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Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.
We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.
Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.
Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
Patients with non-Hodgkin's lymphoma and chronic lymphocytic leukaemia are at an elevated risk of further malignancy. Head and neck squamous cell carcinoma often presents with cervical lymph node metastasis, and can pose a diagnostic challenge in patients with non-Hodgkin's lymphoma or chronic lymphocytic leukaemia who may have pre-existing palpable neck nodes.
A retrospective case review of a health board was conducted to identify patients with head and neck squamous cell carcinoma with a previous diagnosis of non-Hodgkin's lymphoma or chronic lymphocytic leukaemia.
Four patients with head and neck squamous cell carcinoma that developed after non-Hodgkin's lymphoma or chronic lymphocytic leukaemia were identified. Two patients had a background of non-Hodgkin's lymphoma treated with chemotherapy. The remaining two patients had a background of chronic lymphocytic leukaemia under active surveillance. Three out of the four patients died within 30 months of diagnosis.
Head and neck squamous cell carcinoma following non-Hodgkin's lymphoma or chronic lymphocytic leukaemia is aggressive. A heightened clinical suspicion is essential to facilitate early diagnosis and treatment of head and neck squamous cell carcinoma in patients with dual pathology.
The researches show a rapid growth of mental disorders among adolescents and young adults that often cooccurs with risk behaviours, such as suicide, which is one of the leading cause of death among young ages 15-34. Therefore it's necessary to use some tools that can promote mental health getting to young lives such as Internet and media.
SUPREME (Suicide Prevention by Internet and Media Based Mental Health Promotion) is aimed to increasing the prevention of risk behaviours and mental health promotion through the use of mass media and Internet.
The main expected outcome is to improve mental health among European adolescents.
In each European countries a sample of 300 students (average age of 15 years) will be selected. The prevention program will be a highly interactive website that which will address topics such as raising awareness about mental health and suicide, combating stigma, and stimulate peer help. The program will use different means of referral to the intervention website: “Adolescent related” and “Professional related”. A questionnaire will be administered to the pupils for require the data on lifestyles, values and attitudes, psychological well-being, familiar relationship and friendship.
Some web-sites, managed by mental health professionals, produced encouraging results about their use in prevention of risk behaviours and in increase well-being, especially in youth with low self-esteem and low life-satisfaction. With the implementation of the SUPREME project we will be able to identify best practices for promoting mental health through the Internet and the media.
Suicide is one of the leading causes of death worldwide, and the third leading cause of death among people aged below 25. Mental health promotion is a central aspect of the battle against suicide and mental ill-health. The internet and the media are effective tools for disseminating information and education to adolescents and improving their mental health and well-being. in 2011 there were 2.1 billion Internet users world-wide. in a random sample of over 3000 American adults, it was found that 58% of the Internet users reported searching for health information for themselves (Atkinson et al. 2009).
The main objective of the SUPREME project is to develop a website aimed at mental health promotion and to investigate its efficacy. A secondary goal is to compare two different strategies for promoting the use of the website: one where peers are the main promoters and another with mental health professionals. The study is partly funded by the EACH and comprises 7 European countries: Estonia, Hungary, Italy, Spain, United Kingdom, Lithuania and Sweden.
Adolescents in this study approached in a random sample of schools, in each participating country, yielding a total of 2100 participants. The schools were randomized into control (minimal intervention), and intervention conditions (minimal intervention + website access). Pre-, post- and follow-up measures are used to test the efficacy of the intervention. Each intervention school is also randomized into peer and pro dissemination groups for comparison of recruitment efficiency. Preliminary results are presented.
Posttraumatic stress disorder and substance use disorder is an important comorbidity in terms of its prevalence, clinical impact, and treatment challenges. To date, interventions for this comorbidity have been solely professionally led.
In this pilot study, we sought to evaluate the impact of a peer-led model, using Seeking Safety (SS; Najavits, 2002), which is the most evidence-based intervention thus far for the comorbidity. We adapted it for peer-led use to help make it accessible and safe for this modality.
Eighteen women in residential substance abuse treatment participated. The 25 SS topics were conducted twice weekly. They were assessed at baseline and end of treatment, with some measures also collected at monthly interims.
