scholarly journals 89. Positive Blood Culture Trends and Variability among U.S. Hospitals, 2012-2017

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Natalie McCarthy ◽  
Kelly M Hatfield ◽  
James Baggs ◽  
Sophia Kazakova ◽  
Hannah Wolford ◽  
...  
Keyword(s):  
Blood Culture ◽  
Time Trends ◽  
Temporal Trend ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Hospital Level ◽  
Healthcare Database ◽  
Facility Level ◽  
Collection Practices ◽  
Over Time

Abstract Background Although studies have shown blood culture rates have remained stable in recent years, understanding the variability in positivity over time and among hospitals may inform diagnostic and antimicrobial stewardship efforts. Methods We included all discharges from hospitals participating in the Premier Healthcare Database and Cerner Health Facts from 2012-2017 in months where a hospital reported at least one blood culture with antimicrobial susceptibility results. A blood culture episode was defined as one or more cultures drawn within 1 hour. Episodes on or before day 3 were defined as admission episodes (AE), and those drawn on day 4 or later were defined as post-admission episodes (PAE). Culture episodes yielding any organism were categorized as pathogen+ (i.e., at least 1 non-commensal organism identified) or commensal (i.e., only commensal organisms identified). Positive or commensal episode rates were calculated as the percentage of pathogen+ or commensal episodes among all blood culture episodes for AE and PAE. Logistic regression with generalized estimating equation models accounting for hospital-level clustering were used to measure time trends and facility level associations. Results Among 19.6 million discharges in 493 hospitals, 7.5 million blood culture episodes were identified; 336,102 (4.5%) were pathogen+, and 110,236 (1.5%) were commensals. The rate of pathogen+ AEs increased from 4.2% to 4.7% over the study period (p< .0001) and there was no significant temporal trend in the rate of pathogen+ PAEs (p=.7956) (Figure 1). AE commensals decreased significantly in 2016-2017 compared to previous years (1.6% in 2012 to 1.3% in 2017; p=.0092), and PAE commensals decreased significantly over the study period from 2.0% to 1.2% (p< .0001) (Figure 1). We observed substantial inter-hospital variability for each outcome (Figure 2). In addition, differences among hospital characteristics and seasonality were noted for AE and PAE pathogen+ rates and AE commensal rates (Figure 3), but not urbanicity or teaching hospital status. Monthly Positivity Rate of Blood Culture Episodes, Premier Healthcare Database and Cerner Health Facts, 2012-2017 Adjusted Odds Ratios and 95% Confidence Intervals of Blood Culture Episode Positive (Non-Commensal) and Commensal Rates and Associated Characteristics Conclusion While an increase AE pathogen+ rates and decrease in commensal rates could indicate improved culture ordering and collection practices, significant seasonal, regional, and facility-level variability calls for further investigation. Disclosures John A. Jernigan, MD, MS, Nothing to disclose

Episodic Memory in Later Life: Benefits of Prayer and Meditation

2020 ◽  
Vol 38 (1) ◽  
pp. 30-40
Author(s):  
Nirmala Lekhak ◽  
Tirth R. Bhatta ◽  
Jaclene A. Zauszniewski
Keyword(s):  
Older Adults ◽  
Episodic Memory ◽  
Regression Models ◽  
Secondary Analysis ◽  
Later Life ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Positive Effect ◽  
Retirement Study ◽  
Over Time

Purpose: To examine the effects of prayer and meditation on the episodic memory of older adults. Design: Secondary analysis of Health and Retirement Study (HRS). Method: Drawing from a subsample of HRS ( n = 1,135), this study utilized generalized estimating equation regression models to examine the effects of meditation and prayer on changes in episodic memory of older adults over time. Findings: Findings show a statistically significant positive effect of the use of prayer (0.50, p < .05) on episodic memory score at baseline. We also observed a slight gain in episodic memory over time for older adults who used prayer (0.04, p = .05). Meditation was not found to have a statistically significant effect on changes in memory in later life. Conclusion: This study illustrates the benefits of prayer in preserving memory and provides much needed empirical basis for community-level interventions to enhance memory in later life.

