26419 research outputs found
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Blood Culture Utilization: How Many Follow-Up Cultures are Needed?
No full textBackground: Follow-up blood cultures (BCx) are ordered after an initial positive culture in many instances. The number of follow-up cultures needed is not clear. Obtaining unnecessary BCx may cause unintended consequences. The optimal balance between stewardship and patient safety warrants investigation. We sought to assess the frequency with which a third set is positive after a negative second BCx. Methods: We conducted a retrospective study of BCx submitted to the microbiology laboratory from 1/1/18-11/1/23. We included all patients ≥18 years who had at least two follow-up BCx drawn 24-72 hours after an initial positive culture. Data were collected from electronic medical records. Cultures obtained within two hours of each other were counted as one set. Different strains of an organism were considered to be different organisms. Patients were divided into four groups based on BCx positivity, with a focus on the cohort with a positive culture after a negative follow-up set. Results: 28,875 patients had an initial positive BCx, of which 2,636 had at least two follow-up cultures drawn in the selected timeframe. Within this group, 585 (22.2%) had two positive follow-up sets, 1500 (56.9%) had two negative, 431 (16.4%) had a positive followed by a negative, and 120 (4.6%) had a negative followed by a positive. Of this cohort, 71 (2.7%) grew the same organism in the initial and second follow-up cultures, while 49 (1.9%) did not. In the same-organism subset, the most commonly identified bacteria were coagulase-negative staphylococci (n=21; 0.8%), gram-negative bacteria (n=17; 0.6%), methicillin-sensitive Staphylococcus aureus (n=13; 0.5%), and methicillin-resistant S. aureus (n=7; 0.3%). The most frequently isolated organisms in this subset were S. aureus (n=20; 0.8%), Staphylococcus epidermidis (n=16; 0.6%), and Escherichia coli (n=11; 0.4%). In the different-organism subgroup, 35 (1.3%) of the second follow-up sets had suspected contamination, though true bacteremia from skin/soft tissue (n=4; 0.2%), central line (n=4; 0.2%), unknown (n=3; 0.1%), and other sources was observed, often due to S. aureus (n=4; 0.2%), E. coli (n=2; 0.1%), and Candida (n=2; 0.1%). Conclusion: The number of patients with ongoing bacteremia that would have been missed with one follow-up BCx was small. The skip phenomenon has been described with S. aureus but was seen with gram-negatives as well. The second follow-up cultures were sometimes positive for contaminants. Further data are needed to determine when two follow-up sets should be obtained rather than one
Insider Threat: A Case Study of the Maroochy Water Services Attack
No full textIn 2000, a former employee at Hunter Watertech went rogue and caused a spill of 800,000 liters of sewage. He leveraged his insider knowledge and access to stolen equipment in order to seek retribution for the company that wronged him. After three months of torment police arrested him and an investigation and many studies were done on the incident. A consensus remains that much of this chaos was preventable with simple cybersecurity implementations
A Worker\u27s Struggle
No full text[Introduction] The casualty department at Sir Salimullah Medical College Mitford Hospital was crowded, as it always was. The air smelled of antiseptics, and hurried footsteps echoed through the narrow corridors. It was another day of internship, and I had just finished checking on a patient when a nurse called me over.
“There’s a new case in Trauma. Factory worker. Severe hand injury.”
I hurried over and found a man sitting on the examination table. His face was pale, and his forehead was glistening with sweat. His right hand was wrapped in a blood-soaked cloth. His left hand trembled as he clutched his lap.
His name was Abdul Karim. He worked in a small steel factory on the outskirts of Dhaka. The accident had happened that morning. A moment’s distraction, a slip of the hand, and the sharp blade of the machine had cut through his fingers. The factory supervisor had bandaged his hand hastily and sent him away, warning him not to make a fuss
Understanding Teacher Leadership: Development and Testing of the Survey of Teacher Leadership
No full textTeacher leadership (TL) has been identified as key component of effective schools. While research has grown in this area, there is a dearth of empirically and theoretically supported measures for understanding TL. This study examines the validity and reliability of the Survey of Teacher Leadership (STL). The STL builds on previous theory and research in TL by creating an assessment of teacher TL practices and their associated self-efficacy in these practices. In addition to more established domains of TL, the STL also examines teachers’ leadership practices and self-efficacy in diversity and equity. The STL was sent to all non-charter public school teachers in the U.S. state of Nevada. Over 1200 teachers responded and their data provided a firm empirical foundation for examining the psychometric qualities of the STL. Evidence indicates a five-factor structure with acceptable psychometric qualities
Predictive Maintenance in Naval Vessel Propulsion Systems for Enhanced Marine Operations Using a BiGMM-HMM Framework With Divergence-Based Clustering
