Readmissions with multidrug-resistant infection in patients with prior multidrug resistant infection

OBJECTIVETo determine incidence of and risk factors for readmissions with multidrug-resistant organism (MDRO) infections among patients with previous MDRO infection.DESIGNRetrospective cohort of patients admitted between January 1, 2006, and October 1, 2015.SETTINGBarnes-Jewish Hospital, a 1,250-bed academic tertiary referral center in St Louis, Missouri.METHODSWe identified patients with MDROs obtained from the bloodstream, bronchoalveolar lavage (BAL)/bronchial wash, or other sterile sites. Centers for Disease Control and prevention (CDC) and European CDC definitions of MDROs were utilized. All readmissions ≤1 year from discharge from the index MDRO hospitalization were evaluated for bloodstream, BAL/bronchial wash, or other sterile site cultures positive for the same or different MDROs.RESULTSIn total, 4,429 unique patients had a positive culture for an MDRO; 3,453 of these (78.0%) survived the index hospitalization. Moreover, 2,127 patients (61.6%) were readmitted ≥1 time within a year, for a total of 5,849 readmissions. Furthermore, 512 patients (24.1%) had the same or a different MDRO isolated from blood, BAL/bronchial wash, or another sterile site during a readmission. Bone marrow transplant, end-stage renal disease, lymphoma, methicillin-resistant Staphylococcus aureus, or carbapenem-resistant Pseudomonas aeruginosa during index hospitalization were factors associated with increased risk of having an MDRO isolated during a readmission. MDROs isolated during readmissions were in the same class of MDRO as the index hospitalization 9%–78% of the time, with variation by index pathogen.CONCLUSIONSReadmissions among patients with MDRO infections are frequent. Various patient and organism factors predispose to readmission. When readmitted patients had an MDRO, it was often a pathogen in the same class as that isolated during the index admission, with the exception of Acinetobacter (~9%).Infect Control Hosp Epidemiol 2018;39:12–19</jats:sec

Globular Clusters and Dwarf Spheroidal Galaxies

Traditionally globular clusters and dwarf spheroidal galaxies have been distinguished by using one or more of the following criteria: (1) mass, (2) luminosity, (3) size, (4) mass-to-light ratio and (5) spread in metallicity. However, a few recently discovered objects show some overlap between the domains in parameter space that are occupied by galaxies and clusters. In the present note it is shown that ellipticity can, in some cases, be used to help distinguish between globular clusters and dwarf spheroidal galaxies.Comment: MNRAS (Letters), in pres

Infectious diseases consultation reduces 30-day and 1-year all-cause mortality for multidrug-resistant organism infections

Abstract Background Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections. Methods This study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation. Results A total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae. Conclusions ID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections. </jats:sec

Association of mid-infrared solar plages with Calcium K line emissions and magnetic structures

Solar mid-IR observations in the 8-15 micrometer band continuum with moderate angular resolution (18 arcseconds) reveal the presence of bright structures surrounding sunspots. These plage-like features present good association with calcium CaII K1v plages and active region magnetograms. We describe a new optical setup with reflecting mirrors to produce solar images on the focal plane array of uncooled bolometers of a commercial camera preceded by germanium optics. First observations of a sunspot on September 11, 2006 show a mid-IR continuum plage exhibiting spatial distribution closely associated with CaII K1v line plage and magnetogram structures. The mid-IR continuum bright plage is about 140 K hotter than the neighboring photospheric regions, consistent with hot plasma confined by the magnetic spatial structures in and above the active regionComment: 5 pages, 4 figures. Accepted by PAS

Astrometric-spectroscopic determination of the absolute masses of the HgMn binary star Phi Herculis

The Mercury-Manganese star Phi Her is a well known spectroscopic binary that has been the subject of a recent study by Zavala et al. (2006), in which they resolved the companion using long-baseline interferometry. The total mass of the binary is now fairly well established, but the combination of the spectroscopy with the astrometry has not resulted in individual masses consistent with the spectral types of the components. The motion of the center of light of Phi Her was clearly detected by the Hipparcos satellite. Here we make use of the Hipparcos intermediate data (`abscissa residuals') and show that by combining them in an optimal fashion with the interferometry the individual masses can be obtained reliably using only astrometry. We re-examine and then incorporate existing radial-velocity measurements into the orbital solution, obtaining improved masses of 3.05 +/- 0.24 M_Sun and 1.614 +/- 0.066 M_Sun that are consistent with the theoretical mass-luminosity relation from recent stellar evolution models. These mass determinations provide important information for the understanding of the nature of this peculiar class of stars.Comment: Total of 18 pages including figures and tables, in emulateapj format. To appear in The Astronomical Journal, June 2007 issu

Noise sensitivity of sub- and supercritically bifurcating patterns with group velocities close to the convective-absolute instability

The influence of small additive noise on structure formation near a forwards and near an inverted bifurcation as described by a cubic and quintic Ginzburg Landau amplitude equation, respectively, is studied numerically for group velocities in the vicinity of the convective-absolute instability where the deterministic front dynamics would empty the system.Comment: 16 pages, 7 Postscript figure

A psychometric evaluation of the interRAI Child and Youth Mental Health instruments (ChYMH) anxiety scale in children with and without developmental disabilities

Background: With 10 to 20% of Canadian children suffering with mental illness, the importance of early identification and accurate assessment systems is clear. Unfortunately, many do not receive the mental health treatment necessary and wait-times for assessment can span up to a year. In response, the interRAI suite of assessments were designed to comprehensively assess early signs of mental health impairments in children from birth to 18 years. Methods: This study assesses the psychometric properties of the Anxiety Scale and addresses the identification of anxiety within children diagnosed with intellectual and developmental disabilities (IDD); a commonly underrepresented sample in mental health psychometric studies. Data was collected from children aged 4-18 years in three different samples. Results: Results indicated reliable internal consistency and factor structure, as well as moderate-to-strong convergent validity. Conclusions: We conclude that the Anxiety Scale exhibits psychometric qualities which demonstrate its clinical utility for use within a child sample, as well as in children with IDD. The findings provide support to a larger body of research which show consistent psychometric rigour of the interRAI measures

The laboratory telerobotic manipulator program

New opportunities for the application of telerobotic systems to enhance human intelligence and dexterity in the hazardous environment of space are presented by the NASA Space Station Program. Because of the need for significant increases in extravehicular activity and the potential increase in hazards associated with space programs, emphasis is being heightened on telerobotic systems research and development. The Laboratory Telerobotic Manipulator (LTM) program is performed to develop and demonstrate ground-based telerobotic manipulator system hardware for research and demonstrations aimed at future NASA applications. The LTM incorporates traction drives, modularity, redundant kinematics, and state-of-the-art hierarchical control techniques to form a basis for merging the diverse technological domains of robust, high-dexterity teleoperations and autonomous robotic operation into common hardware to further NASA's research