scholarly journals Trends in and Predictors of Carbapenem Consumption across North American Hospitals: Results from a Multicenter Survey by the MAD-ID Research Network

2019 ◽  
Vol 63 (7) ◽  
Author(s):  
Nathaniel J. Rhodes ◽  
Jamie L. Wagner ◽  
Susan L. Davis ◽  
John A. Bosso ◽  
Debra A. Goff ◽  
...  
Keyword(s):  
North American ◽  
Fixed Effects ◽  
The United States ◽  
Mixed Effects ◽  
Research Network ◽  
Beta Lactam ◽  
Final Model ◽  
Days Of Therapy ◽  
Multicenter Survey ◽  
Consumption Rates

ABSTRACT We sought to define trends in and predictors of carbapenem consumption across community, teaching, and university-affiliated hospitals in the United States and Canada. We conducted a retrospective multicenter survey of carbapenem and broad-spectrum noncarbapenem beta-lactam consumption between January 2011 and December 2013. Consumption was tabulated as defined daily doses (DDD) or as days of therapy (DOT) per 1,000 patient days (PD). Multivariate mixed-effects models were explored, and final model goodness of fit was assessed by regressions of observed versus predicted values and residual distributions. A total of 20 acute-care hospitals responded. The centers treated adult patients (n = 19/20) and pediatric/neonatal patients (n = 17/20). The majority of the centers were nonprofit (n = 17/20) and not affiliated with medical/teaching institutions (n = 11/20). The median (interquartile range [IQR]) carbapenem consumption rates were 38.8 (17.4 to 95.7) DDD/1,000 PD and 29.7 (19.2 to 40.1) DOT/1,000 PD overall. Carbapenem consumption was well described by a multivariate linear mixed-effects model (fixed effects, R2 = 0.792; fixed plus random effects, R2 = 0.974). Carbapenem consumption increased by 1.91-fold/quarter from 48.6 DDD/1,000 PD (P = 0.004) and by 0.056-fold/quarter from 45.7 DOT/1,000 PD (P = 0.93) over the study period. Noncarbapenem consumption was independently related to increasing carbapenem consumption (beta = 0.31 for increasing noncarbapenem beta-lactam consumption; P < 0.001). Regular antibiogram publication and promotion of conversion from intravenous (i.v.) to oral (p.o.) administration independently affected carbapenem consumption rates. In the final model, 58.5% of the observed variance in consumption was attributable to between-hospital differences. Rates of carbapenem consumption across 20 North American hospitals differed greatly, and the observed differences were correlated with hospital-specific demographics. Additional studies focusing on the drivers of hospital-specific carbapenem consumption are needed to determine whether these rates are justifiable.

scholarly journals Fluoroquinolone prescribing for diabetic foot infections following an FDA Drug Safety Communication for aortic aneurysm risk

2021 ◽  
Author(s):  
Catherine Li ◽  
Nicholas J. Mercuro ◽  
Ryan W. Chapin ◽  
Howard S. Gold ◽  
Christopher McCoy
Keyword(s):  
Aortic Aneurysm ◽  
Drug Safety ◽  
Diabetic Foot ◽  
The United States ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Safety Communication ◽  
Diabetic Foot Infections ◽  
Days Of Therapy

In 2018, the United States Food and Drug Administration (FDA) issued a Drug Safety Communication regarding fluoroquinolone-associated aortic aneurysm. This quasi-experimental study assessed antibiotic prescribing for 198 hospitalized patients with diabetic foot infection. Following the warning, median inpatient fluoroquinolone days of therapy (DOT) decreased from 3 to 0 days ( P < 0.001), corresponding with increased beta-lactam DOT and OPAT enrollment. FDA communications may influence antibiotic selection and transitions of care, representing opportunities for antimicrobial stewardship.

Benjamin Henry Latrobe and the nomenclature of two North American fishes

1987 ◽  
Vol 14 (1) ◽  
pp. 85-88
Author(s):  
CHARLOTTE M PORTER
Keyword(s):  
United States ◽  
North American ◽  
The United States ◽  
American Shad ◽  
New Name ◽  
The Common ◽  
Fish Louse

A curious error affects the names of three North American clupeids—the Alewife, American Shad, and Menhaden. The Alewife was first described by the British-born American architect, Benjamin Henry Latrobe in 1799, just two years after what is generally acknowledged as the earliest description of any ichthyological species published in the United States. Latrobe also described the ‘fish louse’, the common isopod parasite of the Alewife, with the new name, Oniscus praegustator. Expressing an enthusiasm for American independence typical of his generation, Latrobe humorously proposed the name Clupea tyrannus for the Alewife because the fish, like all tyrants, had parasites or hangers-on.

