2441. Automated, Rapid Detection of Potential Healthcare-Acquired Infection Clusters Based on Microbiology And Patient Geotemporal Data

Background Whole-genome sequencing (WGS) has shown promise in identifying transmissions of healthcare-associated infections (HAIs), but it may be costly to sequence all potential HAIs. By automatically identifying samples likely to be HAIs, WGS can be focused on specific samples. We describe an algorithm that quickly identifies potential HAI clusters by analyzing patient geotemporal and pathogen microbiology data. This approach systematically triages potential HAI investigations to aid infection control professionals (ICPs) in their workflow. Methods This novel algorithm within Philips IntelliSpace Epidemiology scores the potential of transmission for pairs of infections. Inputs include microbiology (MB) data (genus- or species-level identification and antimicrobial susceptibility test results) and geotemporal (GT) data (timing of sample collection and shared location stays). From the resulting pairwise scores, clusters of potential HAIs are identified. Leveraging 9 months (June, 2018 – March, 2019) of data from a 900-bed US hospital (i.e., 2825 samples, 1814 patients and 13 organisms—of which a subset of 404 samples had WGS performed concomitantly with MB studies), we evaluated the extent to which this algorithm captures genetically similar sample pairs. Results Pairwise scores enrich for genetically similar samples when considering MB data only (odds ratio: 17.3), GT only (odds ratio: 6.1) and a combination of both (odds ratio: 19.8), with highly significant P-values for all (P < 10−16). Considering MB only, 91% of samples group together in potential transmission clusters. With MB and GT data, this fraction drops to 24.6% (694 samples) forming 178 possible clusters, 173 of which contain fewer than ten samples each. The 5 larger clusters contain 40–64 samples each and span multiple units in the hospital. Conclusion The proposed system automatically suggests potential HAI clusters. By combining MB and GT data, the number of samples to review is reduced, enabling ICPs to focus their attention and sequencing efforts. By focusing on a targeted group of higher probability clusters, ICPs may be able to increase their efficiency and effectiveness in controlling the spread of HAIs—thus boosting potential for patient safety and amelioration of cost of care. Disclosures All authors: No reported disclosures.

Tracing the development of spatially modulated gestures in the manual modality in nonsigning Chinese-speaking children

ABSTRACTSpeakers employ gestures to identify nonpresent objects in nonneutral locations (e.g., pointing to the left to indicate a toy car) and maintain the same spatial locations to indicate the same objects throughout the discourse. These kinds of gestures are referred to as shared-location spatially modulated gestures. Previous research showed that native signers form associations between locations and objects as early as age 5. We examined whether nonsigning children also produced shared-location spatially modulated gestures as early as age 5, and if so, whether such ability is associated with verbal memory, spatial memory, and eductive reasoning (i.e., the ability to derive meaning from the complex situations). Our results showed that nonsigning children use spatial devices in their gestures as early as age 5, but such ability is not well developed until age 7 to 11. It is interesting that different types of cognitive skills may come into play in the production of shared-location spatially modulated gestures across different age groups. We found significant correlations between the production of this type of gesture and spatial memory in the younger children and eductive reasoning in the older children. Thus, there is possibly a developmental shift of the cognitive processes involved in the production of shared-location spatially modulated gestures.

Context-Based Grouping and Recommendation in MANETs

The authors propose in this chapter a context grouping mechanism for context distribution over MANETs. Context distribution is becoming a key aspect for successful context-aware applications in mobile and ubiquitous computing environments. Such applications need, for adaptation purposes, context information that is acquired by multiple context sensors distributed over the environment. Nevertheless, applications are not interested in all available context information. Context distribution mechanisms have to cope with the dynamicity that characterizes MANETs and also prevent context information from being delivered to nodes (and applications) that are not interested in it. The authors’ grouping mechanism organizes the distribution of context information in groups whose definition is context based: each context group is defined based on a criteria set (e.g. the shared location and interest) and has a dissemination set, which controls the information that can be shared in the group. They propose a personalized and dynamic way of defining and joining groups by providing a lattice-based classification and recommendation mechanism that analyzes the interrelations between groups and users, and recommend new groups to users, based on the interests and preferences of the user.

Collective Representations, Divided Memory and Patterns of Paradox: Mining and Shipbuilding

This paper seeks to examine the different relationship of two industries to their potential for representation and celebration in collective memory. Looking at case studies of mining and shipbuilding in the shared location of Wearside the paper compares and contrasts features of the two industries in relation to the divergent outcomes of the traces of their collective memory in this place. Using visual representations the paper makes the case that the mining industry has experienced a successful recovery of memory. This is contrasted to the paucity of visual representation in relation to shipbuilding.The reasons for the contrast in the viability of collective memory are examined. Material, cultural and aesthetic issues are addressed. Contrasts are drawn between divisions of labour in the two industries and the ways in which these impact upon community and trade union organisation which further relate to the contrast between industrial and occupational identity. Differences in the legacy of the physical occupational communities of the two industries are illustrated. There is also an examination of the aesthetic forms of representation in which mining is seen as characterised by the aesthetics of labour, whereas shipbuilding is represented more through the aesthetics of product. The way in which the industries were closed also becomes important to understand the variation in the differences of the potential of collective memory. All of these strands are brought together to conclude that in relation to the potential for collective memory, mining can be seen to have gone through a process of ‘mourning’ whereas melancholia seems to more adequately represent the situation with respect to shipbuilding. In illustrating these cases the paper is arguing for a more sophisticated understanding of the process of deindustrialisation and the potential for the recovery of collective memory.

Rumlige dimensioner i det sociale cyberspace

Stine Gotved: Spatial dimensions in social cyberspace The temporal and spatial dimensions of online communication establish the basic conditions for social life within cyberspace communities. Looking at the protocol-based constructions – whether they are communicating in real time or in asynchronous mode and whether they hold a shared location – it is clear that spatial construction matters for the sense of community. Parallel to offline life, the spatial dimensions in online communities are important for how the individual navigates, relates, and communicates. This article presents a typology of online space, in which three different kinds of spatial dimensions are defined. These three spatial dimensions can be found in most (if not all) online communities in varying degrees, and analysis of the patterns of spatial dimension within an online community provides useful information about the basic terms of social life within that community. The typology is discussed in light of Henri Lefebvre's work on spatiality and social space, in order to uncover the implicit inspirations as well as the limitations of his approach by the inclusion of offline spatial sociology. The typology presented here serves as an analytical tool to separate the different spatial dimensions of cyberspace, and hopefully holds the key to understanding many of the differences within online social life.

Psychiatry and Primary Care as Neighbors: From the Promethean Primary Care Physician to Multidisciplinary Clinic

Objective: A successful eight-year experience developing a co-practice model for psychiatry in a primary care practice is described. Methods: The effect on service delivery of specific changes in availability, shared location, and consistency of interdisciplinary relationships are discussed. Results: The following components of successful collaboration were identified: 1) The importance of fiscal organization and leadership factors in creating a successful bridge between psychiatry and primary care. 2) How individual tailoring for the setting (rural vs. urban) affects the collaboration. 3) Adaptations incumbent upon psychiatrists to function well in such settings. 4) The development of a teaching program and training track for medical and psychiatric housestaff in such settings. Conclusions: Making psychiatry accessible at the front line of primary care enhances delivery of care and does not detract from any service.