Process analysis of procalcitonin monitoring within community hospitals

2020 ◽  
Vol 77 (8) ◽  
pp. 632-635
Author(s):  
Kelsey Peña ◽  
Mandelin Cooper ◽  
Nickie Greer ◽  
Ty Elders ◽  
Edward Septimus
Keyword(s):  
United States ◽  
Antibiotic Therapy ◽  
Small Proportion ◽  
Process Analysis ◽  
The United States ◽  
Data Sets ◽  
Community Hospitals ◽  
Current State ◽  
Multiple Levels ◽  
Peak Value

Abstract Purpose Monitoring of procalcitonin (PCT) levels may support appropriate antibiotic discontinuation. The purpose of this study was to determine the current state of PCT monitoring at community hospitals across the United States. Methods Data from adult patients who were admitted to community hospitals affiliated with a large healthcare system between August 1, 2016, and July 31, 2017, and who received antibiotics were evaluated for the number of PCT levels drawn and the timing between multiple levels. Data from eligible patients were evaluated for the discontinuation of antibiotics after meeting prespecified PCT thresholds for discontinuation of therapy, namely, a PCT measurement of <0.5 μg/L or a decrease of ≥80% from a previous peak value. Results PCT levels were evaluated for 103,913 patient data sets collected from 136 hospitals. Of these, 70% of the data sets showed a single PCT level drawn, and approximately 30% (30,887) of the data sets showed multiple levels drawn. The first PCT measurement was drawn within 36 hours of antibiotic initiation in 96% of the patients. Of those with multiple levels, 23% (7,089) had levels drawn 24 to 72 hours apart. A small proportion (20% [6,127]) of the patients with multiple levels were eligible for evaluation of appropriate antibiotic discontinuation. Of these, 1,973 (32.2%) patients had antibiotics discontinued within 36 hours of meeting the prespecified PCT thresholds; these patients had a mean duration of antibiotic therapy of 6.1 days with a median of 4.7. Conclusion Additional standardization of ongoing PCT monitoring and education regarding the appropriate discontinuation of antibiotics when thresholds are reached could aid in the use of this biomarker in support of antibiotic and laboratory stewardship.

Community Hospital Disaster Preparedness in the United States

2018 ◽  
Vol 1 (2) ◽  
pp. 1-22
Author(s):  
Dan J. Vick ◽  
Asa B. Wilson ◽  
Michael Fisher ◽  
Carrie Roseamelia
Keyword(s):  
United States ◽  
Disaster Preparedness ◽  
Community Hospital ◽  
Critical Role ◽  
The United States ◽  
State Governments ◽  
Review Of The Literature ◽  
Community Hospitals ◽  
Current State ◽  
Hospital Disaster Preparedness

Disasters are common events in the United States. They generally result in casualties and community hospitals play a critical role in caring for these victims. Therefore, it is critical that hospitals are prepared for disasters. There has been increased focus on hospital disaster preparedness in the United States because of events that have occurred in the 21st century. To determine the current state of disaster preparedness among community hospitals, a comprehensive review of the literature was conducted that focused on studies and other articles pertaining to disaster preparedness in U.S. community hospitals. The review showed mixed results as to whether hospitals are better prepared to handle disasters. Barriers to preparedness were identified. Opportunities for improvement may require additional study and involvement by federal and state governments, other agencies, and hospitals themselves to overcome barriers and assist hospitals in achieving a higher level of preparedness.

scholarly journals Challenges for Monitoring the Extent and Land Use/Cover Changes in Monarch Butterflies’ Migratory Habitat across the United States and Mexico

Land ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. 156
Author(s):  
Rafael Moreno-Sanchez ◽  
James Raines ◽  
Jay Diffendorfer ◽  
Mark Drummond ◽  
Jessica Manko
Keyword(s):  
United States ◽  
Land Use ◽  
Habitat Quality ◽  
Danaus Plexippus ◽  
The United States ◽  
Digital Data ◽  
Data Sets ◽  
Data Set ◽  
Lulc Changes ◽  
Current State

This paper presents a synopsis of the challenges and limitations presented by existing and emerging land use/land cover (LULC) digital data sets when used to analyze the extent, habitat quality, and LULC changes of the monarch (Danaus plexippus) migratory habitat across the United States of America (US) and Mexico. First, the characteristics, state of the knowledge, and issues related to this habitat are presented. Then, the characteristics of the existing and emerging LULC digital data sets with global or cross-border coverage are listed, followed by the data sets that cover only the US or Mexico. Later, we discuss the challenges for determining the extent, habitat quality, and LULC changes in the monarchs’ migratory habitat when using these LULC data sets in conjunction with the current state of the knowledge of the monarchs’ ecology, behavior, and foraging/roosting plants used during their migration. We point to approaches to address some of these challenges, which can be categorized into: (a) LULC data set characteristics and availability; (b) availability of ancillary land management information; (c) ability to construct accurate forage suitability indices for their migration habitat; and (d) level of knowledge of the ecological and behavioral patterns of the monarchs during their journey.