scholarly journals Progress in Diagnosing Primary Ciliary Dyskinesia: The North American Perspective

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1278
Author(s):  
Michael Glenn O’Connor ◽  
Amjad Horani ◽  
Adam J. Shapiro
Keyword(s):  
Genetic Testing ◽  
North America ◽  
North American ◽  
Primary Ciliary Dyskinesia ◽  
Clinical Phenotype ◽  
The United States ◽  
Diagnostic Process ◽  
The North ◽  
Diagnostic Guideline ◽  
Ciliary Dyskinesia

Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low nNO values require confirmation with genetic testing or ciliary electron micrograph (EM) analysis. Furthermore, these guidelines recognize that not all North American patients have access to nNO testing and isolated genetic testing is appropriate in cases with strong clinical PCD phenotypes. For unresolved diagnostic cases, referral to a PCD Foundation accredited center is recommended. The purpose of this narrative review is to provide insight on the North American PCD diagnostic process, to enhance the understanding of and adherence to current guidelines, and to promote collaboration with diagnostic pathways used outside of North America.

scholarly journals Are the Self-Employed Mentally Healthier Than Salaried Workers? Evidence From Korea, Mexico, and the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 40-41
Author(s):  
Hankyung Jun
Keyword(s):  
Fixed Effects ◽  
Mental Health Problems ◽  
Unobserved Heterogeneity ◽  
The United States ◽  
Fixed Effects Model ◽  
Reverse Causality ◽  
Positive Health ◽  
Self Employment ◽  
Salaried Workers ◽  
The U.S

Abstract Self-employed workers are often reported to have better health than salaried workers. Whether this is because self-employment has health benefits or healthier workers are self-employed is not clear. Self-employed workers may have higher job satisfaction due to higher levels of self-efficacy and autonomy, but may also experience higher job stress, uncertainty, and lack of health insurance leading to mental health problems. Self-employed workers in the U.S. may have different characteristics than those in Mexico and Korea given different working and living environments as well as different institutional arrangements. This study will examine the association between self-employment and mental and cognitive health for older adults in the U.S., Mexico, and South Korea. It uses harmonized panel data from the Health and Retirement Study, the Korean Longitudinal Study of Aging, and the Mexican Health and Aging Study. We compare the health and selection effect of self-employment using a pooled logistic model, fixed-effects model, and a bivariate probit model. In addition to comparing self-employed and salaried workers, we analyze differences between self-employed with and without employees. By using rich data and various models, we address reverse causality and estimate the relationship between self-employment and health. We show that the positive health effects of self-employed workers in the U.S. disappear once controlled for unobserved heterogeneity, indicating the possibility of healthier workers selecting into self-employment. Interestingly, for Korea and Mexico, healthier individuals seem to select into wage work which reflects the difference in working conditions across countries. Further analysis will show effects by business size.

scholarly journals 1665. Using Electronic Health Records to Describe TB in Community Health Settings: a Cohort Analysis in a Large Safety-Net Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S819-S820
Author(s):  
Jonathan Todd ◽  
Jon Puro ◽  
Matthew Jones ◽  
Jee Oakley ◽  
Laura A Vonnahme ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Electronic Health Records ◽  
Safety Net ◽  
The United States ◽  
Research Network ◽  
Health Records ◽  
Treatment Regimens ◽  
Data Source ◽  
Electronic Health

Abstract Background Over 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers. Methods From the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI. Results Among 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35). Conclusion This study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations. Disclosures All Authors: No reported disclosures

scholarly journals “The Future of Archaeology Is Antiracist”: Archaeology in the Time of Black Lives Matter

2021 ◽  
pp. 1-20
Author(s):  
Ayana Omilade Flewellen ◽  
Justin P. Dunnavant ◽  
Alicia Odewale ◽  
Alexandra Jones ◽  
Tsione Wolde-Michael ◽  
...  
Keyword(s):  
United States ◽  
North American ◽  
The United States ◽  
Heritage Preservation ◽  
Social Unrest ◽  
Black Lives Matter ◽  
The North ◽  
Road Map ◽  
The Social ◽  
The Future

This forum builds on the discussion stimulated during an online salon in which the authors participated on June 25, 2020, entitled “Archaeology in the Time of Black Lives Matter,” and which was cosponsored by the Society of Black Archaeologists (SBA), the North American Theoretical Archaeology Group (TAG), and the Columbia Center for Archaeology. The online salon reflected on the social unrest that gripped the United States in the spring of 2020, gauged the history and conditions leading up to it, and considered its rippling throughout the disciplines of archaeology and heritage preservation. Within the forum, the authors go beyond reporting the generative conversation that took place in June by presenting a road map for an antiracist archaeology in which antiblackness is dismantled.