No full textThis study introduces a BiGMM-HMM Integration Framework designed to improve predictive maintenance strategies for naval vessel propulsion systems, addressing the need for efficient and reliable operation in marine engineering applications. The framework effectively manages multimodal sensor data by leveraging a unique combination of Gaussian Mixture Models (GMMs) and Hidden Markov Models (HMMs) in a bidirectional architecture. It analyses the dynamic interactions between sensors and subsystems. Two preprocessing methods are evaluated: Method 1 focuses on subsystem interactions, employing divergence-based root cause analysis to identify key sensor variables by clustering of sensors and subsystems. In contrast, Method 2 processes the entire dataset directly. Experimental results demonstrate that Method 1 outperforms Method 2, achieving an accuracy of 91%, precision of 94%, recall of 91%, and an F1-score of 91%, compared to 87%, 90%, 87%, and 88% for Method 2, respectively. These findings underscore the role of feature selection, clustering, and dimensionality reduction in predictive analytics for marine systems. Utilizing two GMMs—one for label inference and another for transition and emission probabilities—the framework captures the multimodal characteristics of propulsion system data, resulting in improved health state prediction. Applied to a naval propulsion system dataset, this approach provides actionable insights into optimizing maintenance by understanding sensor interdependencies and subsystem interactions, offering substantial advancements in marine engineering operations through more effective maintenance strategies
Part 7: Hampton Roads\u27 Collaborative Spirit Produces Regional Results
No full textIn this chapter, Drew Lumpkin, lead author, examines how collaboration has improved in Hampton Roads over the last two decades. He highlights specific examples of regional collaboration and how these efforts have changed the conversation in Hampton Roads
Are We Ready for Synchronous Conceptual Modeling in Augmented Reality? A Usability Study on Causal Maps With HoloLens 2
No full text(1) Background: Participatory modeling requires combining individual views to create a shared conceptual model. While remote collaboration tools have enabled synchronous online modeling, they are limited to desktop settings. Augmented reality (AR) offers a new approach by potentially providing the sense of presence found in physical collaboration, which may better support participants in achieving the sense of presence found in physical locations, thus supporting them in negotiating meaning and building a shared model. (2) Methods: Building on prior works that developed technology, we performed a usability study with pairs of modelers to examine their ability at performing key conceptual modeling tasks (e.g., merging or deleting concepts) in AR. Our study pays particular attention to the time spent on these tasks and distinguishes how long it takes to perform the action (as enabled by the technology) from how long the participants discussed the action (e.g., to jointly decide whether a new concept should be created). (3) Results: Users completed every task and rated the usability from 3.68 (creating an edge) to 4.37 (finding a node) on a scale from 1 (very difficult) to 5 (very easy). (4) Conclusions: Low familiarity with AR and high time per task limits adoption for conceptual modeling
Novel Micro-and Nanoformulations of Paclitaxel for Targeting Metastatic Breast, Non-Small Cell Lung, and Pancreatic Cancers
No full textNonlinear pharmacokinetics resulting from high lipophilic and low oral bioavailability, and hypersensitivity reactions and hyperlipidemia caused by formulation by Cremophor EL have limited clinical effectiveness of paclitaxel (Taxol). In this way, there is the critical necessity of innovative drug delivery systems (DDSs) to mitigate severe side effects and overcome clinical limitations of paclitaxel. In recent years, various micro- and nanoformulations, specifically polymeric nanoparticles (NPs) and lipid NPs, have been presented and approved by the Food and Drug Administration (FDA). In addition, other nanoformulations, such as polymeric nanoparticles (NPs), micelles, liposomes, and mesoporous silica nanoparticles, have shown promising results in vitro and in vivo; however, some clinical limitations still exist, including the large-scale production and control of nanoformulation morphology. Based on the above short description, we have tried to explain advances and challenges of novel formulations of paclitaxel in both micro- and nanoscale in recent years, particularly in the year range of 2021-2025
Exploring Coworker Perceptions of and Reactions to Quiet Quitting
No full textQuiet quitting is a relatively new phenomenon that has quickly caught the attention of both practitioners and academics. With the world of work becoming increasingly interconnected, we contribute to the discourse by approaching quiet quitting from the novel perspective of understanding how others in the workplace perceive those who engage in quiet quitting. To do so, we first provide a formalized definition of quiet quitting and differentiate coworkers\u27 perceptions of quiet quitting from similar psychological constructs (Studies 1–3). We then examine employee responses to coworkers engaging in quiet quitting with a qualitative study (Study 4) and vignette design (Study 5), finding that as an employee\u27s perception of coworker quiet quitting increases, supportive behaviors decrease and workplace incivility behaviors towards the coworker increase. The effect on workplace incivility behaviors is moderated by self‐rated quiet quitting, such that employees who had higher self‐rated quiet quitting were more likely to engage in incivility towards a coworker regardless of whether their coworker was quiet quitting. Overall, by exploring quiet quitting observed by a coworker, we provide a different perspective on this construct and extend past research to show how employees feel about and react to a coworker\u27s quiet quitting behaviors
Reading Owen\u27s \u3ci\u3eBetween Reason and History: Habermas and the Idea of Progress \u3c/i\u3e
No full text[First paragraph]
From the start Habermas\u27 work has been an attempt at synthesising certain core insights from Kant and Hegel, as it is clearly evident from the beginning chapters of his first major work Knowledge and Human Interest (KHI). In the structure of the book Marx\u27s position is as the mediator of Kant and Hegel and all subsequent authors are considered in order to overcome the shortcomings of this Marxian mediation (KHI: chapter 1-11, Habermas, 1982: 239ff Cf. Kortian, 1980)