scholarly journals Variability and Trends in Blood Culture Utilization, US Hospitals, 2012–2017

2020 ◽  
Vol 41 (S1) ◽  
pp. s430-s431
Author(s):  
Kelly Hatfield ◽  
Natalie McCarthy ◽  
Sujan Reddy ◽  
James Baggs ◽  
Lauren Epstein ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Hospital Level ◽  
Discharge Data ◽  
Teaching Status ◽  
Urban Rural ◽  
Trends Over Time ◽  
Multivariable Models ◽  
Over Time

Background: Microbiology data are utilized to quantify epidemiology and trends in pathogens, antimicrobial resistance, and bloodstream infections. Understanding variability and trends in rates of hospital-level blood culture utilization may be important for interpreting these findings. Methods: We used clinical microbiology results and discharge data to identify monthly blood culture rates from US hospitals participating in the Premier Healthcare Database during 2012–2017. We included all discharges from months where a hospital reported at least 1 blood culture with microbiology and antimicrobial susceptibility results. Blood cultures drawn on or before day 3 were defined as admission cultures (ACs); blood cultures collected after day 3 were defined as a postadmission cultures (PACs). The AC rate was defined as the proportion of all hospitalizations with an AC. The PAC rate was defined as the number of days with a PAC among all patient days. Generalized estimating equation regression models that accounted for hospital-level clustering with an exchangeable correlation matrix were used to measure associations of monthly rates with hospital bed size, teaching status, urban–rural designation, region, month, and year. The AC rates were modeled using logistic regression, and the PAC rates were modeled using a Poisson distribution. Results: We included 11.7 million hospitalizations from 259 hospitals, accounting for nearly 52 million patient days. The median annual hospital-level AC rate was 27.1%, with interhospital variation ranging from 21.1% (quartile 1) to 35.2% (quartile 3) (Fig. 1). Multivariable models revealed no significant trends over time (P = .74), but statistically significant associations between AC rates with month (P < .001) and region (P = .003), associations with teaching status (P = .063), and urban-rural designation (P = .083) approached statistical significance. There was no association with bed size (P = .38). The median annual hospital-level PAC rate was 11.1 per 1,000 patient days, and interhospital variability ranged from 7.6 (quartile 1) to 15.2 (quartile 3) (Fig. 2). Multivariable models of PAC rates showed no significant trends over time (P = .12). We found associations between PAC rates with month (P = .016), bed size (P = .030), and teaching status (P = .040). PAC rates were not associated with urban–rural designation (P = .52) or region (P = .29). Conclusions: Blood culture utilization rates in this large cohort of hospitals were unchanged between 2012 and 2017, though substantial interhospital variability was detected. Although both AC and PAC rates vary by time of year and potentially by teaching status, AC rates vary by geographic characteristics whereas PAC rates vary by bed size. These factors are important to consider when comparing rates of bloodstream infections by hospital.Funding: NoneDisclosures: None

scholarly journals Prospective Relationships Between Physical Activity and Optimism in Young and Mid-aged Women

2015 ◽  
Vol 12 (7) ◽  
pp. 915-923 ◽  
Author(s):  
Toby G. Pavey ◽  
Nicola W. Burton ◽  
Wendy J Brown
Keyword(s):  
Physical Activity ◽  
Young Women ◽  
Time Lag ◽  
Estimating Equation ◽  
Poor Mental Health ◽  
Self Report ◽  
Generalized Estimating Equation ◽  
Negative Effects ◽  
The Relationship ◽  
Over Time