Results showed decreases in trauma-related symptoms (Trauma Symptom Checklist-40 total scale and all subscales, i.e., dissociation, sexual problems, depression, sleep problems, anxiety, and sexual abuse); self-compassion (the Self-Compassion Scale subscales self-judgment, isolation, and overidentified); the Brief Symptom Inventory (total and all nine subscales); and a measure of use of SS coping skills (total score). Also, ratings of fidelity to SS was very high (on the SS Adherence Scale), as was satisfaction with SS.
Limitations of the study and areas for future research development are discussed.
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
Indicators are necessary to monitor national progress toward commitments made to the Convention on Biological Diversity (CBD), but countries often struggle to mobilize quantitative indicators for many biodiversity targets. Assessing the extent to which countries are using measurable indicators from global and national sources by surveying 5th National Reports to the CBD, we found that nationally generated indicators were used 11 times more frequently than global indicators and only one-fifth of indicators matched those recommended by the CBD, suggesting that countries and indicator experts should work more closely to agree upon measurable, scalable, fit-for-purpose indicators for the next generation of CBD targets.
The ‘Portus Project’ investigates the social and economic contexts of the maritime port of Imperial Rome. This article presents the results of analysis of plant, animal and human remains from the site, and evaluates their significance for the reconstruction of the diets and geographic origins of its inhabitants between the second and sixth centuries AD. Integrating this evidence with other material from the recent excavations, including ceramic data, the authors identify clear diachronic shifts in imported foods and diet that relate to the commercial and political changes following the breakdown of Roman control of the Mediterranean.
Changes in Greenland's marine-terminating outlet glaciers have led to changes in the flux of icebergs into Greenland's coastal waters, yet icebergs remain a relatively understudied component of the ice-ocean system. We developed a simple iceberg delineation algorithm for Landsat imagery. A machine learning-based cloud mask incorporated into the algorithm enables us to extract iceberg size distributions from open water even in partially cloudy scenes. We applied the algorithm to the Landsat archive covering Disko Bay, West Greenland, to derive a time series of iceberg size distributions from 2000–02 and 2013–15. The time series captures a change in iceberg size distributions, which we interpret as a result of changes in the calving regime of the parent glacier, Sermeq Kujalleq (Jakobshavn Isbræ). The change in calving style associated with the disintegration and disappearance of Sermeq Kujalleq's floating ice tongue resulted in the production of more small icebergs. The increased number of small icebergs resulted in increasingly negative power law slopes fit to iceberg size distributions in Disko Bay, suggesting that iceberg size distribution time series provide useful insights into changes in calving dynamics.
This study provides an assessment of the temporal changes in ΔR, which is the local deviation from the global surface water marine reservoir effect (MRE), in the Point Barrow area of the Alaskan Arctic, a coastal archaeological area that has experienced severe erosion accelerated by global warming. A total of 26 samples were submitted for radiocarbon (14C) dating from eight secure Thule (AD 1000–1750) archaeological contexts, and specifically from archaeological features with paired processed seal and caribou bones that had been frozen in situ. This new approach towards ΔR estimation provides a best-fit local correction for the 14C dating of human populations by focusing on the marine mammal (seals) predominantly consumed by the Thule (Coltrain et al. 2016). The weighted-mean ΔR value on these pairs is 450 ± 84 yr, which is about 50 years less than the weighted-mean (506 ± 69 yr) for the Point Barrow area calculated through 14C measurements from four known-age bivalves collected in AD 1913 (McNeely et al. 2006). The effects of using this new ΔR value for calibration was assessed through the Bayesian chronological modeling of 54 14C measurements from samples of human skeletons interred in the Nuvuk cemetery at Point Barrow, the largest ancient cemetery in northwest Alaska and traditionally thought to date to the Thule and earlier Birnirk (AD 500–1000) periods.
