A spatial and temporal assessment of nonresponse in the national forest inventory of the U.S.

In nearly all national forest inventories (NFI), some sample plots are unable to be measured such that nonresponse may be an issue of concern. Thus, it is of particular interest to understand the phenomenon in terms of current status and temporal change in nonresponse rates and the associated spatial distribution on the landscape. In the NFI of the USA, denial of access permission on privately owned forest land and hazardous conditions has led to an overall nonresponse rate of 9.8% with some areas exceeding 20% of plots being inaccessible. Further, it was found that nearly 50% of the areas studied were exhibiting increasing rates of nonresponse over time. Comparisons between response and nonresponse plots via remote sensing characteristics suggested there may be systematic differences in some parts of the country, which may cause bias in the sample and resulting estimates. The findings indicate that improved communication strategies with private landowners are needed to reduce nonresponse rates. Due to the unlikelihood of eliminating nonresponse entirely, methods to mitigate potential nonresponse bias should be considered for incorporation into the estimation of population parameters.

Shape selection in Landsat time series: a tool for monitoring forest dynamics.

We present a new methodology for fitting nonparametric shape-restricted regression splines to time series of Landsat imagery for the purpose of modeling, mapping, and monitoring annual forest disturbance dynamics over nearly three decades. For each pixel and spectral band or index of choice in temporal Landsat data, our method delivers a smoothed rendition of the trajectory constrained to behave in an ecologically sensible manner, reflecting one of seven possible 'shapes'. It also provides parameters summarizing the patterns of each change including year of onset, duration, magnitude, and pre- and postchange rates of growth or recovery. Through a case study featuring fire, harvest, and bark beetle outbreak, we illustrate how resultant fitted values and parameters can be fed into empirical models to map disturbance causal agent and tree canopy cover changes coincident with disturbance events through time. We provide our code in the r package ShapeSelectForest on the Comprehensive R Archival Network and describe our computational approaches for running the method over large geographic areas. We also discuss how this methodology is currently being used for forest disturbance and attribute mapping across the conterminous United States.

Anabolic Androgenic Steroids in Orthopaedic Surgery: Current Concepts and Clinical Applications.

Despite the well-documented effects of testosterone and its synthetic derivatives-collectively termed anabolic androgenic steroids (AASs)-on the musculoskeletal system, the therapeutic use of these agents has received limited investigation within the field of orthopaedic surgery. In the last 2 decades, preclinical and clinical research has started to identify promising applications of the short-term use of AASs in the perioperative period. There is evidence to suggest that AASs may improve postoperative recovery after anterior cruciate ligament reconstruction and total joint arthroplasty. In addition, AASs may augment the biological healing environment in specific clinical scenarios including muscle injury, fracture repair, and rotator cuff repair. Current literature fails to present strong evidence for or against the use of AASs in orthopaedics, but there is continuous research on this topic. The purpose of this study was to provide a comprehensive overview of the current status of AAS applications in orthopaedic surgery, with an emphasis on preclinical data, clinical studies, and future directions.

Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department.

INTRODUCTION: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of less than 3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing, and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study was to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department. METHODS: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, when an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin duration of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained. RESULTS: A statistically significant difference was found in blood culture contamination rates in the pre-ISDD group vs. the ISDD group (7.47% vs. 2.59%, p < 0.001). None of the secondary endpoints showed a statistically significant difference. CONCLUSIONS: Implementation of an ISDD reduced blood culture contamination. When implementing the ISDD to a healthcare system, compliance is important and will affect contamination rates dramatically.

Implementation and evaluation of a team-based pharmacy practice model in a community health system.

PURPOSE: The development and implementation of a team-based pharmacy practice model is described. METHODS: In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist's clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation. RESULTS: At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change. CONCLUSION: A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.

Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients.

BACKGROUND: Evidence for the association between Clostridium difficile (C. difficile) and the use of proton pump inhibitor (PPI) is unclear. This study investigated the relationship between Clostridium difficile-associated diarrhea (CDAD) and exposure to acid suppressive therapy in hospitalized adult patients while controlling for the most common predisposing risk factors. METHODS: A retrospective case-control study was conducted at a local hospital of all hospitalized patients between October 1, 2005 and September 30, 2006 who developed CDAD during hospitalization. Subjects were determined to have CDAD if there was a positive C. difficile toxin and clinical correlation of diarrhea at the time of diagnosis. Subjects were pair-matched to controls on the following factors: admission date, antibiotic exposure, gender, age groups, patient location (medical or surgical unit), and room type at time of admission. Seven risk factors were assessed for association with onset of CDAD: exposure to PPIs or H(2)-blockers, renal failure, diabetes mellitus, immunosuppression, malignancy, and gastrointestinal disease. RESULTS: Ninety-four cases were successfully matched to controls. Cases were more likely than controls to receive acid suppressive therapy during hospitalization, 72 (76.6%) versus 40 (42.6%), respectively, P= 0.030. In a multivariate exact conditional logistic regression analysis, CDAD was associated with use of PPI (odds ratio [OR]= 3.6, 95% confidence interval [CI]= 1.7-8.3; P < 0.001), and with renal failure (OR = 5.7, CI = 1.3-39.1; P= 0.02). CONCLUSION: This study showed elevated risk of developing CDAD in hospitalized patients with acid suppressive therapy, especially when PPIs were used.