Background:There is growing evidence that regular physical activity (PA) reduces the risk of poor mental health. Less research has focused on the relationship between PA and positive wellbeing. The study aims were to assess the prospective associations between PA and optimism, in both young and mid-aged women.Methods:9688 young women (born 1973–1978) completed self-report surveys in 2000 (age 22 to 27), 2003, 2006, and 2009; and 11,226 mid-aged women (born 1946–1951) completed surveys in 2001 (age 50–55) 2004, 2007, and 2010, as part of the Australian Longitudinal Study on Women’s Health. Generalized estimating equation models (with 3-year time lag) were used to examine the relationship between PA and optimism in both cohorts.Results:In both cohorts, women reporting higher levels of PA had greater odds of reporting higher optimism over the 9-year period, (young, OR = 5.04, 95% CI: 3.85–6.59; mid-age, OR = 5.77, 95% CI: 4.76–7.00) than women who reported no PA. Odds were attenuated in adjusted models, with depression accounting for a large amount of this attenuation (young, OR = 2.00, 95% CI: 1.57–2.55; mid-age, OR = 1.64 95% CI: 1.38–1.94).Conclusions:Physical activity can promote optimism in young and mid-aged women over time, even after accounting for the negative effects of other psychosocial indicators such as depression.

scholarly journals A longitudinal study of the impact of human mobility on the incidence of COVID-19 in India

2020 ◽  
Author(s):  
Sarbeswar Praharaj ◽  
Hoon Han
Keyword(s):  
Human Mobility ◽  
Estimating Equation ◽  
September 11 ◽  
Generalized Estimating Equation ◽  
Mobility Rate ◽  
Daily Mobility ◽  
Shopping Centres ◽  
Log Linear ◽  
The Impact ◽  
Over Time

AbstractHuman mobility plays a crucial role in determining how fast and where infectious diseases can spread. This study aims to investigate visit to which category of places among grocery, retail, parks, workplaces, residential, and transit stations is more associated with the incidence of COVID-19 in India. A longitudinal analysis of generalized estimating equation (GEE) with a Poisson log-linear model is employed to analyze the daily mobility rate and reported new cases of COVID-19 between March 14 and September 11, 2020. This study finds that mobility to places of grocery (food and vegetable markets, drug stores etc.) and retail (restaurants, cafes, shopping centres etc.) is significantly associated (at p<0.01) with the incidence of COVID-19. In contrast, visits to parks, transit stations and mobility within residential neighbourhoods are not statistically significant (p>0.05) in changing COVID-19 cases over time. These findings highlight that instead of blanket lockdown restrictions, authorities should adopt a place-based approach focusing on vulnerable hotspot locations to contain the COVID-19 and any future infectious disease.

scholarly journals Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008–2016: a repeated cross-sectional study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Minoru Takakura ◽  
Masaya Miyagi ◽  
Akira Kyan
Keyword(s):  
Time Trends ◽  
Parental Education ◽  
Cross Sectional Study ◽  
Socioeconomic Inequalities ◽  
School Type ◽  
Sectional Study ◽  
Cross Sectional ◽  
Japanese Adolescents ◽  
Index Of Inequality ◽  
Over Time

Abstract Background Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016. Methods We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated. Results Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time. Conclusions Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

scholarly journals Trends in cause-specific readmissions in heart failure with preserved versus reduced and mid-range ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.T Cui ◽  
E Thunstrom ◽  
U Dahlstrom ◽  
J.M Zhou ◽  
J.B Ge ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Temporal Trend ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Readmission Rates ◽  
P Values ◽  
National Board ◽  
Over Time

Abstract Background It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions. Results Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values&gt;0.05). Conclusions Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.