Malnutrition remains a leading contributor to the morbidity and mortality of children under the age of 5 years and can weaken the immune system and increase the severity of concurrent infections. Livestock milk with the protective properties of human milk is a potential therapeutic to modulate intestinal microbiota and improve outcomes. The aim of this study was to develop an infection model of childhood malnutrition in the pig to investigate the clinical, intestinal and microbiota changes associated with malnutrition and enterotoxigenic Escherichia coli (ETEC) infection and to test the ability of goat milk and milk from genetically engineered goats expressing the antimicrobial human lysozyme (hLZ) milk to mitigate these effects. Pigs were weaned onto a protein–energy-restricted diet and after 3 weeks were supplemented daily with goat, hLZ or no milk for a further 2 weeks and then challenged with ETEC. The restricted diet enriched faecal microbiota in Proteobacteria as seen in stunted children. Before infection, hLZ milk supplementation improved barrier function and villous height to a greater extent than goat milk. Both goat and hLZ milk enriched for taxa (Ruminococcaceae) associated with weight gain. Post-ETEC infection, pigs supplemented with hLZ milk weighed more, had improved Z-scores, longer villi and showed more stable bacterial populations during ETEC challenge than both the goat and no milk groups. This model of childhood disease was developed to test the confounding effects of malnutrition and infection and demonstrated the potential use of hLZ goat milk to mitigate the impacts of malnutrition and infection.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
M. M. Hedman, University of Idaho Moscow, Idaho, USA,
F. Postberg, University of Heidelberg Heidelberg, GERMANY,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
S. Renner, University of Lille Lille, FRANCE,
H.-W. Hsu, University of Colorado Boulder, Colorado, USA
All of the giant planets in the outer Solar System possess rings composed primarily of particles less than 100 microns across. Such small particles are conventionally referred to as “dust grains” regardless of their composition, and so these rings are considered “dusty rings” (as opposed to the more famous main rings of Saturn and Uranus, whose particles are more than a millimeter across). Dusty rings are often very tenuous and so can be much more difficult to observe than Saturn's broad, bright, and dense main rings. Nevertheless, dusty rings are extremely interesting because they have very rich dynamics and are extremely sensitive probes of their environment.
The high surface-area-to-volume ratio of dust-sized grains makes them much more responsive to non-gravitational forces like solar radiation pressure, plasma drag, and torques from the planet's electromagnetic field. Furthermore, sub-millimeter particles can be lost from the ring system on relatively short timescales due to erosion via charged-particle and micrometeoroid bombardment or through ejection by the non-gravitational forces listed above. This means that small particles need to be constantly supplied to these rings from larger bodies, and indeed all of the known dusty rings are associated with larger objects that are the likely sources of dusty debris. The most dramatic example of this is Saturn's E ring, which is clearly supplied by material erupting from beneath the surface of the geologically active moon Enceladus. However, this is a special case, and most dusty rings are instead associated with denser rings (which are composed primarily of millimeter-to-metersized particles) or small moons. These objects can serve as dust sources because they are constantly being bombarded by micrometeoroids, and these impacts release fine debris that can escape the weak gravitational fields of these small bodies and go into orbit around the planet. Note that the amount of dust released by this process depends on the size, mass, and regolith properties of the source object, and calculations of the dust production rate based on simple estimates of impact ejecta velocity distributions suggest that source moons that are several kilometers across are the most efficient at producing dusty rings (Burns et al., 1999).
I. De Pater, University of California, Berkeley Berkeley, California, USA,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
M. R. Showalter, SETI Institute Mountain View, California, USA,
H. B. Throop, Planetary Science Institute Tucson, Arizona, USA,
J. A. Burns, Cornell University Ithaca, New York, USA
Despite extensive clinical concern about rates of obesity in patients
with schizophrenia, there is little evidence of the extent of this
problem at a population level.
To estimate levels of obesity in a national population sample by
comparing patients with schizophrenia with matched controls.
We calculated levels of obesity for each patient with schizophrenia from
the national Primary Care Clinical Informatics Unit database (n=4658)
matched with age, gender and neighbourhood controls.
We demonstrated a significant increased obesity hazard for the
schizophrenia group using Cox regression analysis, with odds ratio (OR)
of 1.94 (95% CI 1.81–2.10) (under the assumption of missing body mass
index (BMI) indicating non-obesity) and OR=1.68 (95% CI 1.55–1.81) where
no assumptions were made for missing BMI data.
People with schizophrenia are at increased risk of being obese compared
with controls matched by age, gender and practice attended. Priority
should be given to research which aims to reduce weight and increase
activity in those with schizophrenia.