI 0.39-0.96). CONCLUSIONS: We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism appeared to be associated with lower risk among oldest old (adults aged 77 years and over)

Interventions to improve antibiotic prescribing practices for hospital inpatients

Background Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. Objectives To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. Selection criteria We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and no intervention. Data collection and analysis Two review authors extracted data and assessed study risk of bias. We performed meta-analysis and meta-regression of RCTs and meta-regression of ITS studies. We classified behaviour change functions for all interventions in the review, including those studies in the previously published versions. We analysed dichotomous data with a risk difference (RD). We assessed certainty of evidence with GRADE criteria. Main results This review includes 221 studies (58 RCTs, and 163 NRS). Most studies were from North America (96) or Europe (87). The remaining studies were from Asia (19), South America (8), Australia (8), and the East Asia (3). Although 62% of RCTs were at a high risk of bias, the results for the main review outcomes were similar when we restricted the analysis to studies at low risk of bias. More hospital inpatients were treated according to antibiotic prescribing policy with the intervention compared with no intervention based on 29 RCTs of predominantly enablement interventions (RD 15%, 95% confidence interval (CI) 14% to 16%; 23,394 participants; high-certainty evidence). This represents an increase from 43% to 58% .There were high levels of heterogeneity of effect size but the direction consistently favoured intervention. The duration of antibiotic treatment decreased by 1.95 days (95% CI 2.22 to 1.67; 14 RCTs; 3318 participants; high-certainty evidence) from 11.0 days. Information from non-randomised studies showed interventions to be associated with improvement in prescribing according to antibiotic policy in routine clinical practice, with 70% of interventions being hospital-wide compared with 31% for RCTs. The risk of death was similar between intervention and control groups (11% in both arms), indicating that antibiotic use can likely be reduced without adversely affecting mortality (RD 0%, 95% CI -1% to 0%; 28 RCTs; 15,827 participants; moderate-certainty evidence). Antibiotic stewardship interventions probably reduce length of stay by 1.12 days (95% CI 0.7 to 1.54 days; 15 RCTs; 3834 participants; moderate-certainty evidence). One RCT and six NRS raised concerns that restrictive interventions may lead to delay in treatment and negative professional culture because of breakdown in communication and trust between infection specialists and clinical teams (low-certainty evidence). Both enablement and restriction were independently associated with increased compliance with antibiotic policies, and enablement enhanced the effect of restrictive interventions (high-certainty evidence). Enabling interventions that included feedback were probably more effective than those that did not (moderate-certainty evidence). There was very low-certainty evidence about the effect of the interventions on reducing Clostridium difficile infections (median -48.6%, interquartile range -80.7% to -19.2%; 7 studies). This was also the case for resistant gram-negative bacteria (median -12.9%, interquartile range -35.3% to 25.2%; 11 studies) and resistant gram-positive bacteria (median -19.3%, interquartile range -50.1% to +23.1%; 9 studies). There was too much variance in microbial outcomes to reliably assess the effect of change in antibiotic use. Heterogeneity of intervention effect on prescribing outcomes We analysed effect modifiers in 29 RCTs and 91 ITS studies. Enablement and restriction were independently associated with a larger effect size (high-certainty evidence). Feedback was included in 4 (17%) of 23 RCTs and 20 (47%) of 43 ITS studies of enabling interventions and was associated with greater intervention effect. Enablement was included in 13 (45%) of 29 ITS studies with restrictive interventions and enhanced intervention effect. Authors' conclusions We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs