Search

BACKGROUND: The National Medical Council has recognized the importance of self-directed learning (SDL) for medical graduates and it has been included as one of the competencies for Indian Medical Graduates. The present study was conducted to explore different determinants, and the factors facilitating and deterring of SDL among medical undergraduates. MATERIALS AND METHODS: This cross-sectional qualitative study was conducted with 40 phase 2 MBBS students and data were collected through focused group discussions over a period of four weeks. A content analysis approach was used in the analysis. RESULTS: The participants included 23 women (58%) and 17 men (42%). The study revealed three main themes and six sub-themes as factors deterring SDL. The majority of participants (84%) favored individual learning, while a smaller number preferred team-based learning. DISCUSSION: Cognitive factors emerged as the most common barriers, including problems with initiation and engagement in SDL and the enormous amount of data available. Educational environmental factors, such as heavy workloads and time constraints, as well as frequent assessments, were also identified as barriers. Attitudinal and mental barriers encompassed issues like lack of practical experience, difficulties in adapting to new learning environments, and challenges in concentration and focus. CONCLUSION: Overall, this study fills gaps in our understanding of factors deterring students’ engagement in SDL and provides valuable insights for educators and institutions in implementing effective SDL activities. By addressing these barriers, medical education can equip students better to become lifelong learners and meet the evolving demands of the medical profession.

Introduction: Laboratory diagnosis of Corona Virus Disease- 2019 (COVID-19) plays a major role in diagnosing and treating infection. The corner stone in strategic public health interventions and breaking the chain of transmission was diagnostic laboratory testing and case-based data. The purpose of the study was to establish quality control standards for RT-PCR testing laboratory by performing Root Cause Analysis (RCA) of invalid Internal Control (IC). Aim: The aim of the study was to estimate the percentage of invalid IC and to describe the most probable associated factors. Materials and Methods: This cross-sectional observational study was conducted at the RT-PCR laboratory in Microbiology department of Govt. Kilpauk Medical College and Hospital for a period of one month, October 2021. The nasopharyngeal and oropharyngeal swabs collected for COVID-19 testing were included in the study. A detailed check-list was prepared by the author for evaluating of invalid IC. Results: All the variables of RT-PCR test were categorised as pre-analytical, analytical and postanalytical phases and each and every component was assessed as per the protocol. Out of 23500 samples included in the study, a positive test result for COVID-19 was obtained in 164 (0.69%) and a negative result in 22533 (95.89%) patients. Around 803 (3.41%) samples included in the study showed an invalid IC. Conclusion: Current observation showed that an invalid IC could be caused by any factors starting from sample collection to reporting. Major causes for an invalid IC were due to improper extraction and sample collection.

Introduction: Dengue is a viral infection with diverse clinical manifestations. Infection in most of the patients is subclinical. It may also present as undifferentiated fever, severe dengue like Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Secondary dengue infection predisposes to severe dengue, a serious threat to the community as they increase morbidities and mortality. The diagnosis of secondary infection is either by Polymerase Chain Reaction (PCR) to detect the serotype or dengue IgG/IgM antibody ratio. A ratio of more than 1.1 is evidence of secondary dengue. Aim: To find out the prevalence of secondary dengue by measuring the dengue anti-IgG/IgM ratio by Enzyme Linked Immunosorbent Assay (ELISA) test. Materials and Methods: This cross-sectional observational study was conducted at Government Kilpauk Medical College, Chennai for a period of six months from July 2021 to December 2021. Sample size was 450 calculated at 95% confidence level, (CI 28.3-38.3) with 33.3% as prevalence. Blood samples were collected and Nonstructural Protein 1 (NS1) antigen assay was done. The IgG and IgM antibodies assays were done for NS1 antigen positive individuals. The IgG/IgM ratio was calculated in patients who were positive for both IgG and IgM. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 20.0. Percentage, mean and standard deviation were calculated. Results: Total of 450 patients were included, out of which 194 were NS1 antigen positive, 106 were males and 88 females with the mean age 25±14.85 years. NS1 antigen was positive in 89.17%. Two-tailed Fisher’s-exact test showed a significant proportion of patients among NS1 positive were positive for both IgG and IgM. An IgG/IgM ratio of >1.1 was found in 62.04%. The association between IgG/IgM ratio of >1.1 and thrombocytopenia was significant [p-value=0.00504, Odd’s ratio (OD) =3.316]. Conclusion: Dengue IgG/IgM antibody ratio of more than 1.1 on the third day of symptom onset and the platelet count assist in the early diagnosis of secondary dengue thereby helps clinicians to initiate the appropriate treatment at the right time, reduce mortality rate and decrease the economic burden of the country.

Fish vibriosis is among the most common diseases that is caused by a bacteria belonging to the genus Vibrio (Vibrio anguillarium). It causes considerable economic loss in the commercial cultivation of Asian sea bass (Lates calcarifer). The resistance of microorganisms to antibiotics has resulted in a growing need for developing a new antibacterial therapy that is effective in aquaculture. The aim of this study is to develop neem nanoemulsion with antibacterial activity against V. anguillarium to identify a possible alternative to the commonly used antibiotics in aquaculture. Neem nanoemulsion was prepared and the effectiveness was studied both in vitro and in vivo (agar well diffusion assay and artificial infection). Injection and immersion challenge of neem nanoemulsion formulated the fish less susceptible to V. anguillarium infection. The results confirmed the potential use of neem nanoemulsion as a source of antibacterial compounds or as a healthpromoting medicine for fish culture. [ABSTRACT FROM AUTHOR]

Copyright of Nanosistemi, Nanomateriali, Nanotehnologii is the property of G.V. Kurdyumov Institute for Metal Physics, N.A.S.U and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Attention-deficit/hyperactivity disorder (ADHD) remains one of the most prevalent mental health diagnoses identified in school-age children. Affected children show an increased risk for school failure, social difficulties, and the development of psychiatric co-morbidities. Despite the availability of evidence-based behavioral protocols for managing ADHD-related impairments, psychologists often encounter difficulties involving parents in the sustained implementation of these interventions. Cognitive-behavioral treatment aims to teach children with Attention Deficit Hyperactivity Disorder (ADHD) strategies to help them increase their self-control and problem-solving abilities, through modeling, role playing and self-instruction. Cognitive-behavioral treatment has shown mixed effectiveness regarding ADHD behaviors Cognitive-behavioral therapy (CBT) can address treatment obstacles through emphasizing psycho-education, the development of a collaborative treatment context. This article presents a case study of Jay, a 9-year-old child with ADHD. He was supplemented with child-focused CBT strategies by the psychologist and parental behavioral management training by the parent. This case study outlines a central role of CBT intervention in collaboration with the Parent in managing ADHD children. [ABSTRACT FROM AUTHOR]

Finite element mesh generators exist in the public domain, a few even based on a parametric device description. The typical mesh generator requires some man–machine interaction to define the points and boundary conditions, and does not work for non-stop optimization iterations for which we need a mesh dynamically evolving through the iterations with optimization variables as changing parameters. Such mesh generators as do exist are rare, commercial, and not easily available to researchers except at great cost and never with the code to modify them to suit individual needs. We take a regular open source mesh generator and write a script-based interface as open source to run non-stop for optimization. We then use it to create a non-destructive evaluation system for army ground vehicles’ defect characterization and use it equally for machine design. A simple scheme of averaging neighbour heights gives us a smooth geometry without having to use Bezier curves. The mesh runs on the central processing unit but finite element optimization is on the graphics processing unit for speed and practicable testing times. [ABSTRACT FROM PUBLISHER]

Background and Objective: To evaluate the association between severe generalized periodontitis and carotid intima-media thickness (CIMT) in young, otherwise systemically healthy individuals. Materials and Methods: A total of 60 systemically healthy individuals of age between 20 and 40 years were included in the study. Group I consisted of 30 individuals with healthy periodontal tissue and Group II with 30 individuals with severe generalized periodontitis. Ultrasonographic evaluation of bilateral CIMT at the level of common carotid artery was done. Results: The overall mean intima-media thickness (IMT) in Group I was 0.52 ± 0.07 mm and in Group II was 0.61 ± 0.07 mm. Bivariate analysis considering the binomial IMT (≥0.6) as outcome variable showed odd's ratio = 16 for probing depth and clinical attachment loss. The final model of stepwise logistic regression using binomial IMT (>0.6) as outcome variable showed statistical significance with clinical attachment loss suggesting that as the clinical attachment loss increases the IMT also increases. Conclusion: Severe generalized periodontitis is associated with subclinical atherosclerosis in young systemically healthy patients.

Introduction: Developing research skills and attitude to practice health research is an important area to be focused during undergraduate medical education. Aim: To assess the knowledge, attitude and perceived barriers among first year medical students to practice research skills during under graduate medical course. Materials and Methods: This survey-based cross-sectional study was conducted among 205 (male: 93, female: 112) first year medical undergraduate students of a tertiary care medical school in Chennai, Tamil Nadu, India. The questionnaire consisted of demographic data, four true or false type, three open-ended questions for knowledge, a Likert’s scale of point 1-5 to assess the perceived promoting factors and barriers to taking up research during under graduation and yes or no type questions to assess the practice of research. Analysis of data were done using SPSS version 16.0 and data is expressed in proportions. Results: The survey results showed 72% of the participants had an acceptable level of knowledge on the basic research concepts and 81% of them had a high positive attitude to practice research during different years of undergraduate medical course. The mainly perceived barriers are lack of time (79%), lack of research skills training (87%) and academic overload to acquire professional skills (50%), to take up research during under graduation. Conclusion: The study participants are with moderate awareness towards research skills and very positive to take up research during their under graduation period. The structured research skills training and effective support system will help them to overcome the barriers and motivate them to undertake research and also pursue research as a career.

BACKGROUND: Metacognition is the awareness and the capability to regulate one's own thinking process. Metacognition is critical in medical education for clinical reasoning and management. Hence, the objective of this study is to evaluate the construct validity and reliability of the Metacognitive Awareness Inventory (MAI) among first-year medical and dental students, from a private medical university in India, using confirmatory analysis and internal consistency method. MATERIALS AND METHODS: This was a cross-sectional study using convenient sampling. Fifty-two-item MAI was administered to 933 first-year medical and dental students from a private medical university in India. Exploratory factor analysis (EFA), principal component analysis, Cronbach's α, and confirmatory factor analysis with global fit indices were performed. Structural equation modeling (SEM) was performed to evaluate the relationship between the structural path and factors using AMOS version 22. RESULTS: During EFA, 12 items with 0.80). SEM for each item (observed) and factor (unobserved) illustrated the hypothesized model. CONCLUSION: The resultant 40-item model based on MAI designed by Schraw is a valid and reliable tool for assessing the metacognitive awareness of Indian students. Employing a valid and reliable tool in assessing the metacognitive awareness will help the academicians in incorporating appropriate curricular interventions.

Aim: This study was conducted to estimate the prevalence of enteric parasites in HIV patients in Chennai and to correlate with CD4 counts and diarrhoeal status. Material and Methods: Faecal specimens from 100 HIV infected individuals with CD4 < 1000/µl were screened for enteric parasites with wet mounts, modified acid-fast stain for coccidian parasites, modified trichrome stain for Microsporidia, before and after the stool concentration. Agar plate culture for Strongyloides was put up. Chi-square and ANOVA tests were used for statistical analysis. Results: Study group comprised of 38 subjects with acute diarrhoea, 30 with chronic diarrhoea (> 2 weeks) and remaining 32 without diarrhoea. Enteric parasites were detected in 33% of subjects; Isoapora belli (21) being the commonest followed by E.histolyt/Entamoeba dispar (5), Entamoeba coli (2), Cryptosporidium spp (2), Hookworms (2), Strongyloides stercoralis (2), Giardia lamblia (1) and Microsporidium spp (1). There was a significant inverse relation between CD4 counts and duration of diarrhoea. Opportunistic parasites were isolated from the subjects with wide range of CD4 counts and different diarrhoeal status but most commonly from chronic diarrhoea patients. Conclusion: The prevalence of intestinal parasitic infections in HIV patients is high in Chennai, India, especially at CD4

Background and Objectives: The emergence of methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum β– lactamases (ESBLs) in neonatal intensive care unit patients is increasing. This study aims to find out the bacteriological profile in neonatal sepsis and study their antimicrobial susceptibility pattern including detection of MRSA and ESBLs. Materials and Methods: This study was conducted for a period of one and a half years from January 2010 to June 2011 in a tertiary care hospital in Chennai. A total of 182 blood samples were collected using sterile precautions. They were processed following standard laboratory protocol. Antibiogram was done using appropriate antibiotics by Kirby-Bauer disc diffusion method. Isolated Staphylococcus aureus were tested for methicillin resistance using Cefoxitin disc (30µg), ESBL was detected using combined disc method, MIC reduction and Polymerase chain reaction, metallobetalactamases using EDTA and Amp-C beta lactamases using AmpC disc test. C-reactive protein (CRP) was estimated for all the cases. Results: Out of the 182 cases, 110 (60.4%) were culture positive. Fifty five (63.9 %) of early onset sepsis cases had Gram negative bacteria (GNB) and 19 (79.1%) of late onset sepsis cases had Gram positive bacteria. Out of the total pathogens, 31 (28.1%) were Klebsiella pneumoniae and 30 (27%) were Staphylococcus aureus. 17 (56.6 %) of Staphylococcus aureus were found to be MRSA and they were 100% sensitive to Vancomycin. 33 (67.3%) of Enterobacteriaceae were ESBL producers. ESBL isolates were 100% sensitive to Imipenem. Three (6.1%) of Enterobacteriaceae were AmpC producers and 3 (27.2%) of Pseudomonas aeruginosa were MBL producers. CRP was positive in 99 (54.3%) cases, out of which 94 (94.9%) were culture positive. Conclusion: Klebsiella spp. and Staphylococcus aureus were the commonest bacteria causing neonatal sepsis in this centre. Multidrug resistance among the isolates was common. Early diagnosis and institution of specific antibiotics after studying the sensitivity pattern will help in reducing neonatal morbidity and mortality and prevent emergence of drug resistant strains.

Background: Surgical education necessitates hands-on training, which poses ethical challenges when practicing on real patients. Simulation training emerges as a pivotal solution, offering a safe and effective environment for skill acquisition. However, existing simulation models often overlook common surgical conditions like superficial skin abscesses. The National Medical Commission advocates for simulation-based training in basic surgical skills, highlighting the need for accessible and cost-effective models. Thus, this study aimed to develop and evaluate a novel Indigenous Cost-effective model for Incision & Drainage (NICA) of subcutaneous abscesses, addressing the gap in surgical education., Methodology: Following institutional ethics clearance, the study employed Kern's Six-step approach for curriculum development. The NICA model was conceptualized and crafted using locally available, low-cost materials, validated by expert opinion, and implemented in a simulation lab setting. A total of 155 surgical interns underwent training, consisting of didactic video sessions, hands-on practice with the NICA model, and structured assessments. Pre- and post-training evaluations were conducted to measure interns' performance and feedback., Results: Expert validation confirmed NICA model's fidelity and usefulness. Training 155 surgical interns resulted in significant skill improvements. Pre-training, 33% correctly performed pre-procedural requisites, 46% executed procedural techniques, and 48% performed post-procedural steps accurately. Post-training, these percentages surged to 95%, 97%, and 98%, respectively. Post test score showed significant skill enhancements across all domains (p < 0.05). Intern feedback highlighted increased confidence, satisfaction, and interest in learning, affirming NICA model's effectiveness., Conclusion: The development and implementation of the NICA model offer a scalable and cost-effective solution for surgical training in resource-limited settings. The model's effectiveness in enhancing interns' skills and confidence underscores its potential to address training needs effectively. The study highlights the significance of simulation-based training in surgical education and advocates for the widespread adoption of indigenous low-cost models to improve surgical skills acquisition., Competing Interests: Declarations. Ethics approval and consent to participate: Institutional Ethics approval was obtained from SRIHER (DU) (IEC-NI/22/APR/82/38). Informed consent was obtained from all subjects prior to data collection. Consent for publication: Not applicable. The manuscript and images do not contain any individual person’s identifiable data. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Peripheral intravenous catheters (PIVCs) are the most commonly used invasive devices in acute care hospitals, with nurses being primarily responsible for the insertion and care of these devices. This point prevalence study aimed to describe current PIVC status and nursing documentation in a large, regional health care system and to explore variables associated with PIVC complications. The study was conducted with adult inpatients. There were 665 PIVCs included in the study. Dressings were clean, dry, and intact in 83% of observations; only 2.7% did not have a transparent dressing. Thirty-one percent of PIVCs were inserted in areas of flexion. Median dwell time was 2.39 days (± 2.36 days), with upper arm sites having the longest dwell time. Overall inter-rater reliability (IRR) for an infiltration or phlebitis score of 0 was high (97.4% and 92%, respectively). However, overall agreement was only 77.16% for infiltration and 40.07% for phlebitis, with significant disagreement as scores increased. Study findings support that there was strong compliance with the Infusion Nurses Society's (INS) Infusion Therapy Standards of Practice vascular access practice recommendations; however, opportunities to improve infiltration/phlebitis assessment and documentation exist., Competing Interests: Conflict of Interest: The authors have no conflict of interest to disclose., (Copyright © 2024 Infusion Nurses Society.)

Defects in the crystal structures of metal-organic frameworks (MOFs), whether present intrinsically or introduced via so-called defect engineering, can play strong roles in the properties of MOFs for various applications. Unfortunately, direct experimental detection and characterization of defects in MOFs are very challenging. We show that in many cases, the differences between experimentally observed and computationally predicted water stabilities of MOFs can be used to deduce information on the presence of point defects in real materials. Most computational studies of MOFs consider these materials to be defect-free, and in many cases, the resulting structures are predicted to be hydrophobic. Systematic experimental studies, however, have shown that many MOFs are hydrophilic. We show that the existence of chemically plausible point defects can often account for this discrepancy and use this observation in combination with detailed molecular simulations to assess the impact of local defects and flexibility in a variety of MOFs for which defects had not been considered previously., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

The tuning of micropore environments in zeolitic imidazolate frameworks (ZIFs) by mixed-linker synthesis has the potential for enabling new molecular separation properties. However, de novo synthesis of mixed-linker (hybrid) ZIFs is often challenging due to the disparate chemical properties of the different linkers. Here, we elucidate the structure and properties of an unconventional ZIF-8-7 hybrid material synthesized via a controlled-acid-gas-assisted degradation and reconstruction (solvent-assisted crystal redemption, SACRed) strategy. Selective insertion of benzimidazole (ZIF-7 linker) into ZIF-8 using SACRed is used as a facile method to generate a ZIF-8-7 hybrid material that is otherwise difficult to synthesize by de novo methods. Detailed crystal structure and textural characterizations clarify the significant differences in the microstructure of the SACRed-derived ZIF-8-7 hybrid material relative to a de novo synthesized hybrid of the same overall linker composition as well as the parent ZIF-8 material. Unary and binary adsorption measurements reveal the tunability of adsorption characteristics as well as the prevalence of nonideal cooperative mixture adsorption effects that lead to large deviations from predictions made with ideal adsorbed solution theory., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Microporous metal-organic frameworks (MOFs) have been widely studied for molecular separation and catalysis. The uniform micropores of MOFs (<2 nm) can introduce diffusion limitations and render the interiors of the crystal inaccessible to target molecules. The introduction of hierarchical porosity (interconnected micro and mesopores) can enhance intra-crystalline diffusion while maintaining the separation/catalytic selectivity. Conventional hierarchical MOF synthesis involves complex strategies such as elongated linkers, soft templating, and sacrificial templates. Here, we demonstrate a more general approach using our controlled acid gas-enabled degradation and reconstruction (Solvent-Assisted Crystal Redemption) strategy. Selective linker labilization of ZIF-8 is shown to generate a hierarchical pore structure with mesoporous cages (∼50 nm) while maintaining microporosity. Detailed structural and spectroscopic characterization of the controlled degradation, linker insertion, and subsequent linker thermolysis is presented to show the clustering of acid gas-induced defects and the generation of mesopores. These findings indicate the generality of controlled degradation and reconstruction as a means for linker insertion in a wider variety of MOFs and creating hierarchical porosity. Enhanced molecular diffusion and catalytic activity in the hierarchical ZIF-8 are demonstrated by the adsorption kinetics of 1-butanol and a Knoevenagel condensation reaction.