Models for Longitudinal Data: A Generalized Estimating Equation Approach

Biometrics ◽  
1988 ◽  
Vol 44 (4) ◽  
pp. 1049 ◽  
Author(s):  
Scott L. Zeger ◽  
Kung-Yee Liang ◽  
Paul S. Albert
Keyword(s):  
Longitudinal Data ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Equation Approach ◽  
Generalized Estimating

Remittances and the Financing of Terrorism In Sub-Saharan Africa: 1974 - 2006

2012 ◽  
Vol 18 (1) ◽  
Author(s):  
Juliet U. Elu ◽  
Gregory N. Price
Keyword(s):  
Economic Growth ◽  
Count Data ◽  
Important Determinant ◽  
Estimating Equation ◽  
Sub Saharan Africa ◽  
Generalized Estimating Equation ◽  
Parameter Estimates ◽  
Consumption Expenditures ◽  
Sub Saharan ◽  
Financing Of Terrorism

AbstractRemittances have been recognized as an important determinant of economic growth for Sub-Saharan African economies as they can finance other determinants that constitute drivers of growth. To the extent that remittances finance terrorism, they can also inhibit economic growth as terrorism can constrain important drivers of growth such as investment and consumption expenditures. In this paper, we appeal to a theory of rational terrorism and consider whether remittances to Sub-Saharan Africa finance terrorism. We estimate the parameters of a static and dynamic terrorism incident supply function with maximum likelihood and Generalized Estimating Equation count data estimators for Sub-Saharan Africa between 1974 and 2006. Our parameter estimates suggest that for Sub-Saharan Africa, remittances are a source of finance for terrorism. We find that approximately one terrorism incident is financed in Sub-Saharan Africa for remittance inflows that range between approximately one quarter of a million dollars and one million dollars.

Abstract 18: Trends in Median CPR Duration Over Time in Patients With and Without Return of Spontaneous Circulation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Katherine M Berg ◽  
Michael Donnino ◽  
Ari Moskowitz ◽  
Mathias J Holmberg ◽  
Sebastian Wiberg ◽  
...  
Keyword(s):  
Survival Rates ◽  
Nonparametric Test ◽  
Spontaneous Circulation ◽  
Hospital Level ◽  
Gender And Race ◽  
Increasing Trend ◽  
Trends Over Time ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest ◽  
Over Time

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achieved ROSC and those who did not, and stratified this analysis by age, gender and race. Methods: We included adult IHCA cases in GWTG-R from 2001-2017, excluding data from a given hospital and year if fewer than 5 eligible arrests were recorded. A nonparametric test for trend was done to evaluate median CPR duration over time in those with and without ROSC, in all patients and in groups stratified by age (<60, 61-80 and >80 years), gender, and race (white and black). Linear regression was done to evaluate the amount of change per year. Association with survival was tested using Pearsons correlation. Results: Of 359,107 IHCA events, 31,189 were excluded, leaving 327,918 for analysis. Over time, there was a significant increase in median CPR duration in patients who did not achieve ROSC, and a decrease in those who did attain ROSC.(Fig.) These trends persisted when stratified by gender, race and age. Each year was associated with a decrease in median CPR duration of 0.37 min (95% CI -0.41 to -0.33 min) in those with ROSC and an increase of 0.29 min (95% CI 0.25 to 0.33 min) in those without. There was a small but significant correlation between median CPR duration in those without ROSC and adjusted survival by hospital over time (r=0.224, p<0.0001). Conclusions: In the GWTG-R registry, median duration of CPR is decreasing over time in patients achieving ROSC, but increasing in those not achieving ROSC. The increasing trend in CPR duration in those without ROSC correlates positively with the trend in survival. Whether the increase in median CPR duration in those without ROSC is contributing causally to improvements in survival warrants further study.

Hip and Trunk Muscle Activity and Mechanics During Walking With and Without Unilateral Weight

2021 ◽  
pp. 1-8
Author(s):  
Kerri A. Graber ◽  
Kari L. Loverro ◽  
Mark Baldwin ◽  
Erika Nelson-Wong ◽  
Joshua Tanor ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Therapeutic Option ◽  
Frontal Plane ◽  
Estimating Equation ◽  
Trunk Muscle ◽  
Lower Extremity Injury ◽  
Generalized Estimating Equation ◽  
Functional Activities ◽  
Strengthening Exercises ◽  
Hip Abductor

Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%–20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤ .003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P < .001), while no change was found ipsilateral to the weight (P ≥ .790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity.

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