Effectiveness of half-dose versus full-dose influenza vaccine in health care workers.

PURPOSE: A prospective, randomized, double-blind study comparing the effectiveness of half-dose versus full-dose trivalent inactivated influenza vaccine (TIV) in health care workers was conducted. METHODS: The study was conducted at a 760-bed tertiary care community hospital. Study participants (n = 444) were hospital staff or employees over 18 years of age who were enrolled during a two-week period in October and November 2004. Participants were assigned to either full-dose (n = 222) or half-dose (n = 222) TIV. The participants completed a standardized questionnaire monthly from November 2004 through March 2005. The primary outcome was the incidence of influenza between the two groups; the secondary outcomes were self-reported days of work missed as a result of influenza and the proportion of participants in each group self-reporting signs and symptoms of influenza. Laboratory confirmation of influenza diagnosis was sought in participants reporting a clinical diagnosis by their physicians. Differences in the groups were analyzed with Fisher's exact test, with a < 0.05 considered significant. RESULTS: There was no difference between the full-dose and half-dose groups in the diagnosis of influenza (4% versus 7%, p = 0.198). Laboratory confirmation of an influenza diagnosis occurred in one participant who received full-dose TIV. CONCLUSION: Half-dose TIV demonstrated a similar effectiveness to full-dose TIV, measured by the number of diagnoses of influenza and symptom survey of participating health care workers. Administration of half-dose TIV is an acceptable strategy for maximizing the number of vaccinations in health care workers, but additional studies are needed to confirm the comparable immunogenicity and effectiveness between the two doses.

Sacral chordoma: a case report with radiographic and histologic correlation and a review of the literature.

A case of sacral chordoma clinically simulating pilonidal 'cyst' in a 47-year-old male is presented. The clinical presentation with radiographic and histologic features of this entity with post-treatment clinical follow up is presented with a review of the literature.

Longitudinal change in coronary heart disease risk factors in older runners.

BACKGROUND: it is currently not clear how coronary heart disease (CHD) risk factors change over time in chronic exercisers. Therefore, the purpose of this study is to describe the longitudinal change in CHD risk factors in chronically endurance-trained men and women, and to determine the exercise and nutritional factors associated with those respective changes. METHODS AND RESULTS: ninety-one middle-aged runners (56 male, 35 female) were tested on two occasions approximately 10 years apart (aged 50.8 +/- 8.0 versus 60.0 +/- 7.9 years at respective visits). Body composition, VO2max, blood pressure (BP) and blood chemistries were measured, and the subjects' self-reported training and nutritional history. Data were analysed by factorial analysis of variance (ANOVA) and multivariate step-wise regression. Among the entire sample, training volume decreased (61.1 +/- 28.2 versus 44.7 +/- 24.6 km/week, P<0.05) but nutritional variables did not change. Body fat (16.9 +/- 5.3% for men versus 21.1 +/- 5.3% for women, P<0.05), blood lipids, blood glucose and systolic and diastolic BP all changed negatively over the study duration. These changes occurred similarly in both genders and irrespective of menstrual and hormone replacement status among the women. Lastly, the changes in CHD risk factors were not predicted by change in exercise or nutritional patterns. CONCLUSIONS: despite the maintenance of significant volumes of exercise and the absence of changes in diet, most CHD risk factors demonstrated unfavourable changes over 10 years in chronic men and women runners. However, the absolute values for most CHD risk factors remained better than those reported for sedentary peers of comparable age.

Impact of fluconazole administration on outcomes in critically ill patients.

BACKGROUND: Serious infections caused by Candida spp. are an increasingly important cause of morbidity and mortality in critically ill patients. It is unclear which patients will benefit from therapy and at what point to institute treatment. OBJECTIVE: To evaluate the impact of administration of fluconazole therapy in critically ill trauma patients on mortality, length of hospital stay, incidence of deep-seated fungal infection, and positive fungal cultures from any site. METHODS: We conducted a retrospective, matched case-control study of 116 critically ill surgical trauma patients who did or did not receive fluconazole. Patients were followed until hospital discharge or death. A consecutive sample of 58 patients who received fluconazole was selected. A parallel group of patients was evaluated, from which 58 were matched with fluconazole-treated patients based on age (+/- 5 y), gender, and APACHE II score (+/- 3). RESULTS: The groups of patients were well matched, with the exception of central venous catheter placement and broad-spectrum antibiotic use. We found no difference between groups in hospital mortality (21% vs 26%; p = 0.661) or incidence of deep-seated fungal infection (0% vs 2%; p = NS). However, patients receiving fluconazole had a significantly longer stay in both the intensive care unit (ICU) (18 +/- 13 vs 7 +/- 11 days; p < 0.001) and hospital (25 +/- 15 vs 9 +/- 11 days; p < 0.001). Fluconazole patients were significantly more likely to have Candida cultured from sites associated with colonization (43% vs 2%; p < 0.001), possibly explaining why they received fluconazole. CONCLUSIONS: We were unable to detect a benefit from use of fluconazole in our surgical trauma patient population. Isolation of Candida from the mouth or throat alone, in the absence of correlating clinical signs of infection, should not lead to initiation of fluconazole therapy. Fluconazole use should be reserved for carefully selected patients in the trauma ICU setting.