A majority of circulating IgG is produced by plasma cells residing in the bone marrow (BM). Long-lived BM plasma cells constitute our humoral immune memory and are essential for infection-specific immunity. They may also provide a reservoir of potentially pathogenic autoantibodies, including rheumatoid arthritis (RA)-associated anti-citrullinated protein autoantibodies (ACPA). Here we investigated paired human BM plasma cell and peripheral blood (PB) B-cell repertoires in seropositive RA, four ACPA+ RA patients and one ACPA- using two different single-cell approaches, flow cytometry sorting, and transcriptomics, followed by recombinant antibody generation. Immunoglobulin (Ig) analysis of >900 paired heavy-light chains from BM plasma cells identified by either surface CD138 expression or transcriptome profiles (including gene expression of MZB1, JCHAIN and XBP1) demonstrated differences in IgG/A repertoires and N-linked glycosylation between patients. For three patients, we identified clonotypes shared between BM plasma cells and PB memory B cells. Notably, four individuals displayed plasma cells with identical heavy chains but different light chains, which may indicate receptor revision or clonal convergence. ACPA-producing BM plasma cells were identified in two ACPA+ patients. Three of 44 recombinantly expressed monoclonal antibodies from ACPA+ RA BM plasma cells were CCP2+, specifically binding to citrullinated peptides. Out of these, two clones reacted with citrullinated histone-4 and activated neutrophils. In conclusion, single-cell investigation of B-cell repertoires in RA bone marrow provided new understanding of human plasma cells clonal relationships and demonstrated pathogenically relevant disease-associated autoantibody expression in long-lived plasma cells., Competing Interests: Declaration of competing interest Linda Mathsson-Alm is employed by Thermo Fisher Scientific. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system., Methods: All patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention., Results: During the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA's use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time., Conclusions: EMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Porosity and surface area analysis play a prominent role in modern materials science. At the heart of this sits the Brunauer-Emmett-Teller (BET) theory, which has been a remarkably successful contribution to the field of materials science. The BET method was developed in the 1930s for open surfaces but is now the most widely used metric for the estimation of surface areas of micro- and mesoporous materials. Despite its widespread use, the calculation of BET surface areas causes a spread in reported areas, resulting in reproducibility problems in both academia and industry. To prove this, for this analysis, 18 already-measured raw adsorption isotherms were provided to sixty-one labs, who were asked to calculate the corresponding BET areas. This round-robin exercise resulted in a wide range of values. Here, the reproducibility of BET area determination from identical isotherms is demonstrated to be a largely ignored issue, raising critical concerns over the reliability of reported BET areas. To solve this major issue, a new computational approach to accurately and systematically determine the BET area of nanoporous materials is developed. The software, called "BET surface identification" (BETSI), expands on the well-known Rouquerol criteria and makes an unambiguous BET area assignment possible., (© 2022 The Authors. Advanced Materials published by Wiley-VCH GmbH.)

Background: Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes., Methods: We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018-February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes., Results: Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08-1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P  = .02)., Conclusions: Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

In a 2016 survey of 46 Michigan hospitals, we identified four key needs for antibiotic stewardship: clinically-relevant antibiotic data, monitoring compliance, syndrome-specific interventions, and discharge stewardship. A stewardship initiative now addresses these needs within the Michigan Hospital Medicine Safety Consortium., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

B cells are postulated to be central in seropositive rheumatoid arthritis (RA). Here, we use exploratory mass cytometry (n = 23) and next-generation sequencing (n = 19) to study B-cell repertoire shifts in RA patients. Expression of several B-cell markers were significantly different in ACPA + RA compared to healthy controls, including an increase in HLA-DR across subsets, CD22 in clusters of IgM + B cells and CD11c in IgA + memory. Moreover, both IgA + and IgG + double negative (IgD - CD27 - ) CD11c + B cells were increased in ACPA + RA, and there was a trend for elevation in a CXCR5/CCR6 high transitional B-cell cluster. In the RA BCR repertoire, there were significant differences in subclass distribution and, notably, the frequency of VH with low somatic hypermutation (SHM) was strikingly higher, especially in IgG1 (p < 0.0001). Furthermore, both ACPA + and ACPA - RA patients had significantly higher total serum IgA and IgM compared to controls, based on serology of larger cohorts (n = 3494 IgA; n = 397 IgM). The observed elevated Ig-levels, distortion in IgM + B cells, increase in double negative B cells, change in B-cell markers, and elevation of unmutated IgG + B cells suggests defects in B-cell tolerance in RA. This may represent an underlying cause of increased polyreactivity and autoimmunity in RA.