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

scholarly journals Towards Including Dynamic Vegetation Parameters in the EUMETSAT H SAF ASCAT Soil Moisture Products

2021 ◽  
Vol 13 (8) ◽  
pp. 1463
Author(s):  
Susan C. Steele-Dunne ◽  
Sebastian Hahn ◽  
Wolfgang Wagner ◽  
Mariette Vreugdenhil
Keyword(s):  
Soil Moisture ◽  
Interannual Variability ◽  
Incidence Angle ◽  
Pearson Correlation ◽  
The United States ◽  
Research Network ◽  
Window Width ◽  
High Frequency Variability ◽  
Vegetation Parameters ◽  
The Impact

The TU Wien Soil Moisture Retrieval (TUW SMR) approach is used to produce several operational soil moisture products from the Advanced Scatterometer (ASCAT) on the Metop series of satellites as part of the EUMETSAT Satellite Application Facility on Support to Operational Hydrology and Water Management (H SAF). The incidence angle dependence of backscatter is described by a second-order Taylor polynomial, the coefficients of which are used to normalize ASCAT observations to the reference incidence angle of 40∘ and for correcting vegetation effects. Recently, a kernel smoother was developed to estimate the coefficients dynamically, in order to account for interannual variability. In this study, we used the kernel smoother for estimating these coefficients, where we distinguished for the first time between their two uses, meaning that we used a short and fixed window width for the backscatter normalisation while we tested different window widths for optimizing the vegetation correction. In particular, we investigated the impact of using the dynamic vegetation parameters on soil moisture retrieval. We compared soil moisture retrievals based on the dynamic vegetation parameters to those estimated using the current operational approach by examining their agreement, in terms of the Pearson correlation coefficient, unbiased RMSE and bias with respect to in situ soil moisture. Data from the United States Climate Research Network were used to study the influence of climate class and land cover type on performance. The sensitivity to the kernel smoother half-width was also investigated. Results show that estimating the vegetation parameters with the kernel smoother can yield an improvement when there is interannual variability in vegetation due to a trend or a change in the amplitude or timing of the seasonal cycle. However, using the kernel smoother introduces high-frequency variability in the dynamic vegetation parameters, particularly for shorter kernel half-widths.

scholarly journals PSV-13 Genetic parameters and quantitative trait loci for heat stress related traits in sheep

2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 163-164
Author(s):  
Devin R Jacobs ◽  
Claudia E Silvera-Rojas ◽  
Jennifer M Bormann ◽  
Terry A Gipson ◽  
Arthur L Goetsch ◽  
...  
Keyword(s):  
Heat Stress ◽  
Quantitative Trait Loci ◽  
Rectal Temperature ◽  
Quantitative Trait ◽  
Fixed Effects ◽  
Univariate Analysis ◽  
Average Daily Gain ◽  
The United States ◽  
Nucleotide Polymorphisms ◽  
Trait Loci

Abstract Greater selection emphasis has been placed on efficiency than on fitness in livestock populations over the last several decades. Heat stress is a concern in production systems due to the negative effects on production, reproduction, and immunity. The objective of the study was to estimate variance components and identify quantitative trait loci (QTL) for heat stress related traits in sheep. A total of 125 Dorper, Katahdin, and St. Croix ewes originating from four regions of the United States were selected for the experiment. Animals were separated into four trials due to facility limitations. Data were collected for each trial over four consecutive two-week periods in an environmentally controlled facility with targeted heat load index (HLI) for daytime/nighttime of 70/70, 85/77, 90/77, and 95/81. Body weight was collected three times per week and rectal temperature was collected weekly. Black globe temperature and humidity were measured every 15 minutes. Animals were genotyped using the Illumina OvineSNP50 BeadChip. After quality control, 49,396 effective single nucleotide polymorphisms were included in the univariate analysis performed with the BLUPF90 suite of programs. Fixed effects in the models included region of origin, breed, trial, and age as a covariate. Traits analyzed included rectal temperature at 95 HLI (RT95), feed intake at 95 HLI (FI95), and average daily gain for the period for HLI between 90 and 95 (ADG). Heritabilities for RT95, FI95, and ADG were 0.35, 0.10, and 0.10, respectively. Largest effect QTL were identified on chromosomes 23, 9, and 6 for RT95, chromosomes 9, 2, and 20 for FI95, and chromosomes 6, 1, and 5 for ADG. Many of the regions identified have also been associated with weight and carcass traits in other studies, but few had obvious connections to the heat stress related response. In conclusion, results suggest selection could improve heat tolerance in sheep.

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