Impact of updated clinical practice guidelines on outpatient treatment for Clostridioides difficile infection and associated clinical outcomes

BACKGROUND: The 2017 Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) METHODS: A pre-post study design was employed using Medicare data. CDI treatment utilization and clinical outcomes (4- and 8-week sustained response, CDI recurrence) were compared between patients indexed from April-September 2017 (preguideline period) and those indexed from April-September 2018 (postguideline period). Clinical outcomes associated with fidaxomicin versus vancomycin were compared using propensity score-matched analyses. RESULTS: From the pre- to postguideline period, metronidazole use decreased (initial CDI: 81.2% to 53.5%; recurrent CDI: 49.7% to 27.6%) while vancomycin (initial CDI: 17.9% to 44.9%; recurrent CDI: 48.1% to 66.4%) and fidaxomicin (initial CDI: 0.87% to 1.63%; recurrent CDI: 2.2% to 6.0%) use increased significantly ( CONCLUSIONS: Vancomycin use increased and metronidazole use decreased after the 2017 guideline update. Fidaxomicin use increased but remained low. Improved outcomes associated with fidaxomicin relative to vancomycin suggest benefits from its greater use in Medicare patients

Estimation of Intertidal Oyster Reef Density Using Spectral and Structural Characteristics Derived from Unoccupied Aircraft Systems and Structure from Motion Photogrammetry

Eastern oysters (Crassostrea virginica) are an important component of the ecology and economy in coastal zones. Through the long-term consolidation of densely clustered shells, oyster reefs generate three-dimensional and complex structures that yield a suite of ecosystem services, such as nursery habitat, stabilizing shorelines, regulating nutrients, and increasing biological diversity. The decline of global oyster habitat has been well documented and can be attributed to factors, such as overharvesting, pollution, and disease. Monitoring oyster reefs is necessary to evaluate persistence and track changes in habitat conditions but can be time and labor intensive. In this present study, spectral and structural metrics of intertidal oyster reefs derived from Unoccupied Aircraft Systems (UAS) and Structure from Motion (SfM) outputs are used to estimate intertidal oyster density. This workflow provides a remote, rapid, nondestructive, and potentially standardizable method to assess large-scale intertidal oyster reef density that will significantly improve management strategies to protect this important coastal resource from habitat degradation

Estimation of Intertidal Oyster Reef Density Using Spectral and Structural Characteristics Derived from Unoccupied Aircraft Systems and Structure from Motion Photogrammetry

Eastern oysters (Crassostrea virginica) are an important component of the ecology and economy in coastal zones. Through the long-term consolidation of densely clustered shells, oyster reefs generate three-dimensional and complex structures that yield a suite of ecosystem services, such as nursery habitat, stabilizing shorelines, regulating nutrients, and increasing biological diversity. The decline of global oyster habitat has been well documented and can be attributed to factors, such as overharvesting, pollution, and disease. Monitoring oyster reefs is necessary to evaluate persistence and track changes in habitat conditions but can be time and labor intensive. In this present study, spectral and structural metrics of intertidal oyster reefs derived from Unoccupied Aircraft Systems (UAS) and Structure from Motion (SfM) outputs are used to estimate intertidal oyster density. This workflow provides a remote, rapid, nondestructive, and potentially standardizable method to assess large-scale intertidal oyster reef density that will significantly improve management strategies to protect this important coastal resource from habitat degradation