scholarly journals Is There Really ‘Another’ Counterexample to the Secularization Thesis? Religious Dynamics in Italy Between 1910 and 2013

2021 ◽  
Author(s):  
Ettore Scappini
Keyword(s):  
United States ◽  
Western Country ◽  
Religious Practice ◽  
The United States ◽  
Data Sets ◽  
Current State ◽  
Regular Manner ◽  
The Many ◽  
Time Use Surveys

Abstract Background Among the modern Western countries where the issue of religiosity has been studied, the United States and Italy offer the only examples of empirically verified periods when religious practice was consolidated or even revived to some extent. A recent study, however, shows that the nature of religious exceptionalism in the United States does not constitute a real counterexample. This leaves Italy as the only country that might provide evidence of the falseness of the assumption that the secularization process is inescapable. Purpose This study seeks to enhance our knowledge about the case of Italy, where the many surveys conducted over the years have produced a wide variety of often divergent results, prompting a fervent debate among scholars. Several authors argue that the level of participation remained almost constant from 1980 to 1990. Others, on the contrary, claim that the level of participation increased between 1980 and 2000. This paper contributes to this path of study, aiming to shed light on the development of religiosity in Italy between 1910 and 2013. Methods Different data sets—time use surveys, ‘stylized surveys’, direct surveys and other kind of data—and an innovative method will be used to develop the reasoning and trace the trend of secularization. Results As will be shown, there are discontinuities in the pattern of religious practice over time. These fractures were due to attrition caused in turn by factors related to economic phenomena like migration and political/ideological subcultures, which temporarily changed the level of religious practice and, at least for a time, counterbalanced the long-term trend away from religious practice. Conclusions and Implications The trends presented suggest that secularization in Italy developed without any discontinuity, leading to confirmation that modernization and religious action ‘counteracted’ each other in an extremely regular manner. Therefore, according to the current state of knowledge, no documented modern Western country constitutes a counterexample to the secularization thesis. It can thus be claimed that modernization and secularization are inextricably linked processes.

Community Hospital Disaster Preparedness in the United States

2020 ◽  
pp. 429-453
Author(s):  
Dan J. Vick ◽  
Asa B. Wilson ◽  
Michael Fisher ◽  
Carrie Roseamelia
Keyword(s):  
United States ◽  
Disaster Preparedness ◽  
Critical Role ◽  
The United States ◽  
State Governments ◽  
Review Of The Literature ◽  
Community Hospitals ◽  
Comprehensive Review ◽  
Current State ◽  
Hospital Disaster Preparedness

Disasters are common events in the United States. They generally result in casualties and community hospitals play a critical role in caring for these victims. Therefore, it is critical that hospitals are prepared for disasters. There has been increased focus on hospital disaster preparedness in the United States because of events that have occurred in the 21st century. To determine the current state of disaster preparedness among community hospitals, a comprehensive review of the literature was conducted that focused on studies and other articles pertaining to disaster preparedness in U.S. community hospitals. The review showed mixed results as to whether hospitals are better prepared to handle disasters. Barriers to preparedness were identified. Opportunities for improvement may require additional study and involvement by federal and state governments, other agencies, and hospitals themselves to overcome barriers and assist hospitals in achieving a higher level of preparedness.

Asian Americans and Pacific Islanders: Employment Issues in the United States

2011 ◽  
Vol 9 (1-2) ◽  
pp. 58-69
Author(s):  
Marlene Kim
Keyword(s):  
United States ◽  
Asian Americans ◽  
The United States ◽  
Current Data ◽  
Pacific Islanders ◽  
Native Hawaiians ◽  
Data Sets ◽  
High Poverty ◽  
Unemployment Rates

Asian Americans and Pacific Islanders (AAPIs) in the United States face problems of discrimination, the glass ceiling, and very high long-term unemployment rates. As a diverse population, although some Asian Americans are more successful than average, others, like those from Southeast Asia and Native Hawaiians and Pacific Islanders (NHPIs), work in low-paying jobs and suffer from high poverty rates, high unemployment rates, and low earnings. Collecting more detailed and additional data from employers, oversampling AAPIs in current data sets, making administrative data available to researchers, providing more resources for research on AAPIs, and enforcing nondiscrimination laws and affirmative action mandates would assist this population.

scholarly journals Ice-Breaking Fleets of the United States and Canada: Assessing the Current State of Affairs and Future Plans

2021 ◽  
Vol 13 (2) ◽  
pp. 703
Author(s):  
Megan Drewniak ◽  
Dimitrios Dalaklis ◽  
Anastasia Christodoulou ◽  
Rebecca Sheehan
Keyword(s):  
United States ◽  
The United States ◽  
Maritime Transportation ◽  
The Arctic ◽  
Polar Ice ◽  
Northwest Passage ◽  
Ice Cap ◽  
Ice Coverage ◽  
Current State ◽  
State Of Affairs