Importance: Treatment of asymptomatic bacteriuria (ASB) with antibiotics is a common factor in inappropriate antibiotic use, but risk factors and outcomes associated with treatment of ASB in hospitalized patients are not well defined., Objective: To evaluate factors associated with treatment of ASB among hospitalized patients and the possible association between treatment and clinical outcomes., Design, Setting, and Participants: A retrospective cohort study was conducted from January 1, 2016, through February 1, 2018, at 46 hospitals participating in the Michigan Hospital Medicine Safety Consortium. A total of 2733 hospitalized medical patients with ASB, defined as a positive urine culture without any documented signs or symptoms attributable to urinary tract infection, were included in the analysis., Exposures: One or more antibiotic dose for treatment of ASB., Main Outcomes and Measures: Estimators of antibiotic treatment of ASB. Secondary outcomes included 30-day mortality, 30-day hospital readmission, 30-day emergency department visit, discharge to post-acute care settings, Clostridioides difficile infection (formerly known as Clostridium difficile) at 30 days, and duration of hospitalization after urine testing., Results: Of 2733 patients with ASB, 2138 were women (78.2%); median age was 77 years (interquartile range [IQR], 66-86 years). A total of 2259 patients (82.7%) were treated with antibiotics for a median of 7 days (IQR, 4-9 days). Factors associated with ASB treatment included older age (odds ratio [OR], 1.10 per 10-year increase; 95% CI, 1.02-1.18), dementia (OR, 1.57; 95% CI, 1.15-2.13), acutely altered mental status (OR, 1.93; 95% CI, 1.23-3.04), urinary incontinence (OR, 1.81; 95% CI, 1.36-2.41), leukocytosis (white blood cell count >10 000/μL) (OR, 1.55; 95% CI, 1.21-2.00), positive urinalysis (presence of leukocyte esterase or nitrite, or >5 white blood cells per high-power field) (OR, 2.83; 95% CI, 2.05-3.93), and urine culture with a bacterial colony count greater than 100 000 colony-forming units per high-power field (OR, 2.30; 95% CI, 1.83-2.91). Treatment of ASB was associated with longer duration of hospitalization after urine testing (4 vs 3 days; relative risk, 1.37; 95% CI, 1.28-1.47). No other differences in secondary outcomes were identified after propensity weighting., Conclusions and Relevance: Hospitalized patients with ASB commonly receive inappropriate antibiotic therapy. Antibiotic treatment did not appear to be associated with improved outcomes; rather, treatment may be associated with longer duration of hospitalization after urine testing. To possibly reduce inappropriate antibiotic use, stewardship efforts should focus on improving urine testing practices and management strategies for elderly patients with altered mental status.

Background: Randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration., Objective: To examine predictors and outcomes associated with excess duration of antibiotic treatment., Design: Retrospective cohort study., Setting: 43 hospitals in the Michigan Hospital Medicine Safety Consortium., Patients: 6481 general care medical patients with pneumonia., Measurements: The primary outcome was the rate of excess antibiotic treatment duration (excess days per 30-day period). Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification [community-acquired vs. health care-associated]) from the actual duration. Negative binomial generalized estimating equations (GEEs) were used to calculate rate ratios to assess predictors of 30-day rates of excess duration. Patient outcomes, assessed at 30 days via the medical record and telephone calls, were evaluated using logit GEEs that adjusted for patient characteristics and probability of treatment., Results: Two thirds (67.8% [4391 of 6481]) of patients received excess antibiotic therapy. Antibiotics prescribed at discharge accounted for 93.2% of excess duration. Patients who had respiratory cultures or nonculture diagnostic testing, had a longer stay, received a high-risk antibiotic in the prior 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge were more likely to receive excess treatment. Excess treatment was not associated with lower rates of any adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection. Each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge., Limitation: Retrospective design; not all patients could be contacted to report 30-day outcomes., Conclusion: Patients hospitalized with pneumonia often receive excess antibiotic therapy. Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes., Primary Funding Source: Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program.