In recent years, a continuous decline of ice-coverage in the Arctic has been recorded, but these high latitudes are still dominated by earth’s polar ice cap. Therefore, safe and sustainable shipping operations in this still frozen region have as a precondition the availability of ice-breaking support. The analysis in hand provides an assessment of the United States’ and Canada’s polar ice-breaking program with the purpose of examining to what extent these countries’ relevant resources are able to meet the facilitated growth of industrial interests in the High North. This assessment will specifically focus on the maritime transportation sector along the Northwest Passage and consists of four main sections. The first provides a very brief description of the main Arctic passages. The second section specifically explores the current situation of the Northwest Passage, including the relevant navigational challenges, lack of infrastructure, available routes that may be used for transit, potential choke points, and current state of vessel activity along these routes. The third one examines the economic viability of the Northwest Passage compared to that of the Panama Canal; the fourth and final section is investigating the current and future capabilities of the United States’ and Canada’s ice-breaking fleet. Unfortunately, both countries were found to be lacking the necessary assets with ice-breaking capabilities and will need to accelerate their efforts in order to effectively respond to the growing needs of the Arctic. The total number of available ice-breaking assets is impacting negatively the level of support by the marine transportation system of both the United States and Canada; these two countries are facing the possibility to be unable to effectively meet the expected future needs because of the lengthy acquisition and production process required for new ice-breaking fleets.

Biosurveillance: A Modern Look

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
James Lee Brooks
Keyword(s):  
United States ◽  
Homeland Security ◽  
The United States ◽  
First Century ◽  
Direct Result ◽  
Current State ◽  
Twenty First Century ◽  
Security Operations

AbstractThe early part of the twenty-first century saw a revolution in the field of Homeland Security. The 9/11 attacks, shortly followed thereafter by the Anthrax Attacks, served as a wakeup call to the United States and showed the inadequacy of the current state of the nation’s Homeland Security operations. Biodefense, and as a direct result Biosurveillance, changed dramatically after these tragedies, planting the seeds of fear in the minds of Americans. They were shown that not only could the United States be attacked at any time, but the weapon could be an invisible disease-causing agent.

scholarly journals The United States’ Regulatory Environment Is Evolving to Accommodate a Coming Boom in Gene Therapy Research

2019 ◽  
Vol 24 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Daniel Eisenman
Keyword(s):  
United States ◽  
Gene Therapy ◽  
Clinical Trials ◽  
The United States ◽  
Regulatory Environment ◽  
Evidence Based ◽  
Regulatory Structure ◽  
Regulatory Changes ◽  
Current State ◽  
Therapy Field

Introduction: A dramatic increase in the number of clinical trials involving gene-modified cell therapy and gene therapy is taking place. The field is on the verge of a boom, and the regulatory environment is evolving to accommodate the growth. Discussion: This commentary summarizes the current state of the field, including an overview of the growth. The United States (US) regulatory structure for gene therapy will be summarized, and the evolution of the oversight structure will be explained. Conclusion: The gene therapy field has recently produced its first FDA-approved therapeutics and has a pipeline of other investigational products in the final stages of clinical trials before they can be evaluated by the FDA as safe and effective therapeutics. As research continues to evolve, so must the oversight structure. Biosafety professionals and IBCs have always played key roles in contributing to the safe, evidence-based advancement of gene therapy research. With the recent regulatory changes and current surge in gene therapy research, the importance of those roles has increased dramatically.

Family Visitation in the PACU: The Current State of Practice in the United States

2009 ◽  
Vol 24 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Kathleen DeLeskey
Keyword(s):  
United States ◽  
The United States ◽  
Current State ◽  
State Of Practice

scholarly journals Human Coinfection withBorrelia burgdorferiandBabesia microtiin the United States

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Kristen L. Knapp ◽  
Nancy A. Rice
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Causative Agent ◽  
Ixodes Scapularis ◽  
Immunological Response ◽  
The United States ◽  
Babesia Microti ◽  
Current State ◽  
Tick Borne Disease ◽  
Multiple Pathogens

Borrelia burgdorferi, the causative agent of Lyme disease, andBabesia microti, a causative agent of babesiosis, are increasingly implicated in the growing tick-borne disease burden in the northeastern United States. These pathogens are transmitted via the bite of an infected tick vector,Ixodes scapularis, which is capable of harboring and inoculating a host with multiple pathogens simultaneously. Clinical presentation of the diseases is heterogeneous and ranges from mild flu-like symptoms to near-fatal cardiac arrhythmias. While the reason for the variability is not known, the possibility exists that concomitant infection with bothB. burgdorferiandB. microtimay synergistically increase disease severity. In an effort to clarify the current state of understanding regarding coinfection withB. burgdorferiandB. microti, in this review, we discuss the geographical distribution and pathogenesis of Lyme disease and babesiosis in the United States, the immunological response of humans toB. burgdorferiorB. microtiinfection, the existing knowledge regarding coinfection disease pathology, and critical factors that have led to ambiguity in the literature regarding coinfection, in order to eliminate confusion in future experimental design and investigation.

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